Among the most commonly diagnosed neurodevelopmental disorders, Attention-Deficit/Hyperactivity Disorder (ADHD) features a pattern of inattention and/or hyperactivity that interferes with functioning or development. Typically identified in childhood, symptoms of ADHD need to be evident across multiple settings and caregivers in order for the diagnosis to be confirmed.1 While individuals with ADHD are often impacted throughout their lives, symptoms can be managed with behavior therapy and/or medication.
What Is ADHD?
Current research suggests that attention-deficit/hyperactivity disorder is a chronic condition, with approximately half of children continuing to exhibit symptoms and impairment into adulthood. ADHD is also associated with other types of psychiatric disorders, including oppositional defiant disorder (ODD), conduct disorder, mood and anxiety disorders, and substance use disorders.5
Symptoms of ADHD
Symptoms of ADHD are first observed in childhood (i.e., before age 12). These children often display difficulties with persistence in the face of challenging tasks, excessive motor activity (hyperactivity), and in thinking through the consequences of their actions (impulsivity).
With regard to impulsive behaviors, individuals with ADHD are best described as having “ready, fire, aim” behaviors. They often act without thinking about the impact of their behaviors, demonstrating poor foresight and planning. These behaviors may be the product of an underlying inability or intolerance to delay gratification, which will be discussed further in subsequent sections.
Signs of ADHD in Children
Although not specific to ADHD exclusively, children with ADHD can also present with mild delays in language, motor, or social development.1Many parents first report excessive motor activity when their child is a toddler, but these symptoms can often be difficult to distinguish from typical development before age 4. Most commonly, ADHD is diagnosed during elementary school years (ages 5-7) where symptoms of inattention become more impairing.
Signs of ADHD in Adolescence
Symptoms of impulsivity, excessive activity levels, and poor focus tend to be stable throughout early adolescence. For many individuals, hyperactive behaviors tend to lessen as they age and give way to fidgeting, impatience, and/or general restlessness. Adolescents with ADHD tend to demonstrate more educational difficulties, including more failing grades and higher school dropouts, than their neurotypical peers. They also have more difficulty in their relationships with peers, teachers, siblings, and parents.3
Signs of ADHD in Adults
As adolescents develop into adulthood, research suggests a reduction in core symptoms of ADHD.4 Some symptoms and signs of adult ADHD, such as qualities of poor planning and inattention, tend to persist throughout their lifetime. Older individuals who continue to meet criteria for ADHD tend to have more problems with adjustment and poorer mental health than comparison groups.
These adults also continue to have difficulty with impulsivity, which can lead to financial and/or legal problems (i.e., these individuals are more likely to switch jobs, get speeding tickets, and have driving accidents), though many may have found techniques and skills to become “high-functioning.”4 This is also referred to as “ADHD masking.”
However, some research demonstrates that adults who were hyperactive youngsters use their energy more adaptively as adults. For example, they may work multiple jobs, choose jobs that are more active, and/or work longer hours. In this way, the aimlessness of childhood restlessness has given way to more purposeful activity-seeking in adulthood.
As some adults who present to physicians and other mental health professionals have not previously been diagnosed in childhood, additional criteria beyond medical history have been suggested. It should be noted that each criterion is only met if the behavior occurs more frequently and is more impairing than individuals with the same developmental age.
These criteria include:4
- Sense of underachievement/low self-esteem
- Difficulty getting organized
- Chronic procrastination
- Trouble with follow-through on tasks
- Tendency to speak one’s mind with little insight into the timing or appropriateness of the remark
- Frequent search for high stimulation
- Intolerance for boredom
- High distractibility
- Often creative, intuitive, and highly intelligent
- Difficulty following “proper” procedure
- Low tolerance for frustration
- Tendency to work endlessly
- Sense of insecurity or worry
- Mood swings
- Tendency toward addictive behavior
Signs & Symptoms of Each Type of ADHD
There are three types of ADHD: ADHD with predominantly inattentive presentation, ADHD with predominantly hyperactive/impulsive presentation, and ADHD with combined presentation.
