ADHD Awareness Month

ADHD is a developmental disorder associated with an ongoing pattern of inattention, hyperactivity, and/or impulsivity. The symptoms of ADHD can interfere significantly with an individual’s daily activities and relationships. ADHD begins in childhood and can continue into the teen years and adulthood.

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

• Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.
• Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.
• Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

Signs and Symptoms

Some people with ADHD mainly have symptoms of inattention. Others mostly have symptoms of hyperactivity-impulsivity. Some people have both types of symptoms.

Many people experience some inattention, unfocused motor activity, and impulsivity, but for people with ADHD, these behaviors:

• are more severe
• occur more often
• interfere with or reduce the quality of how they function socially, at school, or in a job

Inattention

People with symptoms of inattention may often:

• Overlook or miss details and make seemingly careless mistakes in schoolwork, at work, or during other activities
• Have difficulty sustaining attention during play or tasks, such as conversations, lectures, or lengthy reading
• Not seem to listen when spoken to directly
• Find it hard to follow through on instructions or finish schoolwork, chores, or duties in the workplace, or may start tasks but lose focus and get easily sidetracked
• Have difficulty organizing tasks and activities, doing tasks in sequence, keeping materials and belongings in order, managing time, and meeting deadlines
• Avoid tasks that require sustained mental effort, such as homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
• Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
• Be easily distracted by unrelated thoughts or stimuli
• Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Hyperactivity-Impulsivity

People with symptoms of hyperactivity-impulsivity may often:

• Fidget and squirm while seated
• Leave their seats in situations when staying seated is expected, such as in the classroom or the office
• Run, dash around, or climb at inappropriate times or, in teens and adults, often feel restless
• Be unable to play or engage in hobbies quietly
• Be constantly in motion or on the go, or act as if driven by a motor
• Talk excessively
• Answer questions before they are fully asked, finish other people’s sentences, or speak without waiting for a turn in a conversation
• Have difficulty waiting one’s turn
• Interrupt or intrude on others, for example in conversations, games, or activities

Primary care providers sometimes diagnose and treat ADHD. They may also refer individuals to a mental health professional, such as a psychiatrist or clinical psychologist, who can do a thorough evaluation and make an ADHD diagnosis.

For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for their age. Stress, sleep disorders, anxiety, depression, and other physical conditions or illnesses can cause similar symptoms to those of ADHD. Therefore, a thorough evaluation is necessary to determine the cause of the symptoms.

Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12.

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in children who primarily have symptoms of inattention, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and symptoms may more likely include feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Risk Factors

Researchers are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other disorders, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors that might raise the risk of developing ADHD and are studying how brain injuries, nutrition, and social environments might play a role in ADHD.

ADHD is more common in males than females, and females with ADHD are more likely to primarily have inattention symptoms. People with ADHD often have other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse.

Treatment and Therapies

While there is no cure for ADHD, currently available treatments may reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.

Telemental Health

Research suggests that telemental health services can be effective for many people, including, but not limited to those with ADHD, PTSD, depression, and anxiety. Telemental health is the use of telecommunications or videoconferencing technology to provide mental health services. It is sometimes referred to as telepsychiatry or telepsychology. Research suggests that telemental health services can be effective for many people, including, but not limited to those with attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), depression, and anxiety.

As the need for providing virtual mental health care services has increased, providers are finding ways to use phone and videoconferencing technology to bring therapy, evaluations, interventions, and medication management to individuals where they are.

Although the practice has become much more common, especially as a result of the coronavirus (COVID-19) pandemic, more research is needed to understand when and how telemental health services should be used.

Learn about factors to consider when using telemental health.

Potential Benefits

• Convenience: Telemental health appointments don’t require travel and often mean less time off work and smoother logistics coordination for things like transportation or childcare. Patients also can schedule appointments with less advance notice and at more flexible hours.
• Broader reach: The technology is available to people who may not have had access to mental health services previously, including those in remote areas and emergency care situations.
• Fewer barriers: For those who may have been hesitant to look for mental health care in the past, telemental health services might be an easier first step than traditional mental health services.
• Advances in technology: As telemental health services have increased, providers have become more familiar with evolving videoconferencing technology, with some switching to entirely virtual practices.

Potential Drawbacks

• Access to technology: Services may be limited by lack of internet connection and devices.
• Quality issues: Varying levels of technological quality can affect how services are provided and received.
• Cost: Evolving technology means updating equipment, platforms, and networks for patients.
• Privacy: Cameras in users’ homes and virtual online platforms pose privacy considerations. Individuals also might be more hesitant to share sensitive personal information with a provider in a situation where others might hear.
• Insurance coverage: The rise in telehealth during the COVID-19 pandemic has led to policy changes to make services accessible to more people. However, it is not known how long such flexibilities will stay in place, and understanding what services are available can be complicated. Coverage and provider licensure requirements vary from state to state.

