What Is ADHD?
Attention-deficit/hyperactivity disorder (previously known as attention deficit disorder or ADD) is a neurobehavioral disorder characterized by core symptoms of inattentiveness, distractibility, hyperactivity, and impulsivity. ADHD is thought to be the most common childhood mental health disorder, with estimates of its prevalence in children ranging from 5 to 11 percent.
Some children with ADHD find it difficult to concentrate on schoolwork or other tasks and may daydream frequently. Others become disruptive, defiant, or have trouble getting along with parents, peers, or teachers. Children who struggle with hyperactivity and impulsivity, in particular, often have behavioral challenges that can be difficult for adults to manage.
It’s also possible for both sets of symptoms to exist together, in what is typically called combined type ADHD. Executive functioning (planning, emotional regulation, and decision-making) is often affected as well.
Experts have debated whether treatment for ADHD should be primarily behavioral (therapy, attention training, increased play, greater structure) or pharmacological. Several large studies have concluded that a combination of both may be most effective.
Managing work, school, and household tasks can be a challenge for children and adults with ADHD. Fortunately, they can learn coping skills to work around struggles and harness their talents—as many successful individuals with ADHD have already done.
What Are the Symptoms of ADHD?
The symptoms of ADHD fall into two distinct categories—inattention and hyperactivity/impulsivity. Boys, who tend to show more hyperactive or impulsive symptoms, have historically been more likely to be diagnosed with ADHD than girls. But improved awareness of inattentive symptoms has led to an increase in diagnoses among girls in recent years.
Problems of inattention include difficulty sustaining attention, easily becoming distracted, and not paying attention to details or instructions. They also include making careless mistakes at work or school, the inability to finish projects, and losing or forgetting things. Problems of hyperactivity and impulsivity include feeling restless, fidgeting or squirming, and talking excessively or interrupting others at inappropriate times.
Given the fuzzy character of the disorder, the symptoms of ADHD are not always clear cut. Since everyone experiences inattention or impulsivity from time to time, an individual’s symptoms must be persistent to be considered diagnostically relevant and impair function in school, at work, or at home.
For children, symptoms must be unusual for the corresponding developmental stage, as some may represent typical behavior for one's age group. For an adult to be diagnosed, symptoms must have emerged before age 12.
What Causes ADHD?
The causes of ADHD are not clear. As with other mental health and behavioral disorders, genes likely play a role, but more recent research also implicates exposure to environmental toxins such as pesticides or lead, as well as prenatal cigarette smoking or alcohol intake. The belief that eating too much sugar causes the condition has not held up in research.
“Poor parenting” is not to blame for ADHD, but parenting styles and strategies can have an effect on children's self-regulating abilities. Children who are exposed to inconsistent discipline, or who suffer from neglect, may find it more challenging to rein in their impulses or direct their attention later on.
How to Treat ADHD
Medication and behavioral treatments are both widely used to treat ADHD.
Patients who receive behavioral treatments—typically therapy, parent training, or neurofeedback—often ultimately need less medication, or are able to stop using it entirely. At the same time, several influential studies have concluded that the two treatment approaches may work best in tandem.
The most commonly used ADHD medications are stimulants such as Ritalin and Adderall. Non-stimulants, like Strattera or certain classes of antidepressants, can be used for those who don’t respond to stimulants or cannot tolerate them.
Whatever medication is used, it's important to receive the correct dosage, since ADHD medications, and stimulants in particular, can worsen other conditions that may co-occur with ADHD, including bipolar disorder, obsessive-compulsive disorder, and anxiety.
How to Manage ADHD at School
Both inattentive and hyperactive symptoms can cause difficulties at school. Modern classrooms do not always allow for freedom of movement, hands-on learning, or tailored lessons; thus, children who speak out of turn, fidget excessively, or struggle to pay attention to lectures may find it difficult to keep up or behave appropriately.
Treatment plans—whether behavioral or pharmacological—will often help children do better in school. Children and teens with ADHD may also benefit from specific accommodations to help adapt curricula, classroom environments, and testing procedures to their learning styles and to compensate for developmental delays.
Awareness among school staff, as well as a supportive environment that respects learning differences, can go a long way toward building a child's confidence and encouraging her to find areas in which she excels.
How Technology Affects ADHD
There is an ongoing debate over whether multitasking, an increasing societal dependence on technology, or the competing demands of the modern world could be creating ADD symptoms in otherwise attentive people.
Most psychologists believe that attentional challenges long predate even the most rudimentary technology. Yet it’s also true that increasing diagnosis rates have coincided with a growing influence of technology on many people’s daily lives.
Aside from the merits of the clinical debate, however, a plugged-in world of noisy, visually cluttered phones, screens, and other devices can be frustrating to many and is likely to be especially challenging for individuals with ADHD.
How ADHD Affects Your Relationships
Maintaining fulfilling relationships can be a challenge for people with attentional problems. Because they are easily distracted, they may not appear to be listening closely to loved ones, and time-management challenges may lead them to be frequently late—or to forget social plans and errands altogether.
Because close relationships are so crucial to happiness and well-being, it's critical for those with ADHD to be aware of the effects of their condition on others and to develop skills for building stronger social ties. On the other hand, it’s equally important for loved ones to be cognizant of ADHD-related challenges, and to understand that in many cases, the person with ADHD is aware of—and struggling to manage—their frustrating behaviors.
Is ADHD Real? Understanding the Controversy
ADHD has been listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for decades, but it remains controversial. Is it a true disorder, or simply a collection of naturally occurring behaviors that aren't tolerated in today’s high-demand, results-driven world?
Even among those who agree that ADHD exists, there are competing theories about what the diagnosis entails. Until recently, it was considered a childhood disorder that individuals eventually grew out of. But while evidence suggests that up to 50 percent of children do appear to outgrow the condition, many others don’t: About 4 percent of adults in the U.S. have been diagnosed with ADHD, and more may be undiagnosed.
In addition, even among children who “outgrow” symptoms, early developmental delays and academic setbacks may create enduring problems.