Here are signs and symptoms of each type of ADHD:
1. ADHD With Predominantly Inattentive Presentation
Individuals meeting diagnostic criteria for this subtype of ADHD present with fewer symptoms of hyperactivity.
Inattentive ADHD symptoms typically manifest in some or all of the following ways:1
- Difficulty with close attention to detail across multiple contexts, resulting in frequent mistakes and creating a negative impact on work productivity (e.g., at school, work, or during non-preferred leisure activities)
- Difficulty maintaining attention in non-preferred tasks or activities. Examples include challenges remaining on-task during reading tasks or lengthy conversations.
- Demonstrates “wandering attention” even without the presence of clear distractions in the environment
- Difficulty following through with tasks (preferred or nonpreferred). These individuals may often start projects with relative ease but fail to complete them.
- Challenges related to organization; including completing multiple-step actions, time blindness, and keeping things in order
- Avoidance of tasks that require persistence of mental effort (e.g., completion of homework, lengthy forms, or monotonous review of information)
- Difficulty holding onto things necessary for task completion (e.g., eyeglasses, car keys, cellphone, wallet, etc.)
- Easily distracted by stimuli in the environment (includes fleeting, unrelated thoughts)
- Forgetful during activities of daily living (e.g., routine chores, errands, returning calls, keeping appointments)
2. ADHD With Predominantly Hyperactive/Impulsive Presentation
Individuals meeting diagnostic criteria for this subtype of ADHD have significant difficulty with behavioral excess (i.e., behaviors that are more overt, and at times, socially stigmatizing).
Hyperactive and/or impulsive symptoms typically manifest in some or all of the following ways:1
- Frequent fidgeting or tapping with hands or feet; squirming in seat
- Inability to remain seated during times when doing so is expected (e.g., while working in a classroom or office)
- Excessive motor activity (e.g., running, climbing, restlessness) in situations where it may be inappropriate
- Difficulty engaging in quiet leisure activities (e.g., private reading in a library)
- Behavior characterized as being “driven by a motor” (e.g., unable to remain still for an extended period of time)
- Excessive talking
- Inability to inhibit one’s own communicative behavior (e.g., blurts out answers to questions, difficulty waiting for one’s turn in conversation)
- Interrupts or intrudes on others (e.g., takes over others’ activities, uses others’ things or invades others’ space without asking)
3. ADHD With Combined Presentation
Individuals meeting diagnostic criteria for this subtype demonstrate significant symptomology in both inattentive and hyperactive/impulsive categories.1
Treatment of ADHD
Treatment for ADHD includes different kinds of therapy, medication, and lifestyle changes.
Therapy For ADHD
Behavior therapy has been identified over the last 20 years as being an evidence-based treatment for adult ADHD.10 Behavioral strategies grounded in learning theory includes a focus on procedures wherein parents and/or caregivers (i.e., behavioral parent training) are trained to use specific strategies to increase desired behaviors (e.g., compliance, organization) and decrease undesirable behaviors (e.g., noncompliance, disruptions).
Several meta-analyses over the last decade have established that behavioral treatments result in moderate to substantial improvement for children who engage in a variety of disruptive and noncompliant behaviors.10These types of therapies can be provided by licensed psychologists, social workers, and/counselors with the appropriate educational background and training.
Medications For ADHD
Numerous systematic reviews show that up to 70% of children respond well to stimulant medications, with short-term improvement in ADHD symptoms related to inattention and hyperactivity/impulsivity.11Stimulant medications typically used to treat these symptoms include Methylphenidate (brand names: Ritalin, Quillivant, QuilliChew, Metadate, Concerta), Dextroamphetamine + Amphetamine (brand name: Adderall) and Dextroamphetamine (brand name: Dexedrine).
Additional types of pharmacotherapy for ADHD symptoms include atomoxetine (brand name: Strattera), an FDA-approved alternative to stimulant medication, which replaces certain neurotransmitters in the brain, and guanfacine (brand name: Tenex), which is a blood pressure medication that is often prescribed off-label to treat ADHD.
