ADD & ADHD

What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder and one of the most common conditions diagnosed in children (National Institute of Mental Health (opens in a new tab)). It usually begins in childhood and often continues into adulthood (MedlinePlus (opens in a new tab)). It shows up as an ongoing pattern of trouble keeping attention, controlling impulses and regulating activity — a pattern that can get in the way of daily life, including relationships and school or work performance (NIMH (opens in a new tab)).

Symptoms

• Inattention: difficulty paying attention to details, staying focused, following through on tasks and organizing activities; being easily distracted; forgetting daily activities or losing needed items.
• Hyperactivity and impulsivity: fidgeting, difficulty staying seated, talking excessively, interrupting others and acting without thinking about the consequences (NIMH (opens in a new tab)).

Types of ADHD

• Predominantly inattentive — mainly inattention, without much hyperactivity or impulsivity.
• Predominantly hyperactive-impulsive — mainly hyperactivity and impulsivity.
• Combined — symptoms of both (NIMH (opens in a new tab)).

Causes and risk factors

The exact cause isn’t fully understood. Many studies suggest that genes play a large role, and ADHD probably results from a combination of factors. Researchers are also looking at differences in brain development, and at environmental factors that might raise the risk, including brain injuries, nutrition and social environments (NIMH (opens in a new tab); MedlinePlus (opens in a new tab)).

Diagnosis

ADHD is diagnosed through a full evaluation by a health care provider: a review of mental health and medical history, standardized behavior rating scales or symptom checklists, and input from people who know the person well, such as family members and teachers. Symptoms must begin in childhood, last at least 6 months, appear in two or more settings (such as home and school or work), and clearly interfere with functioning. Stress, sleep disorders, anxiety, depression and other conditions can cause similar symptoms, so a thorough evaluation matters (NIMH (opens in a new tab); MedlinePlus (opens in a new tab)).

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Conventional medicine (AMA)

There is no cure for ADHD, but several treatments manage symptoms effectively. The right mix depends on age, symptoms and individual needs (NIMH (opens in a new tab)).

1. Behavior therapy

• Young children: the American Academy of Pediatrics recommends parent training in behavior management as the first treatment for children under 6 — teaching parents ways to reinforce positive behavior and manage disruptive behavior (CDC (opens in a new tab)).
• Older children and teens: medicine combined with behavior therapy is often recommended. Behavioral support includes structure, positive reinforcement and skills training (CDC (opens in a new tab)).
• Cognitive behavioral therapy (CBT), parent training and school interventions give practical strategies for managing symptoms (NIMH (opens in a new tab)).

2. Medicines

• Stimulants are the most common type of medicine used to treat ADHD, and research shows them to be highly effective. They work by increasing levels of brain chemicals involved in thinking and attention. Like all medicines, they can have side effects and must be prescribed and monitored by a health care provider (NIMH (opens in a new tab)). Methylphenidate is one example (MedlinePlus (opens in a new tab)).
• Non-stimulants are another option. Atomoxetine, for example, is used as part of a total treatment program for children and adults with ADHD (MedlinePlus (opens in a new tab)). Providers also sometimes prescribe antidepressants, although the U.S. Food and Drug Administration has not approved them specifically for ADHD (NIMH (opens in a new tab)). Sometimes a person must try several different medicines before finding the one that works.
• Safety note: children and teens with ADHD who take atomoxetine are more likely to think about suicide, so their behavior should be watched closely, especially at the start of treatment or when the dose changes. Call the doctor right away for any sudden changes in mood or behavior (MedlinePlus (opens in a new tab)). If you or someone you know is having thoughts of suicide, call or text 988; in a life-threatening situation, call 911 (NIMH (opens in a new tab)).

3. Combination therapy

Many treatment plans combine medicine and behavior therapy, which can work better and cover a wider range of symptoms (American Academy of Pediatrics, Pediatrics (opens in a new tab)).

4. School and community support

Schools play a key role through accommodations and support suited to each child. Parents, teachers and healthcare providers working together is essential (CDC (opens in a new tab)).

5. Monitoring and adjustment

Regular follow-ups check how well treatment is working and adjust it as a child grows and circumstances change (CDC (opens in a new tab)).

Lifestyle

Regular physical activity, a structured environment and healthy eating can also help manage symptoms (NIMH (opens in a new tab)).

What to expect

ADHD calls for a many-sided approach. Although there is no cure, current treatments may help reduce symptoms and improve functioning, and effective treatment can make day-to-day life easier for people with ADHD and their families. It is never too late to seek a diagnosis and treatment (NIMH (opens in a new tab)).

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