ADHD

Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school. Most cases are diagnosed when children are 6 to 12 years old.

The symptoms of ADHD usually improve with age, but many adults who are diagnosed with the condition at a young age continue to experience problems.

People with ADHD may also have additional problems, such as sleep and anxiety disorders.

Getting help 

Many children go through phases where they're restless or inattentive. This is often completely normal and doesn't necessarily mean they have ADHD.

However, you should consider raising your concerns with your child's teacher, their school's special educational needs co-ordinator (SENCO) or GP if you think their behaviour may be different to most children their age.

It's also a good idea to speak to your GP if you're an adult and you think you may have ADHD, but you weren't diagnosed with the condition as a child.

What causes ADHD?

The exact cause of ADHD is unknown, but the condition has been shown to run in families. Research has also identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition.

Other factors that have been suggested as potentially having a role in ADHD include:

• being born prematurely (before the 37th week of pregnancy)
• having a low birthweight
• smoking, alcohol or drug abuse during pregnancy

It's thought that around 2% to 5% of school-aged children may have ADHD.

ADHD can occur in people of any intellectual ability, although it's more common in people with learning difficulties.

How ADHD is treated

Although there's no cure for ADHD, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medication, if necessary.

Medication is often the first treatment offered to adults with ADHD, although psychological therapies such as cognitive behavioural therapy (CBT) may also help.

Living with ADHD

Looking after a child with ADHD can be challenging, but it's important to remember that they can't help their behaviour.

Some issues that may arise in day-to-day life include:

• getting your child to sleep at night
• getting ready for school on time
• listening to and carrying out instructions
• being organised
• social occasions
• shopping

Adults with ADHD may also find they have similar problems, and some may have issues with drugs, crime and employment.

Symptoms

Causes

The exact cause of attention deficit hyperactivity disorder (ADHD) isn't fully understood, although a combination of factors is thought to be responsible.

Genetics

ADHD tends to run in families and, in most cases, it's thought the genes you inherit from your parents are a significant factor in developing the condition.

Research shows that both parents and siblings of a child with ADHD are four to five times more likely to have ADHD themselves.

However, the way ADHD is inherited is likely to be complex and isn't thought to be related to a single genetic fault.

Brain function and structure

Research has identified a number of possible differences in the brains of people with ADHD compared to those who don't have the condition, although the exact significance of these isn't clear.

For example, studies involving brain scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger.

Research has also shown that the brain may take an average of two to three years longer to mature in children with ADHD, compared to children who don't have the condition.

Other studies have suggested that people with ADHD may have an imbalance in the level of neurotransmitters in the brain, or that these chemicals may not work properly.

Other possible causes

Various other causes have also been suggested as playing a role in the development of ADHD, including:

• being born prematurely (before the 37th week of pregnancy)
• having a low birthweight
• brain damage either in the womb or in the first few years of life
• drinking alcohol, smoking or misusing drugs while pregnant
• exposure to high levels of toxic lead at a young age

However, the evidence for many of these factors is inconclusive, and more research is needed to determine if they contribute to ADHD.

Diagnosing

If you think that you or your child may have attention deficit hyperactivity disorder (ADHD), you might want to consider speaking to your GP about it.

If you're worried about your child, it may help to speak to their teachers before seeing your GP, to find out if they have any concerns about your child's behaviour.

Your GP can't formally diagnose ADHD, but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.

When you see your GP, they may ask you:

• about your symptoms or those of your child
• when these symptoms started
• where the symptoms occur – for example, at home or in school
• whether the symptoms affect your or your child’s day-to-day life – for example, if they make socialising difficult
• if there have been any recent significant events in your life or your child's, such as a death or divorce in the family
• if there's a family history of ADHD
• about any other problems or symptoms of different health conditions you or your child may have

Next steps

If your GP thinks your child may have ADHD, they may first suggest a period of "watchful waiting" lasting around 10 weeks – to see if your child's symptoms improve, stay the same or get worse. They may also suggest starting a parent training or education programme to teach you ways of helping your child (see treating ADHD for more information).