ADHD Medication Side Effects
ADHD medication side effects include nervousness, insomnia, dry mouth, loss of appetite, constipation, and tachycardia. While a pediatrician is qualified to prescribe these medications, many will refer families to a specialist (i.e., developmental pediatricians and/or psychiatrists) for ongoing medication management. Prior to taking medication, you should speak with your prescribing doctor to determine whether stimulants vs. non-stimulants are the best treatment for you or your child.
Here are seven potential lifestyle changes that can help someone cope with ADHD:
- Create a routine that follows a set schedule: A set routine can help you manage distractions and gives you fewer needs to make decisions throughout the day.
- Get organized and maintain your organizational systems: Have designated spots for things like school/work supplies, shoes, clothing, wallet and keys, etc.
- Manage distractions by learning what background noises impede attention and what may help: Maybe you need to incorporate more movement or listen to upbeat music while completing tasks.
- Take breaks when completing long tasks and try to break down long or complicated tasks into shorter, more manageable ones: Breaks are helpful as it can be easy to get overstimulated with ADHD.
- Search for and create positive opportunities: Identifying ways in which you can excel to help create positive experiences.
- Maintain a healthy lifestyle, including eating nutritious foods and getting regular physical exercise: Having a healthy and balanced lifestyle is important as ADHD can make it hard to stick to tasks and commitments.
- Try body-doubling: When you are doing a task and having a hard time concentrating, having someone around doing their own work or a task they need to do can be motivational, making it easier to complete tasks.
10 Strategies for Dealing With Symptoms of ADHD
There are many strategies that can help guide teachers, parents, and other caregivers to support children, teens, and young adults who are struggling with the ADHD diagnosis. These strategies include personalization of tasks, more realistic goal-setting, preferential seating, and pneumonic devices.
Here are ten strategies to deal with symptoms of ADHD:
1. Personalize Tasks and Assignments
Make assignments personally meaningful for individuals with ADHD and allow them to complete things having to do with their interests. This will help them rely less on rote memorization and make more meaningful and relevant connections with the material.
2. Set Smaller, More Realistic Goals
Given poor frustration tolerance when faced with challenging tasks that is common for individuals with ADHD, it is important that teachers understand what these students currently are and are not capable of, so that they can develop challenging, yet realistic goals that are attainable based on their abilities.
Individuals with ADHD can often develop a sense of learned helplessness over the years. For these students, achieving even the smallest goals are predictive of increased achievement and self-esteem.
3. Let Them Move
Many individuals with ADHD are able to attend most effectively on tasks that require sensory-motor manipulation. Thus, these individuals should be given as many opportunities as possible within an academic schedule to be involved in classes that allow movement, building, and construction (i.e., wood shop, culinary, art, etc.).
4. Provide Visual Resources
Students with ADHD benefit from the use of a word bank on tests and quizzes. In addition, they benefit from graphic organizers in helping them formulate and structure their thoughts on written assignments.
5. Give Preferential Seating
To help students with ADHD maintain attention, specifically activation/arousal needs, preferential seating may be beneficial in helping them stay on task. These students should be placed at a desk in front of the room, away from both the windows and the classroom entrance, but near the teacher at the point of instruction.
6. Give Breaks
Given the difficulty individuals with ADHD have sustaining attention for extended periods of time, opportunities for short, frequent breaks should be provided throughout the school and work day.
7. Provide Notes
Students with ADHD often benefit from having copies of classroom notes so they can direct their attention to the teacher’s lesson in real time.
8. Link Information & Use Mnemonic Devices
Individuals with ADHD may benefit from using associative linkages when encoding information. By linking new information to what has been previously learned, these individuals may be able to gain a more global understanding of the information and improve recall.
When learning new information, individuals with ADHD may benefit from using mnemonic devices and repeating them aloud frequently in order to capitalize on his strength in auditory memory. These strategies include mental pictures (using imagery and visualizations) and first-letter cues (to remember the words in a series or statement).
Repetition & Association
Individuals with ADHD often have difficulties remembering people’s names. The following strategy may be useful to aid in encoding new information:
- Pay attention and listen to the name when the person is introduced.
- Repeat the name to the person being introduced, “Hello, John Smith, it is a pleasure to meet you,” and say it several times to yourself.
