What is ADHD?

ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually

first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have
trouble paying attention, controlling impulsive behaviors (may act without thinking about
what the result will be), or be overly active.

Signs and Symptoms

It is normal for children to have trouble focusing and behaving at one time or another.
However, children with ADHD do not just grow out of these behaviors. The symptoms
continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might:

● daydream a lot
● forget or lose things a lot
● squirm or fidget
● talk too much
● make careless mistakes or take unnecessary risks
● have a hard time resisting temptation
● have trouble taking turns
● have difficulty getting along with others

Deciding if a child has ADHD is a process with several steps. This page gives you an overview of
how ADHD is diagnosed. There is no single test to diagnose ADHD, and many other problems, like
sleep disorders, anxiety, depression, and certain types of learning disabilities, can have similar
symptoms.

If you are concerned about whether a child might have ADHD, the first step is to talk with a
healthcare provider to find out if the symptoms fit the diagnosis. The diagnosis can be made by a
mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a
pediatrician.

The American Academy of Pediatrics (AAP) recommends that healthcare providers ask parents,
teachers, and other adults who care for the child about the child’s behavior in different settings,
like at home, school, or with peers.

The healthcare provider should also determine whether the child has another condition that can
either explain the symptoms better, or that occurs at the same time as ADHD.

How is ADHD diagnosed?

Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and
Statistical Manual, Fifth edition (DSM-5)1, to help diagnose ADHD. This diagnostic standard helps
ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard
across communities can also help determine how many children have ADHD, and how public
health is impacted by this condition.
DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that
interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16 years, or five
or more for adolescents age 17 years and older and adults; symptoms of inattention have
been present for at least 6 months, and they are inappropriate for developmental level:
○ Often fails to give close attention to details or makes careless mistakes in
schoolwork, at work, or with other activities.
○ Often has trouble holding attention on tasks or play activities.
○ Often does not seem to listen when spoken to directly.
○ Often does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (e.g., loses focus, side-tracked).
○ Often has trouble organizing tasks and activities.
○ Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a
long period of time (such as schoolwork or homework).
○ Often loses things necessary for tasks and activities (e.g. school materials, pencils,
books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
○ Is often easily distracted
○ Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for
children up to age 16 years, or five or more for adolescents age 17 years and older and
adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to
an extent that is disruptive and inappropriate for the person’s developmental level:
○ Often fidgets with or taps hands or feet, or squirms in seat.
○ Often leaves seat in situations when remaining seated is expected.
○ Often runs about or climbs in situations where it is not appropriate (adolescents
or adults may be limited to feeling restless).
○ Often unable to play or take part in leisure activities quietly.
○ Is often “on the go” acting as if “driven by a motor”.
○ Often talks excessively.
○ Often blurts out an answer before a question has been completed.
○ Often has trouble waiting their turn.
○ Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

● Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
● Several symptoms are present in two or more settings, (such as at home, school or work;
with friends or relatives; in other activities).
● There is clear evidence that the symptoms interfere with, or reduce the quality of, social,
school, or work functioning.
● The symptoms are not better explained by another mental disorder (such as a mood
disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms
do not happen only during the course of schizophrenia or another psychotic disorder.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
● Combined Presentation: if enough symptoms of both criteria inattention and
hyperactivity-impulsivity were present for the past 6 months
● Predominantly Inattentive Presentation: if enough symptoms of inattention, but not
hyperactivity-impulsivity, were present for the past six months
● Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of
hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

Diagnosing ADHD in Adults

ADHD often lasts into adulthood. To diagnose ADHD in adults and adolescents age 17 years or
older, only 5 symptoms are needed instead of the 6 needed for younger children. Symptoms
might look different at older ages. For example, in adults, hyperactivity may appear as extreme
restlessness or wearing others out with their activity.

Types
As mentioned before, there are three different ways ADHD presents itself, depending on which
types of symptoms are strongest in the individual:
● Predominantly Inattentive Presentation: It is hard for the individual to organize or
finish a task, to pay attention to details, or to follow instructions or conversations.
The person is easily distracted or forgets details of daily routines.
● Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a
lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller
children may run, jump or climb constantly. The individual feels restless and has
trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab
things from people, or speak at inappropriate times. It is hard for the person to wait
their turn or listen to directions. A person with impulsiveness may have more
accidents and injuries than others.
● Combined Presentation: Symptoms of the above two types are equally present in the
person.

Causes of ADHD
Scientists are studying cause(s) and risk factors in an effort to find better ways to manage
and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are
unknown, but current research shows that genetics plays an important role. Recent studies
link genetic factors with ADHD.1

In addition to genetics, scientists are studying other possible causes and risk factors
including:

● Brain injury
● Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
● Alcohol and tobacco use during pregnancy
● Premature delivery
● Low birth weight
Research does not support the popularly held views that ADHD is caused by eating too much
sugar, watching too much television, parenting, or social and environmental factors such as
poverty or family chaos. Of course, many things, including these, might make symptoms
worse, especially in certain people. But the evidence is not strong enough to conclude that
they are the main causes of ADHD.

Diagnosis
Deciding if a child has ADHD is a process with several steps. There is no single test to
diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and
certain types of learning disabilities, can have similar symptoms. One step of the process
involves having a medical exam, including hearing and vision tests, to rule out other
problems with symptoms like ADHD. Diagnosing ADHD usually includes a checklist for rating
ADHD symptoms and taking a history of the child from parents, teachers, and sometimes,
the child.

Treatments
In most cases, ADHD is best treated with a combination of behavior therapy and medication.
For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly
training for parents, is recommended as the first line of treatment before medication is tried.
What works best can depend on the child and family. Good treatment plans will include
close monitoring, follow-ups, and making changes, if needed, along the way.

When a child is diagnosed with attention-deficit/hyperactivity disorder (ADHD), parents

often have concerns about which treatment is right for their child. ADHD can be managed
with the right treatment. There are many treatment options, and what works best can
depend on the individual child and family. To find the best options, it is recommended that
parents work closely with others involved in their child’s life—healthcare providers,
therapists, teachers, coaches, and other family members.

Types of treatment for ADHD include

● Behavior therapy, including training for parents; and

● Medications.

Treatment recommendations for ADHD

For children with ADHD younger than 6 years of age, the American Academy of Pediatrics
(AAP) recommends parent training in behavior management as the first line of treatment,
before medication is tried. For children 6 years of age and older, the recommendations
include medication and behavior therapy together — parent training in behavior
management for children up to age 12 and other types of behavior therapy and training for
adolescents. Schools can be part of the treatment as well. AAP recommendations also
include adding behavioral classroom intervention and school support.

Good treatment plans will include close monitoring of whether and how much the
treatment helps the child’s behavior, as well as making changes as needed along the way.
Behavior Therapy, Including Training for Parents
ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects
relationships with family and other children. Children with ADHD often show behaviors that
can be very disruptive to others. Behavior therapy is a treatment option that can help
reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is
made.

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate
unwanted or problem behaviors. Behavior therapy for ADHD can include

● Parent training in behavior management;

● Behavior therapy with children; and
● Behavioral interventions in the classroom

These approaches can also be used together. For children who attend early childhood
programs, it is usually most effective if parents and educators work together to help the
child.

Children younger than 6 years of age

For young children with ADHD, behavior therapy is an important first step before trying
medication because:

● Parent training in behavior management gives parents the skills and strategies to
help their child.
● Parent training in behavior management has been shown to work as well as
medication for ADHD in young children.
● Young children have more side effects from ADHD medications than older children.
● The long-term effects of ADHD medications on young children have not been
well-studied.

School-age children and adolescents

For children ages 6 years and older, AAP recommends combining medication treatment with
behavior therapy. Several types of behavior therapies are effective, including:

● Parent training in behavior management;

● Behavioral interventions in the classroom;
● Peer interventions that focus on behavior; and
● Organizational skills training.

These approaches are often most effective if they are used together, depending on the
needs of the individual child and the family.

Medications
Medication can help children manage their ADHD symptoms in their everyday life and can
help them control the behaviors that cause difficulties with family, friends, and at school.

Several different types of medications are FDA-approved to treat ADHD in children as young
as 6 years of age:
 ● Stimulants are the best-known and most widely used ADHD medications. Between
70-80% of children with ADHD have fewer ADHD symptoms when taking these
fast-acting medications.
● Nonstimulants were approved for the treatment of ADHD in 2003. They do not work
as quickly as stimulants, but their effect can last up to 24 hours.

Medications can affect children differently and can have side effects such as decreased
appetite or sleep problems. One child may respond well to one medication, but not to
another.

Healthcare providers who prescribe medication may need to try different medications and
doses. The AAP recommends that healthcare providers observe and adjust the dose of
medication to find the right balance between benefits and side effects. It is important for
parents to work with their child’s healthcare providers to find the medication that works
best for their child.

Parent Education and Support

CDC funds the National Resource Center on ADHD (NRC), a program of Children and Adults
with Attention-Deficit/Hyperactivity Disorder (CHADD). The NRC provides resources,
information, and advice for parents on how to help their child.

Tips for Parents

The following are suggestions that may help with your child’s behavior:

● Create a routine. Try to follow the same schedule every day, from wake-up time to
bedtime.
● Get organized.
● Encourage your child to put schoolbags, clothing, and toys in the same place every
day so that they will be less likely to lose them.
● Manage distractions. Turn off the TV, limit noise, and provide a clean workspace
when your child is doing homework. Some children with ADHD learn well if they are
moving or listening to background music. Watch your child and see what works.
● Limit choices. To help your child not feel overwhelmed or overstimulated, offer
choices with only a few options. For example, have them choose between this outfit
or that one, this meal or that one, or this toy or that one.
● Be clear and specific when you talk with your child. Let your child know you are
listening by describing what you heard them say. Use clear, brief directions when
they need to do something.
● Help your child plan. Break down complicated tasks into simpler, shorter steps. For
long tasks, starting early and taking breaks may help limit stress.
● Use goals and praise or other rewards. Use a chart to list goals and track positive
behaviors, then let your child know they have done well by telling them or by
rewarding their efforts in other ways. Be sure the goals are realistic—small steps are
important!
● Discipline effectively. Instead of scolding, yelling, or spanking, use effective
directions, time-outs or removal of privileges as consequences for inappropriate
behavior.
 ● Create positive opportunities. Children with ADHD may find certain situations
stressful. Finding out and encouraging what your child does well—whether it’s
school, sports, art, music, or play—can help create positive experiences.
● Provide a healthy lifestyle. Nutritious food, lots of physical activity, and sufficient
sleep are important; they can help keep ADHD symptoms from getting worse.

ADHD in Adults
ADHD lasts into adulthood for at least one-third of children with ADHD1. Treatments for
adults can include medication, psychotherapy, education or training, or a combination of
treatments. For more information about diagnosis and treatment throughout the lifespan,
please visit the websites of the National Resource Center on ADHD and the National
Institutes of Mental Health

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with
ADHD. In addition to behavioral therapy and medication, having a healthy lifestyle can make
it easier for your child to deal with ADHD symptoms. Here are some healthy behaviors that
may help:

● Developing healthy eating habits such as eating plenty of fruits, vegetables, and
whole grains and choosing lean protein sources
● Participating in daily physical activity based on age
● Limiting the amount of daily screen time from TVs, computers, phones, and other
electronics
● Getting the recommended amount of sleep each night based on age

Adapted from: What is ADHD? | CDC