Attention-Deficit Hyperactivity Disorder (ADHD)
What is attention-deficit hyperactivity disorder (ADHD)?
It is completely normal for everyone to struggle to pay attention, focus, listen or be patient all of the time. Although this is usually normal, if you find that you are struggling with these things most of the time, you may have an underlying condition called attention-deficit hyperactivity disorder (ADHD).
Attention-deficit hyperactivity disorder (ADHD) is a medical condition that affects certain types of behaviour, particularly your ability to pay attention and show self-control.
Around 5% of the world population is thought to have ADHD. It is classified as a mental health condition and can have a big effect on your quality of life.
What are the symptoms of ADHD?
There are three groups of symptoms in ADHD:
Inattentiveness means not being able to pay attention very well. Examples of symptoms of inattentiveness include:
- Finding it difficult to pay attention
- Being easily distracted
- Being unable to stick to longer tasks
- Making careless mistakes
- Losing things often
- Finding it difficult to carry out instructions
- Finding it hard to organise tasks
- Constantly changing task or activity
- Appearing to daydream a lot
Hyperactivity means being overly active and energetic. Examples of symptoms of hyperactivity include:
- Finding it difficult to sit still
- Finding it hard to stay quiet when needed
- Moving around more than normal
- Talking a lot
- Acting in a way that may disrupt others unintentionally
Impulsiveness means doing something quickly and suddenly without thinking about the consequences. Examples of impulsive behaviour include:
- Being unable to wait your turn
- Acting without thinking
- Having very little sense of danger
- Interrupting people
- Having intense emotional reactions
Can ADHD kill you?
No, ADHD cannot kill you. However, the impulsive behaviours of ADHD can mean that you behave in a more risky or dangerous way. This risky and dangerous behaviour could unintentionally put your life at risk, and may accidentally lead to death.
What are the different types of ADHD?
There are three main types of ADHD:
Inattentive type ADHD is also known as attention deficit disorder (ADD). In this type of ADHD, people mainly have the symptoms of inattentiveness, and very few symptoms of hyperactivity and impulsiveness. This can make it harder to diagnose people with inattentive type ADHD, because the symptoms of inattentiveness are less obvious than the symptoms of hyperactivity and impulsiveness.
If you have ADD, you probably find it hard to concentrate or focus your attention on something even for a short amount of time. You may find that you:
- Struggle to stick to a task
- Miss important details when doing a task
- Struggle to finish things you have started
People around you may say that you seem to daydream a lot, or that you are forgetful.
In contrast to ADD, people with hyperactive-impulsive ADHD tend to have more symptoms of hyperactivity and impulsivity, and far fewer symptoms of inattentiveness.
If you have this type of ADHD, you may find it hard to stay still, or you may fidget a lot or get bored easily. Without meaning to, people with hyperactive-impulsive ADHD can act in a way that disrupts others, often by interrupting or making careless, risky mistakes.
This is the most common type of ADHD that affects the most number of people. If you have combined ADHD, you show symptoms of inattentiveness, hyperactivity and impulsiveness.
This type of ADHD is easier to diagnose as it is more obvious than the other two types.
Who usually gets ADHD?
Certain groups of people are thought to have a higher risk of developing ADHD. These groups include:
- Premature babies (those born before 37 weeks)
- Babies with a low birth weight
- People with epilepsy
- People with brain damage that occurs either in the womb or after a head injury
ADHD in children
ADHD is most likely to be diagnosed in childhood. It is thought to affect 4-8% of school-age children, and most children with ADHD are diagnosed by the time they are 6 years old. Boys are diagnosed more than girls. This is thought to be because boys tend to show more hyperactive and disruptive symptoms than girls do.
ADHD in teenagers
If not recognised in childhood, ADHD can be more difficult to recognise and diagnose in teenagers. They are less likely to show hyperactive behaviours, but their friends, families and teachers may recognise that they:
- Are struggling in school
- Have bad sleeping patterns
- Are struggling to maintain friendships
- Are engaging in risky behaviours such as alcohol or drug misuse
ADHD in adults
If you get to adulthood without being diagnosed with ADHD, it can be even more difficult to get a diagnosis from a doctor. A lot of the time, the symptoms tend to be more subtle in adults, and because adults are less likely to show hyperactive symptoms, they may have just been labelled a ‘difficult’ child when they were younger.
Adults with ADHD are likely to:
- Have problems with their relationships with loved ones due to destructive behaviour
- Take part in riskier behaviours like dangerous driving or alcohol or drug misuse
- Struggle to hold down jobs
- Struggle to progress with their career
What causes ADHD?
The exact cause of ADHD is not known yet. However, it is thought to happen due to a combination of factors such as:
Research into ADHD shows that if your parent or sibling has ADHD, then you are more likely to develop it too, therefore it is thought to run in families. There isn’t however, one specific gene that causes ADHD.
It is thought that certain parts of the brain may be smaller in children with ADHD, specifically areas responsible for planning, behaviours and personality. There has also been research done to see if certain brain chemicals (called neurotransmitters) are different in people with ADHD, but a lot more research is needed in this area before an answer can be given.
It used to be thought that children who eat more sugar were more likely to develop ADHD. Research does not support this view. As always though, it is important to encourage a healthy diet in children to prevent other diseases that could negatively effect their health.
How is ADHD diagnosed?
If you think that you or your child could have ADHD, it is best to speak to your family doctor about it first. They cannot diagnose ADHD, but they can ask you questions to explore your concerns further and refer you to a specialist if needed.
Your doctor may ask:
- Which symptoms are worrying you
- When did the symptoms start
- Where the symptoms happen the most e.g. at school or at work
- If there have been any recent stressful life events
- If you have any other health conditions
- If there is a family history of ADHD
If your doctor thinks that you or your child may have ADHD, and it is affecting your daily life or their daily life, then they may refer you to see a specialist so that a formal assessment can be done.
Depending on your age or background, your family doctor may ask you to see one or more of the following specialists:
- An adult or child psychiatrist
- Paediatrician (a doctor who specialises in children's health)
- A social worker
- An occupational therapist
- A learning disability specialist
- A clinical psychologist
The specialist that your family doctor sends you to see has to do an assessment before they can diagnose ADHD. This assessment may include:
- A physical examination
- Asking detailed questions about your symptoms or your life
- Hearing reports from people in your life, such as parents, colleagues and teachers
In order for a child or teenager to be diagnosed with ADHD, they must meet a certain set of criteria which include the following:
- They must have at least 6 symptoms of inattentiveness and/or at least some symptoms of hyperactivity and impulsivity
- Their symptoms must have started before they reached 12 years of age
- Their symptoms have affected them in two or more areas such as at home and at school
- Their symptoms must have been ongoing for at least 6 months
- Their symptoms must have had an affect on their quality of life
Diagnosing ADHD in adults can be more difficult. It is not currently thought that ADHD can develop in adulthood, rather that it has been missed as a child. If your symptoms have been around since you were a child, then you are more likely to get a diagnosis.
In order to be diagnosed as an adult, ADHD must still be having an effect on your life as an adult. For example, ADHD may still be causing you to:
- Struggle with relationships with friends, family or a partner
- Undertake risky behaviours such as dangerous driving and/or alcohol or drug misuse
- Have difficulty making new friendships or keeping old ones
- Struggle to progress at work
In adulthood, there are other mental health problems that can cause problems with behaviours. For example:
- Depression can cause difficulty concentrating on tasks
- Anxiety can cause some of the symptoms of hyperactivity
- Personality disorders such as bipolar can show behaviours of impulsivity
How can ADHD affect quality of life?
Having ADHD can have a very big impact on your quality of life in many different ways.
Receiving a diagnosis of ADHD can feel like a stigma in itself. There can be many negatives associated with ADHD in terms of your quality of life, for example:
- It can affect your relationships with friends at school
- It can affect relationships with teachers or family members due to difficult behaviour that is outside of your control
- There is an increased risk of misusing alcohol and drugs
- It can affect your ability to drive
- It can affect your ability to have employment
Is there anything positive about being diagnosed with ADHD?
There are however, also many positive things about receiving a diagnosis, especially if it is something that you have been struggling with for a while. These positive things include:
- Being able to improve people’s understanding of your symptoms
- Identifying your individual strengths and building on them
- Improving your access to help services within school or employment to help you progress like others around you
- Giving you access to help groups
- Providing Support for your family or carer
Which other conditions have similar symptoms to ADHD?