- Make the name meaningful and concrete by using substitute words for names that are long or hard to remember.
For example, Woitazewski may become “What a zoo ski.” Focus on distinctive features of the person’s face or appearance. Review the association and the person’s name periodically. Motor cuing where an action is associated with a person’s name may be helpful. For example, “Skip” can be paired with thinking about skipping rope.
Individuals with ADHD may benefit from “chunking” information; that is, grouping pieces of information together into larger chunks so that fewer “bits” need to be remembered. For example, the seven digits of a telephone number can be grouped into four numbers: 285-5678 becomes two, eighty-five, fifty-six, seventy-eight.
Writing it Down
Individuals with ADHD may compensate for limited memory capacity by writing down important information as quickly as possible after it is presented. Recording orally presented information in writing not only makes the information visual but also requires the integration of modalities.
Individuals with ADHD may benefit from clustering information semantically (by meaning). Using cues to cluster information into categories to help improve recall. Learning to organize information and material in meaningful ways may help these individuals better remember where to locate personal belongings and work materials. For example, canned goods might be organized into meaningful categories, such as fruits, vegetables, and soups.
9. Set Boundaries
Parents and family members should develop clear schedules, rules, and guidelines for children with ADHD. Young adults should be encouraged to keep a daily planner that includes all upcoming events and activities.
More advanced students with ADHD benefit from setting feasible timelines for completion of work and/or school-related activities. By establishing clear priorities for completing tasks, they can more likely complete the most important tasks first. Setting aside a specific study area at home and keeping all necessary materials organized and available in that area will help students with ADHD concentrate on and complete work and/or school-related activities.
10. Self-Monitor & Listen
Individuals should be encouraged to increase self-monitoring by asking themselves, “Did I get everything this person said?” and by double-checking with the speaker. Encourage children and young adults with ADHD to listen to others but also not to be afraid to tell others that they must get their attention when they have something important to communicate.
How to Get Help For ADHD
Children and young adults who are struggling with symptoms of ADHD can often feel incompetent, frustrated, and misunderstood. Getting them the support they need, whether in the form of medication or behavior therapy, is the start of a process that can take time before significant gains are observed.
The first point of contact is often a teacher or daycare provider, who can provide some context about whether a child is falling behind academically, behaviorally, or socially. Pediatricians are typically the first in medical assessment who can discuss a potential diagnosis and/or provide information about developmental expectations.
While some may prescribe medication, many will refer patients seeking treatment to specialists such as developmental pediatricians, psychiatrists, or pediatric psychologists. It is not uncommon for multiple professionals to be involved in the management of ADHD symptoms, as many individuals benefit from both ADHD medication and behavioral therapy.
Find a Therapist
For adults with ADHD, if you feel ready to find a therapist, start your search in an online directory. Here you can narrow your search by speciality, cost, location, and more.
Living With ADHD Long-Term
As ADHD is a chronic condition, many individuals with the diagnosis have ongoing difficulties throughout their lifetime, including a risk of ADHD and depression.3 For those taking medication, it may become clear that symptoms shift with changes in the environment requiring ongoing management of dosages and types.
Younger children may require educational and/or behavioral support at school, including an IEP or 504 plans. Adolescents and adults living with ADHD may consider informing administrators or employers about an ADHD diagnosis for accommodations to increase productivity.
Aside from more formal accommodations, individuals with ADHD can take measures on their own to support skills deficits. Common strategies to manage symptoms include note taking to address working memory deficits, structured scheduling to avoid procrastination, and use of technology and planners to support difficulty with organization.
There are some games and exercises that purport to improve memory and attention, ranging from crossword puzzles and Sudoku to more expensive options (e.g., Lumosity© or BrainHQ©), though these activities do not claim to treat specific diagnoses.
If you are dealing with ADHD symptoms or feel like you may be struggling despite trying the tips and lifestyle changes, consider speaking with a professional. Together you and your care team can support you in helping you manage your symptoms
For Further Reading
While only a professional can diagnose and treat Attention-Deficit/Hyperactivity Disorder, there are several organizations that can provide support and guidance, including: