Understanding ADHD: Types, Diagnosis, and Treatment
This article will provide an overview of ADHD, including early symptoms and how doctors diagnose ADHD. It will also cover treatment options and steps families can take to manage ADHD together.
ADHD is the most common behavioral disorder in childhood and adolescence, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates that 9% of children ages 2–17 years have received an ADHD diagnosis.
Approximately 4% of adults ages 18–44 have ADHD, according to the National Alliance on Mental Illness (NAMI).
The CDC notes that reported rates of ADHD have increased significantly over the past two decades. However, they add that it is difficult to know whether this reflects an increase in actual cases or a higher rate of diagnosis.
There are three types of ADHD:
- Predominantly inattentive: This is the most common type of ADHD. People with predominantly inattentive ADHD may often seem to be “in their own world” or “daydreaming.”
- Predominantly hyperactive-impulsive: Traits of this type of ADHD include frequent activity, difficulty remaining still, and impulsive actions.
- Combined: People with combined ADHD experience all three types of symptoms: inattention, hyperactivity, and impulsivity.
Doctors diagnose different types of ADHD based on specific diagnostic criteria that evaluate the quantity and severity of certain symptoms.
People who have ADHD may have symptoms mostly related to inattention, mostly related to hyperactivity and impulsivity, or a combination of symptoms related to all three.
These symptoms may be present in healthy children but are more prominent in children with ADHD. For both children and adults with ADHD, the symptoms are severe enough to cause problems at school, home, or work. They may also interfere with peer relationships.
The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) outlines these symptoms types and specific behaviors:
Symptoms of inattention
Doctors diagnose predominantly inattentive ADHD in children up to age 16 who show six or more of these symptoms. In people older than 17, doctors only need five or more of these symptoms to diagnose the condition. The person must have experienced these symptoms for at least 6 months, and the presence of symptoms must be inappropriate for the person’s age:
- often not giving close attention to detail or making careless mistakes in homework, office tasks, or other activities
- often having trouble keeping attention on tasks or when playing
- often not seeming to be listening when spoken to directly
- often not completing a task or following through on instructions, such as by losing focus or becoming distracted
- often having difficulty organizing tasks
- often avoiding or being reluctant to work on tasks that require mental focus over a long period of time
- often losing items or materials necessary to complete tasks, such as school supplies, keys, or glasses
- becoming distracted easily
- being forgetful in everyday activities
Symptoms of hyperactivity and impulsivity
Doctors diagnose predominantly hyperactive-impulsive ADHD in children up to age 16 who show six or more of these symptoms.
In people older than 17, doctors only need five or more of these symptoms to diagnose the condition. The person must have experienced symptoms for at least 6 months. The presence of these symptoms also must be disruptive and inappropriate for the person’s age:
- often fidgeting, including tapping hands or feet and squirming in seat
- often leaving seat in situations where they should remain seated
- often running or climbing at inappropriate times
- often not taking part quietly in play or other activities
- often seeming “on the go” as if they have a motor they can’t turn off
- often talking excessively
- often blurting out a response before someone has finished asking a question
- often having difficulty waiting their turn
- often interrupting or disrupting other activities, such as breaking into conversations or a group at play
If a person meets the criteria for both categories of symptoms, doctors may give them a diagnosis of combined presentation ADHD.
Symptoms that might indicate a serious condition
In some cases, ADHD may occur with other symptoms that might indicate a serious condition. Seek prompt medical care if you or someone you are with have symptoms of ADHD along with any of these symptoms:
- aggressive behaviors
- difficulties in school or at home
- difficulty controlling temper and a tendency to blame others
- difficulty developing and maintaining relationships with peers
- drug or alcohol use
- frequent anger and resentfulness
- frequent or severe injuries
- mood changes, such as depressed mood or anxiety
- repetitive involuntary movements, such as eye twitches or shoulder shrugging
- tendency to argue or intentionally provoke people
The exact cause of ADHD is not known.
The American Psychiatric Association explains genetics does seem to play a role since 3 in 4 children with ADHD have a relative with the condition. Research published in American Family Physician says ADHD is up to 8 times more common in people with a first-degree family member who has ADHD.
Researchers have identified structural differences in the brains of people with ADHD in regions associated with hyperactivity, impulsivity, and working attention, all behaviors associated with ADHD. While ADHD is complex and a single gene cannot determine risk, experts do believe there is evidence that this abnormality is the result of gene interactions.
Exposure to smoking and alcohol during fetal development and lead poisoning in childhood may contribute to the risk of developing ADHD. Experts are also studying how other factors such as nutrition, brain injury, and social settings might play a role.
A number of factors increase the risk of developing ADHD. Not all people with risk factors will get ADHD.
The CDC lists risk factors for ADHD, including:
- brain injury
- exposure to alcohol as a fetus
- exposure to maternal smoking as a fetus
- family history of ADHD
- lead poisoning
- low birth weight
Reducing your risk of ADHD
While researchers are studying possible ways to treat and prevent ADHD, it is not possible to definitely avoid the condition. However, maintaining a healthy lifestyle and avoiding exposure to tobacco, alcohol, illegal drugs, and environmental toxins can help with healthy brain development.
If you or your child have an increased risk of ADHD, discuss your risk factors with your primary care doctor or pediatrician. Regular checkups and developmental screenings may detect symptoms of ADHD before they cause significant problems.
Research published in Child and Adolescent Psychiatric Clinics of North America in 2014 discusses how experts have studied a variety of potential dietary changes to treat ADHD. These include eliminating foods with artificial colors or the most common foods that trigger food allergies. The consensus from that research was that a small subset of children with ADHD benefited from dietary changes.
A 2021 study published in Scientific Reports found more robust effectiveness in a “few foods diet” (FFD), with 60% of children with ADHD seeing improvement. An FFD is a type of elimination diet that restricts a person to a limited number of foods, then slowly introduces foods back to see which ones trigger symptoms.
The organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) notes that scientific research has not supported the effectiveness of elimination diets for ADHD. It adds that a healthy lifestyle, including balanced nutrition and exercise, can make it easier for people with ADHD to manage their symptoms.
CHADD goes on to say that meal planning is a key component of healthy eating, but the time management and preparation it requires can be difficult for people with ADHD. Some medications for ADHD also can decrease appetite.
Talk with your ADHD treatment team before making any significant changes to your or your child’s diet. They may refer you to a nutritionist or dietician who can provide guidance on healthy meal choices while managing ADHD symptoms.
Approximately 60% of children with ADHD have at least one other mental, emotional, or behavioral disorder. Adults with ADHD may also have a related mental, emotional, or behavioral disorder.
Common co-existing conditions include:
- oppositional defiant disorder, a condition in which the frequency of a child’s tantrums become disruptive
- conduct disorder, a condition in which a child shows a pattern of aggression and disobedience
- dyslexia, a learning disability that causes difficulty with reading
- dyscalculia, a learning disability that causes difficulty with math
- dysgraphia, a learning disability that causes difficulty with writing
- sleep disorders
- autism spectrum disorder
- Tourette’s syndrome
There is no test to diagnose ADHD. The DSM-5 outlines specific criteria for an ADHD diagnosis.
Doctors diagnose ADHD if someone has multiple symptoms of inattention, hyperactivity, and impulsivity. These symptoms must last for at least 6 months and must be more severe than those of their peers. They also must occur across multiple settings and environments.
Guidelines from the American Academy of Family Physicians (AAFP) advise pediatricians and primary care doctors to watch for symptoms of ADHD during wellness visits. This includes listening to parents’ or guardians’ concerns about the child’s behavior or school performance.
The AAFP also recommends ruling out other potential causes of ADHD symptoms, including sleep disorders, learning disabilities, mental health conditions, or substance use disorder.
Questions doctors may ask
When evaluating symptoms, your doctor may ask questions including:
- Do you or your child not seem to listen when directly spoken to?
- Do you or your child often lose or misplace items?
- Do you or your child have problems following instructions or find it hard to finish tasks?
- Do you or your child talk excessively or interrupt when other people are talking?
- Is it difficult for you or your child to sit still?
- Do you have a family history of ADHD?
- Do your symptoms interfere with your school work, career, or other activities?
The American Psychiatric Association points out that while teachers and other school staff may first notice ADHD symptoms, they cannot make a diagnosis of ADHD. If your child’s teacher raises concerns about ADHD, your primary care physician or another health professional can accurately diagnose ADHD and discuss treatment options.
Treatment of ADHD begins with seeking regular medical care, which allows a healthcare professional the opportunity to evaluate potential symptoms of ADHD. With an accurate diagnosis and effective treatment, you can manage ADHD and reduce its impact on your life or your child’s life.
There is no cure for ADHD. Rather, the goal of ADHD treatment is to reduce symptoms, improve behavior, and minimize disruption to daily life.
ADHD treatment often involves a combination of approaches, such as medications, behavioral therapy, lifestyle changes, environmental changes, and education of parents and teachers.
The American Academy of Pediatrics (AAP) recommends children under age 6 start treatment with behavioral therapy. Doctors should only consider medication for children younger than 6 if symptoms are moderate-to-severe or if behavioral therapy is not effective.
For children older than 6, the AAP recommends a combination of medications and behavioral therapy.
Adults who receive an ADHD diagnosis may use a combination of medication, behavioral therapy, coaching, and mental health counseling to manage their ADHD.
Behavioral therapies for ADHD
The CDC lists different types of behavioral therapy for ADHD including:
- Parent and guardian training in behavior management: This type of therapy teaches guardians strategies and skills to help a child with ADHD.
- Behavioral interventions in the classroom: This encourages and rewards positive behaviors at school.
- Organizational training: This therapy teaches children with ADHD how to manage their time, plan projects, and keep track of supplies.
- Peer interventions: This therapy focuses on behavior and social skills for children with ADHD.
School-age children with ADHD may also qualify for a 504 Plan or Individualized Education Plan (IEP) through the Department of Education. This allows students and families to request accommodations including reduced workloads, extended time to complete tests, or preferred seating placement in the classroom.
If your child receives an ADHD diagnosis, talk with your teacher or school administrators about steps to create a 504 Plan or IEP.
Common medications for ADHD
Although it may seem counterintuitive, doctors commonly prescribe stimulants to treat ADHD. Instead of increasing energy and activity levels, they can have a calming effect in people with ADHD and help to improve concentration and focus.
Doctors also prescribe non-stimulants to treat ADHD, and they may have less potential for misuse. Medications doctors prescribe for ADHD may include:
- amphetamine (Adderall)
- atomoxetine (Strattera), a non-stimulant
- dexmethylphenidate (Focalin)
- dextroamphetamine (Dexedrine, Dextrostat)
- lisdexamfetamine dimesylate (Vyvanse)
- methamphetamine hydrochloride (Desoxyn)
- methylphenidate (Concerta, Metadate, Methylin, Ritalin)
Your doctor will talk with you about medication options, including the potential side effects. Together you can discuss whether the benefits of managing ADHD symptoms may outweigh the risks of medication.
If you or your child are currently taking medication and experiencing unwanted side effects, talk with your treatment team. They can discuss alternative medications that may be more manageable.
What you can do to improve ADHD
In addition to medications and behavioral therapy, you can help manage your child’s ADHD symptoms by:
- attending parental skills education classes
- developing a clear system of rewards and punishments
- giving praise when your child is acting appropriately
- having your child receive social skills training
- joining a support group
- organizing your child’s environment
- removing distractions
- setting and sticking to a schedule
- setting clear rules
- sharing relaxing activities with your child
- using “time outs” to remove your child from situations when behavior is inappropriate
- working with your child’s school to evaluate whether he or she qualifies for special education services
Without effective treatment, ADHD can lead to serious symptoms and risks.
You can help minimize your or your child’s risk of serious complications by following the treatment plan you and your healthcare team design specifically for you and your child.
Complications and risks of untreated ADHD include:
- academic problems or failure
- co-occurrence of ADHD with behavioral problems
- difficulties holding a job
- drug and alcohol use and abuse
- increased risk of injury
- law violations and legal troubles
- learning disability
- ongoing symptoms
- problems developing and maintaining relationships with peers
ADHD is a medical condition that causes a person to experience hyperactivity, inattention, or impulsivity that interferes with daily activities. The condition is the most common behavioral disorder diagnosed in children, but adults can also have ADHD.
Symptoms differ by ADHD type, but commonly include difficulty completing tasks, inability to sit still, frequently interrupting conversations, or becoming distracted easily. Doctors or mental health professionals diagnose ADHD by evaluating the number and severity of observed symptoms.
Treatment for ADHD is available and focuses on behavioral therapy, medications, and support at home or at school.