Finding a Telemental Health Services Provider

Many of the same considerations for finding a provider for in-person mental health services apply to finding a telemental health services provider. Considerations specific to telemental health include:

• Security: As videoconferencing platforms continue to evolve, most providers use secure platforms through which recording isn’t possible. Industry best practices for videoconferencing for telemental health services providers suggest selecting platforms with appropriate verification, confidentiality, and security features.
• Introductory sessions: Meeting a provider for the first time in a virtual environment may make it more challenging to determine comfort level. Initial free consultations may make it easier to determine if a telemental health services provider feels like a good fit.

ADHD In Adults

ADHD is not just a childhood disorder. Many adults who are struggling with ADHD don’t know that they have it. Have you experienced challenges with concentration, impulsivity, restlessness, and organization throughout your life? Have you ever wondered whether you might have attention-deficit/hyperactivity disorder (ADHD)? Although ADHD is well known as a condition that affects children, many adults also experience it. ADHD can be harmful to an individual’s social relationships and work and school performance, but effective treatments are available to manage the symptoms of ADHD. Learn about the signs and symptoms of ADHD and when to discuss it with your health care provider.

What are the symptoms of ADHD?

People with ADHD experience an ongoing pattern of the following types of symptoms:

• Inattention–having difficulty paying attention
• Hyperactivity–having too much energy or moving and talking too much
• Impulsivity–acting without thinking or having difficulty with self-control

Some people with ADHD mainly have symptoms of inattention. Others mostly have symptoms of hyperactivity-impulsivity. Some people have both types of symptoms.

Signs of inattention may include challenges with:

• Paying close attention to details or making seemingly careless mistakes at work or during other activities
• Sustaining attention for long tasks, such as preparing reports, completing forms, or reviewing lengthy papers
• Listening closely when spoken to directly
• Following instructions and finishing duties in the workplace
• Organizing tasks and activities and managing time
• Engaging in tasks that require sustained attention
• Losing things such as keys, wallets, and phones
• Being easily distracted by unrelated thoughts or stimuli
• Being forgetful in daily activities, such as paying bills, keeping appointments, or returning calls

Signs of hyperactivity and impulsivity may include:

• Experiencing extreme restlessness, difficulty sitting still for extended periods, and/or wearing others out with one’s activity
• Fidgeting with or tapping hands or feet or squirming in seat
• Being unable to engage quietly in leisure activities
• Talking excessively
• Answering questions before they are asked completely
• Having difficulty waiting for one’s turn, such as when waiting in line
• Interrupting or intruding on others

Other mental disorders may occur with ADHD, including anxiety, mood, and substance use disorders.

How is ADHD diagnosed in adults?

ADHD is a disorder that begins in childhood and continues into adulthood. Adults who are diagnosed with ADHD experienced several symptoms of ADHD before the age of 12. As adults, they currently experience at least five persistent symptoms of inattention and/or five persistent symptoms of hyperactivity-impulsivity. These symptoms must be present in two or more settings (for example, home, work, or school; with friends or relatives; in other activities) and interfere with, or reduce the quality of, social, school, or work functioning.

Adults who think they may have ADHD should talk to their health care provider. Primary care providers routinely diagnose and treat ADHD and may refer individuals to mental health professionals. 

Stress, other mental health conditions, and physical conditions or illnesses can cause similar symptoms to those of ADHD. Therefore, a thorough evaluation by a health care provider or mental health professional is necessary to determine the cause of the symptoms and identify effective treatments. During this evaluation, the health care provider or mental health professional will examine factors including the person’s mood, medical history, and whether they struggle with other issues, such as alcohol or substance misuse.

A thorough evaluation also includes looking at the person’s history of childhood behavior and school experiences. To obtain this information, an individual’s health care provider may ask for permission to talk with partners, family members, close friends, and others who know the individual well. A health care provider or mental health professional may use standardized behavior rating scales or ADHD symptom checklists to determine whether an adult meets the criteria for a diagnosis of ADHD. An individual may complete psychological tests that look at working memory, executive functioning (abilities such as planning and decision-making), visual and spatial (related to space), or reasoning (thinking) skills. Such tests can help identify psychological or cognitive (thinking-related) strengths and challenges and can be used to identify or rule out possible learning disabilities.

How does ADHD affect adults?

Some adults who have ADHD don’t know they have it. These adults may feel it is impossible to get organized, stick to a job, or remember to keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, arriving at work on time, and being productive on the job can be especially challenging for adults with undiagnosed ADHD. These adults may have a history of problems with school, work, and relationships. Adults with ADHD may seem restless and may try to do several things at the same time—most of them unsuccessfully. They sometimes prefer quick fixes rather than taking the steps needed to gain greater rewards.

A person may not be diagnosed with ADHD until adulthood because teachers or family did not recognize the condition at a younger age, they had a mild form of ADHD, or they managed fairly well until they experienced the demands of adulthood, especially at work. Sometimes, young adults with undiagnosed ADHD have academic problems in college because of the intense concentration needed for college courses.

It is never too late to seek a diagnosis and treatment for ADHD and any other mental health condition that may occur with it. Effective treatment can make day-to-day life easier for many adults and their families.

What causes ADHD?