There are several different mental health conditions that can have similar symptoms to ADHD. In some cases, children will also show signs of other problems and conditions in addition to ADHD. This is why, especially in adulthood, ADHD can be hard to diagnose.
Conditions with similar symptoms to ADHD include the following:
Depression and having low mood can often mimic symptoms of inattentiveness that are seen in ADHD. Having a low mood can often affect your ability to concentrate on tasks for a prolonged period of time, and this can affect you for most of the day. However people with depression will often show other symptoms as part of their mental health condition including:
- Feeling hopeless
- Feeling tearful
- Feeling guilty
- Feeling anxious
- Having a lack of energy
- Noticing changes in their appetite
- Experiencing psychosis (i.e. believing or seeing things that are not real)
It is important to note that you can have depression alongside ADHD, and often as a consequence of it.
Treating depression will not treat underlying ADHD, which is why it is important to give your doctor as much information about your symptoms as possible, and let them know how long they have been going on for.
If you suffer with anxiety, some of your symptoms could also appear to be similar to ADHD. For example, your anxiety may make you feel restless and make you fidget a lot. This could look like the hyperactive behaviours of ADHD.
- Heart pounding
- Extreme worry
If you have bipolar disorder, the depressive symptoms and manic symptoms of this condition can both appear similar to symptoms of ADHD.
The depressive symptoms can be similar to the symptoms of inattentiveness that are seen in ADHD, and the manic symptoms can be similar to the hyperactivity and impulsiveness symptoms of ADHD.
During a manic episode, people may engage in risky behaviours, talk very fast, interrupt people or be irritable.
People with bipolar disorder can often experience psychotic symptoms of delusions or hallucinations too, which can help doctors distinguish between bipolar disorder and ADHD.
Another way doctors can distinguish the two conditions is by considering that bipolar disorder only tends to occur in teenagers and adults, whereas people with ADHD should have evidence of symptoms being present since childhood.
There are many similarities between autism and ADHD. Often many children have both autism and ADHD.
Autism is not an illness or disease. Having autism just means that someone's brain works differently to other people's brains. Someone with autism does not need to be "treated" or "cured", although they may need support with certain parts of daily life.
Autism appears in early childhood, and like ADHD, can affect your relationships and self-control behaviours. Autism usually causes developmental delay like being late to talk or walk. It is important to see your doctor if you think this is affecting your child, in order to gain an early diagnosis and receive as much support as possible.
Dyslexia is a learning disability that can cause difficulties with reading, writing and spelling. This could be confused with ADHD when a child shows a lack of concentration with tasks. However this lack of concentration can be due to the fact that they are struggling to process the information.
Children with ADHD often show other symptoms aside from poor concentration, so it is important to mention all of these to your doctor to help get an accurate diagnosis.
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How do you treat ADHD?
There are a few different treatments available to help with ADHD. They often help to make the symptoms less of a problem and improve the quality of daily life.
For most people, a combination of treatments usually works best. Your doctor will be able to work with you to find out which treatment option is best for you.
Things you can do at home
People with ADHD should try to eat a balanced diet. There are no specific food groups that are linked with causing ADHD, but some people notice that certain foods can trigger their symptoms and make them worse. Discuss this with your doctor, as they may recommend keeping a food diary and can refer you to a dietician if needed.
Ensuring that you get lots of exercise will help tire you out and hopefully improve your quality of sleep. However, make sure that you do not exercise too close to bedtime, as this can have the opposite effect.
Planning for children
Living with a child that has ADHD can be very tiring and difficult. There are some steps that can help make it a little bit easier for both your child and yourself. These steps include:
- Having a set routine - this can help your child know what to expect from the day and help your child cope better
- Giving clear, brief instructions can make it clear what your child needs to do and holds their concentration
- Be positive as much as possible, and reinforce good behaviour
- Set boundaries - this allows everyone to know exactly what behaviour is expected
- Watch for warning signs that your child is becoming overstimulated and try and calm them down early
- Keep social situations short to help them keep their self-control
- Have a bedtime routine
- Speak to your child’s teacher about any extra support your child might need
Planning for adults
If you’re an adult living with ADHD it is important to plan your day to day life as much as possible too. It helps bring structure in and leave less time for other more disruptive behaviours. For example:
- Make lists or keep diaries to keep yourself organised
- Exercise regularly to let off steam
- Try relaxation techniques
- Be open with your employer and discuss ways that they can help you do your job better
- Join a support group
- Talk to your doctor about things like driving
Your doctor will be able to let you know if there are any support groups you can join. This could be online or in person.
