Attention-Deficit Disorder (ADD) & Attention-Deficit Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is also known as hyperactivity or attention deficit disorder (ADD). ADHD is a common condition that affects children and adolescents, while ADD is more common in adults. ADHD is a condition resulting in symptoms of inability to maintain attention, impulsive behaviors and/or motor restlessness.

ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active.

According to epidemiological data, approximately 4% to 6% of the U.S. population has ADHD. That is about 8 to 9 million adults.

ADHD usually persists throughout a person’s lifetime. It is not limited to children. Approximately one-half to two-thirds of children with ADHD will continue to have significant problems with ADHD symptoms and behaviors as adults, which can impact their lives on the job, within the family, and in social relationships.

Common Symptoms of ADHD

ADHD is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common core features include:

  • Distractibility (poor sustained attention to tasks)
  • Impulsivity (impaired impulse control and delay of gratification)
  • Hyperactivity (excessive activity and physical restlessness)

In order to meet diagnostic criteria, these behaviors must be excessive, long-term, and pervasive. The behaviors must appear before age 7, and continue for at least 6 months. A crucial consideration is that the behaviors must create a real handicap in at least two areas of a person’s life, such as school, home, work, or social settings. These criteria set ADHD apart from the “normal” distractibility and impulsive behavior of childhood, or the effects of the hectic and overstressed lifestyle prevalent in our society.

According to the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) some common symptoms of ADHD include: often fails to give close attention to details or makes careless mistakes; often has difficulty sustaining attention to tasks; often does not seem to listen when spoken to directly; often fails to follow instructions carefully and completely; losing or forgetting important things; feeling restless, often fidgeting with hands or feet, or squirming; running or climbing excessively; often talks excessively; often blurts out answers before hearing the whole question; often has difficulty awaiting turn.

Please keep in mind that the exact nature and severity of ADHD symptoms varies from person to person. Approximately one-third of people with ADHD do not have the hyperactive or overactive behavior component, for example.

Types of ADHD

There are three different types of ADHD, depending on which symptoms are strongest in the individual:

  • Predominantly Inattentive Type: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
  • Predominantly Hyperactive-Impulsive Type: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
  • Combined Type: Symptoms of the above two types are equally present in the person.

Causes of ADHD

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role.

ADHD is very likely caused by biological factors which influence neurotransmitter activity in certain parts of the brain, and which have a strong genetic basis. Studies at NIMH using a PET (positron emission tomography) scanner to observe the brain at work have shown a link between a person’s ability to pay continued attention and the level of activity in the brain.

Specifically researchers measured the level of glucose used by the areas of the brain that inhibit impulses and control attention. In people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention and other ADHD symptoms.

There is a great deal of evidence that ADHD runs in families, which is suggestive of genetic factors. If one person in a family is diagnosed with AD/HD, there is a 25% to 35% probability that any other family member also has ADHD, compared to a 4% to 6% probability for someone in the general population.

In addition to genetics, scientists are studying other possible causes and risk factors including:

  • Brain injury
  • Environmental exposures (e.g., lead)
  • Alcohol and tobacco use during pregnancy
  • Premature delivery
  • Low birth weight

Treatment for ADHD

In most cases, ADHD is best treated with a combination of medication and behavior therapy.

Medication is often used to help normalize brain activity, as prescribed by a physician. Stimulant medications are commonly used because they have been shown to be most effective for most people with ADHD. However, many other medications may also be used at the discretion of the physician.

Behavior therapy and cognitive therapy are often helpful to modify certain behaviors and to deal with the emotional effects of ADHD. Many adults also benefit from working with an ADHD coach to help manage problem behaviors and develop coping skills, such as improving organizational skills and improving productivity.

No single treatment is the answer for every person and good treatment plans will include close monitoring, follow-ups and any changes needed along the way.