If your child's behaviour doesn't improve, and both you and your GP believe it's seriously affecting their day-to-day life, your GP should refer you and your child to a specialist for a formal assessment (see below).

For adults with possible ADHD, your GP will assess your symptoms and may refer you for an assessment if:

• you weren't diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since then
• your symptoms can't be explained by a mental health condition
• your symptoms have a significant impact on your day-to-day life – for example, if you're underachieving at work or find intimate relationships difficult

You may also be referred to a specialist if you had ADHD as a child or young person, and your symptoms are now causing moderate or severe functional impairment.

Assessment

There are a number of different specialists that you or your child may be referred to for a formal assessment, including:

• a child or adult psychiatrist
• a paediatrician (a specialist in children's health)
• a learning disability specialist, social worker or occupational therapist with expertise in ADHD

Who you're referred to depends on your age and what's available in your local area.

There's no simple test to determine whether you or your child have ADHD, but your specialist can make an accurate diagnosis after a detailed assessment that may include:

• a physical examination, which can help rule out other possible causes for the symptoms
• a series of interviews with you or your child
• interviews or reports from other significant people, such as partners, parents and teachers

The criteria for making a diagnosis of ADHD in children, teenagers and adults are outlined below.

Diagnosis in children and teenagers

Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity and impulsiveness.

Read more about the symptoms of ADHD.

To be diagnosed with ADHD, your child must also have:

• been displaying symptoms continuously for at least six months
• started to show symptoms before the age of 12
• been showing symptoms in at least two different settings – for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or parental control
• symptoms that make their lives considerably more difficult on a social, academic or occupational level
• symptoms that aren't just part of a developmental disorder or difficult phase, and aren't better accounted for by another condition

Diagnosis in adults

Diagnosing ADHD in adults is more difficult because there's some disagreement about whether the list of symptoms used to diagnose children and teenagers also applies to adults.

In some cases, an adult may be diagnosed with ADHD if they have five or more symptoms of inattentiveness, or five or more symptoms of hyperactivity and impulsiveness, that are listed in diagnostic criteria for children with ADHD.

As part of your assessment, the specialist will ask about your present symptoms. However, under current diagnostic guidelines, a diagnosis of ADHD in adults can't be confirmed unless your symptoms have been present from childhood.

If you find it difficult to remember whether you had problems as a child, or you weren't diagnosed with ADHD when you were younger, your specialist may wish to see your old school records or talk to your parents, teachers or anyone else who knew you well when you were a child.

For an adult to be diagnosed with ADHD, their symptoms should also have a moderate impact on different areas of their life, such as:

• underachieving at work or in education
• driving dangerously
• difficultly making or keeping friends
• difficulty in relationships with partners

If your problems are recent and didn't occur regularly in the past, you're not considered to have ADHD. This is because it's currently not thought that ADHD can develop for the first time in adults.

Treatment

Treatment for attention deficit hyperactivity disorder (ADHD) can help relieve the symptoms and make the condition much less of a problem in day-to-day life.

ADHD can be treated using medication or therapy, but a combination of both is often best.

Treatment is usually arranged by a specialist, such as a paediatrician or psychiatrist, although the condition may be monitored by your GP. 

Medication

There are five types of medication licensed for the treatment of ADHD:

• methylphenidate 
• dexamfetamine
• lisdexamfetamine
• atomoxetine
• guanfacine

These medications aren't a permanent cure for ADHD, but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.

In the UK, all of these medications are licensed for use in children and teenagers. Atomoxetine is also licensed for use in adults who had symptoms of ADHD as children.

If you weren't diagnosed with ADHD until adulthood, your GP and specialist can discuss which medications and therapies are suitable for you.

If you or your child is prescribed one of these medications, you'll probably be given small doses at first, which may then be gradually increased. You or your child will need to see your GP for regular check-ups, to ensure the treatment is working effectively and to check for signs of any side effects or problems.

Your specialist will discuss how long you should take your treatment but, in many cases, treatment is continued for as long as it is helping.

Methylphenidate

Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants that work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.

Methylphenidate can be used by teenagers and children with ADHD over the age of six. Although methylphenidate isn't licensed for use in adults, it may be taken under close supervision from your GP and specialist.