Researchers are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other disorders, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors that might raise the risk of developing ADHD and are studying how brain injuries, nutrition, and social environments might play a role in ADHD.

What are the treatments for ADHD?

Treatment for ADHD includes medication, therapy, and other behavioral treatments, or a combination of methods.

Medication

Stimulants are the most common type of medication used to treat ADHD. Research shows these medications can be highly effective. Like all medications, they can have side effects and require an individual’s health care provider to monitor how they may be reacting to the medication. Non-stimulant medications are also available. Health care providers may sometimes prescribe antidepressants to treat adults with ADHD, although the Food and Drug Administration (FDA) has not approved these medications specifically for treating ADHD.

As with all prescriptions, individuals should disclose other medications they take when discussing potential ADHD medications with a health care provider. Medications for common adult health problems, such as diabetes, high blood pressure, anxiety, and depression, may interact with stimulants. In this case, a health care provider can suggest other medication options.

Psychotherapy and Support

Research shows that therapy may not be effective in treating the core symptoms of ADHD. However, adding therapy to an ADHD treatment plan may help individuals better cope with daily challenges. Therapy is especially helpful if ADHD co-occurs with other mental disorders, such as anxiety or depression.

Psychotherapy, including cognitive-behavioral therapy, might help an adult with ADHD become more aware of attention and concentration challenges and work on skills to improve organization and use of time in completing daily tasks. For example, they might help individuals break down large tasks into smaller, more manageable steps. Psychotherapy also can help adults with ADHD gain confidence and control impulsive and risky behaviors. Some adults also may find it helpful to get support from a professional life coach or ADHD coach who can help with different skills to improve daily functioning.

Behavioral therapy is a type of psychotherapy that aims to help a person change their behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:

• monitor their own behavior
• give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting

Parents, teachers, and family members also can give feedback on certain behaviors and help establish clear rules, chore lists, and structured routines to help a person control their behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

Cognitive-behavioral therapy helps a person learn how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.

Family and marital therapy can help family members and spouses find productive ways to handle disruptive behaviors, encourage behavior changes, and improve interactions with the person with ADHD.

Parenting skills training (behavioral parent management training) teaches parents skills for encouraging and rewarding positive behaviors in their children. Parents are taught to use a system of rewards and consequences to change a child’s behavior, to give immediate and positive feedback for behaviors they want to encourage, and to ignore or redirect behaviors they want to discourage.

Specific behavioral classroom management interventions and/or academic accommodations for children and teens have been shown to be effective for managing symptoms and improving functioning at school and with peers. Interventions may include behavior management plans or teaching organizational or study skills. Accommodations may include preferential seating in the classroom, reduced classwork load, or extended time on tests and exams. The school may provide accommodations through what is called a 504 Plan or, for children who qualify for special education services, an Individualized Education Plan (IEP). 

Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.

Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

Complementary Health Approaches

Some people may explore complementary health approaches, such as natural products, to manage symptoms of ADHD. Unlike specific psychotherapy and medication treatments that are scientifically proven to improve ADHD symptoms and impairments, complementary health approaches for ADHD generally have not been found to improve ADHD symptoms and do not qualify as evidence-supported interventions. Talk to your health care provider to find out if these options may or may not be an option for your consideration. 

Tips to Help Kids and Adults with ADHD Stay Organized

For Kids:

Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:

• Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or a bulletin board. Write changes on the schedule as far in advance as possible.
• Organizing everyday items. Have a place for everything, (such as clothing, backpacks, and toys), and keep everything in its place.
• Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home necessary books.
• Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
• Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior and praise it.

For Adults:

A professional counselor or therapist can help an adult with ADHD learn how to organize their life with tools such as:

• Keeping routines.
• Making lists for different tasks and activities.
• Using a calendar for scheduling events.
• Using reminder notes.
• Assigning a special place for keys, bills, and paperwork.
• Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.

How can I find help?

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator, an online tool for finding mental health services and treatment programs in your state. For additional resources, visit NIMH's Help for Mental Illnesses webpage.

How can I help myself?

Therapy and medication are the most effective treatments for ADHD. In addition to these treatments, other strategies may help manage symptoms:

• Exercise regularly, especially when you’re feeling hyperactive or restless.
• Eat regular, healthy meals.
• Get plenty of sleep. Try to turn off screens at least 1 hour before bedtime and get between 7 and 9 hours of sleep every night.
• Work on time management and organization. Prioritize time-sensitive tasks and write down assignments, messages, appointments, and important thoughts.
• Connect with people and maintain relationships. Schedule activities with friends, particularly supportive people who understand your challenges with ADHD.
• Take medications as directed, and avoid the use of alcohol, tobacco, and drugs.

Where can I turn if I feel alone in my diagnosis of ADHD?

Adults with ADHD may gain social support and better-coping skills by talking with family, friends, and colleagues about their diagnosis. If the people in your life are aware of your diagnosis, they will better understand your behavior. Psychotherapy for families and couples can help with relationship problems and teach everyone involved about ADHD. There are also support groups for adults with ADHD.

What should I know about participating in clinical research?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

Please, if you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.