Attention Deficit Hyperactivity Disorder

What is attention deficit hyperactivity disorder (ADHD)?

From: MedlinePlus, National Library of Medicine

ADHD is a neurodevelopmental disorder. It is usually first diagnosed in childhood and often lasts into adulthood. But some people don't get diagnosed with ADHD until they are adults. ADHD involves:

• Having trouble paying attention (inattention)
• Having trouble controlling impulsive behaviors (impulsivity)
• Being overly active (hyperactivity)

What are the types of attention deficit hyperactivity disorder (ADHD)?

From: MedlinePlus, National Library of Medicine

There are three types of ADHD:

• Mostly Inattentive ADHD. People with this type of ADHD have trouble paying attention and are easily distracted. It's hard for them to organize or finish tasks. They may have trouble following instructions or conversations.
• Mostly Hyperactive-Impulsive ADHD. People with this type of ADHD have symptoms of both hyperactivity and impulsivity: With hyperactivity, people feel a need to always be moving. They have trouble sitting still and may fidget and/or talk too much. With impulsivity, people have trouble controlling their actions and words. They tend to act on sudden ideas or feelings without thinking about the possible results. They may interrupt others a lot or have trouble waiting their turn.
• Combined ADHD. People with this type of ADHD have a mix of inattentive and hyperactive-impulsive symptoms. Combined ADHD is the most common type.

It's normal to sometimes have trouble paying attention or sitting still, especially for children. But people with ADHD have more severe symptoms that can sometimes cause serious problems, for example, failing grades for a child or a job loss for an adult. The symptoms are ongoing and may affect family and social life, too.

What causes attention deficit hyperactivity disorder (ADHD)?

From: MedlinePlus, National Library of Medicine

The exact cause of ADHD is unknown. ADHD probably results from a combination of factors, such as genetics and your environment. Researchers are looking at possible environmental factors that might raise the risk of developing ADHD. These factors include brain injuries, nutrition, and social environments.

What are the symptoms of attention deficit hyperactivity disorder (ADHD)?

From: MedlinePlus, National Library of Medicine

The symptoms of ADHD depend on the type of ADHD a person has:

People with symptoms of attention problems may often:

People with symptoms of hyperactivity-impulsivity may often:

People with combined ADHD show a mix of inattention and hyperactivity-impulsivity symptoms

• Miss details or make careless mistakes in schoolwork, at work, or in other activities
• Have trouble staying focused on play activities or work tasks
• Not seem to listen when spoken to directly
• Find it hard to follow instructions or finish tasks, or may start but get easily sidetracked
• Have trouble being organized, keeping belongings in order, and managing time
• Avoid doing tasks that require long periods of mental effort
• Lose important items, such as books, wallets, keys, eyeglasses, and cellphones
• Forget about doing daily activities
• Fidget and squirm while seated
• Get up when staying seated is expected, such as at school or work
• Run around or climb when it's not appropriate (children) or feel restless (teens and adults)
• Have trouble doing quiet activities
• Be constantly moving or "on the go"
• Talk much more than is normal
• Blurt out answers before questions are completed
• Have trouble waiting for their turn
• Interrupt others for example during conversations or games

How is attention deficit hyperactivity disorder (ADHD) diagnosed?

From: MedlinePlus, National Library of Medicine

There is no single test to diagnose ADHD. One step of the process for diagnosing ADHD involves having a physical exam, including vision tests, hearing tests (for children and adults), and other tests to rule out other problems with symptoms like ADHD. Other problems with similar symptoms include anxiety, depression, sleep problems, and certain types of learning disabilities.

The process also involves a thorough medical history and family history. And it usually includes using standardized ADHD symptom checklists, questionnaires, and/or interview questions. These tools have rating scales (scoring systems) that help the provider see if a person's symptoms and history fit a diagnosis of ADHD.

To make a diagnosis of ADHD, the provider needs to have found all of these things:

• Several symptoms of ADHD that began before age 12.
• Several symptoms of inattention and/or hyperactivity-impulsivity that have lasted for at least 6 months and cause serious problems:
• For children up to age 16, there must be at least 6 ongoing symptoms. For people 17 and older, there must be at least 5 ongoing symptoms. Symptoms that happen in 2 or more settings, for example, at home and at work or school. Symptoms that clearly get in the way of functioning well at school, work, and/or in social situations. Symptoms aren't caused by another mental health disorder.

What are the treatments for attention deficit hyperactivity disorder (ADHD)?

From: MedlinePlus, National Library of Medicine

Although there is no cure for ADHD, treatments may help reduce symptoms and improve functioning. ADHD is commonly treated with:

• Medicines.
• Psychotherapy (talk therapy), including behavior therapy.
• Education or training for parents to give them the skills and strategies to help their child. This is especially important for younger children.
• A combination of these treatments.

Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Having a healthy lifestyle, such as healthy eating and regular exercise, may also help manage symptoms.

For school-aged children, school support is important. This could include classroom-based behavioral interventions such as behavior management plans or teaching your child organizational and study skills. It may also include accommodations such as specific seating in the classroom, reduced classwork, or extended time on tests and exams.

Genetic causes described in the linked summary

From: MedlinePlus Genetics

Changes in dozens of genes have been associated with ADHD. Many gene variations, most of which have not been identified, are thought to affect the risk of developing ADHD. Because they are common in many populations worldwide, not all people with these gene variations will have the condition. Many of the gene variations have only a small effect, and most people with ADHD are thought to have numerous associated gene variations. These variations also combine with environmental risk factors to determine an individual's risk of developing this complex condition. Environmental risk factors that may contribute to the development of ADHD include complications during pregnancy and delivery and exposure to heavy metals such as lead. It is unclear how genetic and environmental factors influence each other to contribute to ADHD.

Less commonly, ADHD is caused by rare gene mutations or chromosome abnormalities. In these instances, ADHD is usually one of several features of a syndrome that affects multiple parts of the body. In most individuals with ADHD caused by rare gene mutations, a mutation in a single gene is enough to cause the disorder.

The genes associated with ADHD are thought to be involved in the development of the brain. The various proteins produced from these genes affect multiple aspects of brain development, including production, growth, or organization of nerve cells (neurons). Other genes associated with ADHD provide instructions for proteins that are important for communication between neurons. Some of these proteins help produce or control the chemicals that relay communication signals between neurons (neurotransmitters). Other proteins have roles at the connections between neurons (synapses) where this communication takes place.

The specific ways that changes in associated genes are involved in the development of ADHD are unknown. Research has found that people with ADHD often have low levels of the neurotransmitter dopamine, which has many important functions, including having complex roles in thought (cognition), motivation, behavior, and control of movement. Certain layers of the brain may also develop somewhat differently than usual in people with ADHD.

Inheritance described in the linked summary

From: MedlinePlus Genetics

ADHD has a tendency to run in families, but the inheritance pattern is usually unknown. Overall, the risk of developing this condition is about nine times greater for first-degree relatives of people with the condition (such as siblings or children) as compared to the general public. People with genetic changes associated with ADHD generally inherit an increased risk of developing the condition, rather than the condition itself. When ADHD is a feature of another genetic syndrome, it can be passed on according to the inheritance pattern of that syndrome.

Which doctor should you see?

The suggested department for discussing Attention Deficit Hyperactivity Disorder is Psychiatry, with a psychiatrist as the relevant type of clinician. General physician / Family Medicine; paediatrician for children. Referral depends on symptoms.

Additional services that may be relevant, depending on the findings, include: Clinical Genetics.

This is an editorial referral starting point. The appropriate clinic depends on the person’s age, symptoms, previous diagnosis and local services. The first clinician can decide whether another specialty or a team is needed; a department label does not confirm the diagnosis.

How to prepare for an assessment

Bring a short timeline of the main symptoms: when they first appeared, whether they are constant or episodic, what seems to change them, and how they affect daily activities. Include previous reports, discharge summaries, current medicines and supplements, allergies, and any relevant family history. A dated record is more useful than trying to match every feature in an online article.

Ask the clinician what is already established and what remains uncertain. If a test is suggested, ask what question it answers, what its limitations are and how the result would change the next step. The information here is not an instruction to arrange every possible test. In children, bring growth, developmental and school information if it is relevant to the concern.

• How are symptoms affecting safety, sleep, relationships and everyday function?
• What roles could psychological treatment, medicines or support services have?
• Who should be contacted if safety or functioning deteriorates?

Treatment discussions and follow-up

Where the source describes treatments, these are an overview of possible care, not a prescription for an individual. Ask which option applies to the confirmed diagnosis, what benefit is expected, what adverse effects to watch for and how progress will be assessed. Availability, approvals and local practice can differ from the country described in the source.

Before leaving the appointment, clarify the next review date, who will communicate results, and whom to contact if the situation changes. Discuss difficulties with sleep, work, school, mobility, eating or emotional wellbeing when these are relevant. Practical support may require coordination between the treating clinician and other services.

The collected references do not establish a complete prevention or long-term outlook section for this entry. Missing information should not be interpreted as proof that prevention is impossible or that a particular outcome is inevitable. Ask what is known for the exact subtype, stage and personal circumstances, and which uncertainties remain.

When to seek emergency help

Severe breathing difficulty, collapse, new stroke-like symptoms, a seizure that is prolonged or repeated without recovery, uncontrolled major bleeding, or an immediate risk of self-harm require emergency help. In India, call 112 or reach the nearest emergency department. This is a general, non-exhaustive warning list; it is not a condition-specific triage tool.