The medication can be taken as either immediate-release tablets (small doses taken two to three times a day), or as modified-release tablets (taken once a day in the morning, and they release the dose throughout the day).

Common side effects of methylphenidate include:

• a small increase in blood pressure and heart rate
• loss of appetite, which can lead to weight loss or poor weight gain
• trouble sleeping
• headaches
• stomach aches
• mood swings

Dexamfetamine

Dexamfetamine is also a stimulant medication, which works in a similar way to methylphenidate by stimulating areas of the brain that play a part in controlling attention and behaviour.

Dexamfetamine can be used by teenagers and children with ADHD over the age of three. Although it's not licensed for use in adults, it may be taken under close supervision from your GP and specialist.

Dexamfetamine is usually taken as a tablet once or twice a day, although an oral solution is also available.

Common side effects of dexamfetamine include:

• decreased appetite
• mood swings
• agitation and aggression
• dizziness
• headaches
• diarrhoea
• nausea and vomiting

Lisdexamfetamine

Lisdexamfetamine is a similar medication to dexamfetamine, and works in the same way.

It can be used by children with ADHD over the age of six if treatment with methylphenidate hasn't helped. You may continue to take it into adulthood if your doctor thinks you're benefitting from treatment.

Lisdexamfetamine comes in capsule form, which you or your child usually take once a day.

Common side effects of lisdexamfetamine include:

• decreased appetite, which can lead to weight loss or poor weight gain
• aggression
• drowsiness
• dizziness
• headaches
• diarrhoea
• nausea and vomiting

Atomoxetine

Atomoxetine works differently to other ADHD medications.

It's known as a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, and increasing the amount can aid concentration and help control impulses.

Atomoxetine can be used by teenagers and children over the age of six. It's also licensed for use in adults if symptoms of ADHD are confirmed.

Atomoxetine comes in capsule form, which you or your child usually take once or twice a day.

Common side effects of atomoxetine include:

• a small increase in blood pressure and heart rate
• nausea and vomiting
• stomach aches
• trouble sleeping
• dizziness
• headaches
• irritability

Atomoxetine has also been linked to some more serious side effects that it's important to look out for, including suicidal thoughts and liver damage.

If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.

Guanfacine

Guanfacine acts on part of the brain to improve attention and it also reduces blood pressure.

It's used for ADHD in teenagers and children if other medicines are unsuitable or ineffective.

Guanfacine is usually taken as a tablet once a day, in the morning or evening.

Common side effects include:

• tiredness or fatigue
• headache
• abdominal pain
• dry mouth

Therapy

As well as taking medication, different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.

Some of the therapies that may be used are outlined below.

Psychoeducation

Psychoeducation means that you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.

Behaviour therapy

Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.

If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour.

For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

Parent training and education programmes

If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour.

You may also be offered parent training before your child is formally diagnosed with ADHD.

These programmes are usually arranged in groups of around 10-12 parents. A programme usually consists of 10-16 meetings, which each last up to two hours.

They aim to teach parents and carers about behaviour management (see above), while increasing confidence in your ability to help your child and improve your relationship. 

Social skills training

Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. A CBT therapist would try to change how your child feels about a situation, which would in turn potentially change their behaviour.

CBT can be carried out with a therapist individually or in a group.

Other possible treatments

There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there's no strong evidence these work, and they shouldn't be attempted without medical advice.

Diet

People with ADHD should eat a healthy, balanced diet. Don't cut out foods before seeking medical advice.

Some people may notice a link between types of food and worsening ADHD symptoms. For example, sugar, food colourings and additives, and caffeine are often blamed for aggravating hyperactivity, and some people believe they have intolerances to wheat or dairy products, which may add to their symptoms.

If this is the case, keep a diary of what you eat and drink, and what behaviour this causes. Discuss this with your GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).

Supplements

Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial in people with ADHD, although the evidence supporting this is very limited.

It's advisable to talk to your GP before using any supplements, because some can react unpredictably with medication or make it less effective.

You should also remember that some supplements shouldn't be taken long term, as they can reach dangerous levels in your body.

Living with ADHD