Speaking to people going through the same situation as you can often be helpful and provide a support network for the future.
There are 5 different types of medications currently used for the treatment of ADHD. These are:
These medications can help someone with ADHD feel calmer, concentrate better, and be less impulsive. The medication will usually be started in a small dose, and then be increased as needed.
Methylphenidate is the most common medication used to treat ADHD and is more commonly known under its trade name Ritalin®. It can be offered to people of all ages, and it is either taken once a day or a few times daily.
It is a type of stimulant medication. It helps to increase the activity in the brain in areas that control attention and behaviour, leading you to feel calmer and be able to concentrate and carry out tasks easier.
Side effects of methylphenidate include:
- Increased heart rate
- Trouble sleeping
- Mood swings
- Loss of appetite
Lisdexamfetamine is another medication used in the treatment of ADHD. It tends to be used in teenagers and children where methylphenidate has not helped. It can also be used as a first-line medication in the treatments of adults with ADHD. It is often taken just once a day.
Side effects of lisdexamfetamine include:
- Stomach upset
Dexamfetamine is a similar medication to lisdexamfetamine and works in the same way. It can be offered to children, teenagers and adults. It is usually taken once or twice a day.
Side effects are the same as Lisdexamfetamine and include:
- Stomach upset
Atomoxetine is known as a selective noradrenaline reuptake inhibitor (SNRI). It is a medication that helps to increase the amount of a chemical in the brain called noradrenaline. The idea is that if noradrenaline stays in the brain for longer, it can help increase concentration levels, and can help control impulsive behaviours.
It can be taken by children and teenagers if it is not possible to use methylphenidate or lisdexamfetamine, or it can be used in adults first line. It is usually taken once or twice a day.
Side effects of atomoxetine include:
- Nausea and vomiting
- Trouble sleeping
- Liver damage
WARNING: It is important to note that Atomoxetine has also been linked to some people having suicidal thoughts. If you or your child experience suicidal thoughts whilst on atomoxetine, it is important that you speak to your doctor as soon as possible.
Guanfacine is the last medication that is used in the treatment of ADHD. It acts on the part of the brain that improves attention. It can be given to children and teenagers if it is not possible to use methylphenidate or lisdexamfetamine. It should not be given to adults with ADHD.
Side effects of guanfacine include:
- Lowering the blood pressure
- Dry mouth
As well as treating ADHD with medications, talking therapies can be used as a form of treatment. Examples of these therapies include:
Taking part in psychotherapy would involve you, and your family members, or child sitting down to talk all about ADHD and how it can affect your life. This can help you to fully make sense of ADHD, and can help you accept and live with the condition.
This is often used by parents or teachers to help support children with ADHD. The idea is that a system of rewards is designed to encourage your child to try and control their behaviours. A lot of positive reinforcement is used, including small rewards for good behaviour. It also includes removing privileges for poor behaviour. The hope is that by using this system, your child will get into a good pattern of behaviour in order to gain rewards.
This involves you or your child taking part in role play scenarios to try and teach them what is the best way to behave in social situations with others.
Cognitive behaviour therapy (CBT) is a talking therapy that helps you change the way you think and behave. A therapist would aim to change how to feel about a situation, which can then potentially change how you behave in that situation in the future.
Is there a cure for ADHD?
There is currently no cure for ADHD, however with the correct treatment, you or your child can live a very full and enjoyable life.
Can ADHD go away by itself?
ADHD will not go away by itself, but using the right medication and/or coping techniques, will allow you to keep it under control.
Can you prevent ADHD?
As there has been no clear cause found on what exactly causes ADHD, there is no clear way to prevent it. However, there are many ways in which it can be controlled and successfully managed with treatment.
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