Attention Deficit/Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobiological developmental disorders impacting individuals across the lifespan. According to the American Psychiatric Association (APA), it is estimated that 5% of children and anywhere from 2.5 to 4% of adults have ADHD. In order to be diagnosed with ADHD, an onset of symptoms must occur before the age of 12 and be present in at least two settings (e.g. school and at home). Some symptoms of ADHD include difficulty paying attention and staying focused, difficulty controlling behavior, and hyperactivity (over-activity).

There are three subtypes of ADHD: a predominantly inattentive presentation, a predominantly hyperactive/impulsive presentation, and a combined presentation which apples when there are six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity.

It is important to note, that these symptoms can present differently between males and females and even between children and adults. These differences will be discussed in more detail in the follow sections. How to manage symptoms of ADHD and the ways in which it can impact daily life (e.g. home, school, work, and interpersonal relationships) will also be discussed.

Symptoms of Attention-Deficit/Hyperactivity Disorder

Inattention may include some or all of the following symptoms:

  • Difficulty paying close attention to detail or making careless mistakes in schoolwork, at work, or during other activities
  • Difficulty sustaining attention in tasks or play activities (e.g. difficulty remaining focused during lectures, conversations, or lengthy readings)
  • Easily distracted by extraneous stimuli (for adults this may include unrelated thoughts)
  • Appearing to not listen when spoken to directly
  • Struggling to follow through on instructions and failing to finish schoolwork, chores, or duties in the workplace
  • Difficulty organizing tasks and activities (e.g. difficult managing sequential tasks; difficulty keeping materials and belongings in order; messy; poor time management)
  • Avoidance or reluctance to engage in tasks that require sustained mental effort (e.g. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)
  • Forgetfulness (e.g. forgets to complete chores, run errands, pay bills, keep appointments)
  • Misplacing or losing things necessary for tasks or activities (e.g. school materials, wallet, keys, eyeglasses)

Hyperactivity and impulsivity may include some or all of the following symptoms:

  • Fidgeting with or tapping hands or feet; squirming in seat
  • Leaving seat in situations when remaining seated is expected (e.g. leaving his or her place in the classroom, in office or workplace, etc.)
  • Feelings of restlessness (in children this may include running and climbing in situations where it is inappropriate to do so)
  • Difficulty engaging in leisurely activities quietly
  • Difficulty waiting his or her turn
  • Interrupting or intruding on others (e.g. interrupts conversations, games, or activities; may start using other people’s things without asking; for adults, may intrude or take over what others are doing)
  • Blurting out an answer before a question has been completed (e.g. completes people’s sentences; cannot wait for turn in conversation)
  • Excessive talking

For children and adolescents with ADHD, a majority of them may exhibit some academic difficulties. This is seen by the high comorbidity rates between ADHD and learning disorders. Thus, symptoms of ADHD may be exacerbated by learning issues and vice versa. In addition, children and adolescents with ADHD may have problems related to social adjustment; they may have few friends or may be victim to peer rejection or bullying. If you think your child or adolescent may be experiencing some of these symptoms it will be important to speak with a school psychology, guidance counselor, and/or teacher(s).

While children and adolescents with ADHD can struggle with social and learning difficulties, adults with ADHD can also exhibit similar issues. They tend to have continued problems related to social relationships, have low self-esteem, and lower education and occupational achievement. For example, adults with ADHD are more likely to change jobs frequently. Adults with ADHD may also struggle with symptoms of depression, anxiety, and substance abuse.

It is also important to mention that ADHD is more prevalent in males than in females. Males also tend to be diagnosed more frequently with the combined subtype of ADHD while females tend to be diagnosed more frequently with the inattentive subtype. This difference in subtype, may account for the reason why males are more likely to be diagnosed with ADHD than females. More males exhibit symptoms of hyperactivity and impulsivity, which are easily identifiable and tend to be more associated with ADHD. For this reason, ADHD in some females might be overlooked because they do not display “typical” ADHD behavior and symptoms.

ADHD across the Lifespan

Symptoms of ADHD can change as a child or adolescent transitions into adulthood. Studies have found that between 65 and 80% of children with ADHD continue to exhibit symptoms and meet criteria for ADHD in adolescence. Furthermore, up to 15% of children and adolescence continue to meet the full criteria for ADHD as adults and up to 60% continue to exhibit symptoms of ADHD but do not meet the full criteria to be diagnosed with ADHD anymore. Typically, symptoms of inattention are more commonly seen in adults with ADHD than hyperactivity or impulsivity. Adults exhibiting symptoms of inattention may show inconsistencies in their ability to concentrate, struggle to complete tasks on time, and maintain routines. Although less common, hyperactivity in adults can evolve to manifest as fidgeting, excessive talkativeness, an inner sense of restlessness, and feeling overwhelmed. Impulsivity in adulthood is also characterized as impatience, irritability, problems with time managements, and risky behavior, such as reckless driving.

Evaluation

There is no single test to determine if an individual has ADHD.  For this reason, receiving a diagnosis of ADHD requires a comprehensive evaluation to rule out other causes of problematic behavior. For example, a comprehensive evaluation can help determine if an individual’s inattentiveness is due to ADHD or an untreated anxiety disorder, learning disability, or mood disorder.  A comprehensive evaluation takes time and should include information from multiple sources including, but not limited to the individual and, when applicable, parents and teachers. Information gathered aims to assess the person’s school/work, social and emotional functioning, and developmental level. As mentioned earlier, individuals with ADHD may also have learning disabilities and can qualify for special education services. Having a comprehensive evaluation conducted can help identify any learning disabilities and help individual’s qualify for additional services.  Licensed health care professionals are qualified to diagnose ADHD; however the only individuals eligible to prescribe medication are a medical doctor, psychiatrist, or a psychiatric nurse practitioner.

Self-help tips for Children, Adolescents, and Adults

Many individuals with attention-deficit/hyperactivity disorder have found meaningful ways to manage their symptoms. Here are a few suggestions and activities that can help manage ADHD symptoms.

  • Exercise and eat right. Exercise vigorously and regularly—it helps work off excess energy in a positive way and soothes and calms the body. Eat a wide variety of healthy foods and limit sugary foods and caffeine in order to even out mood swings.
  • Get plenty of sleep. When you’re tired, it is even more difficult to focus, manage stress, stay productive, and keep on top of your responsibilities. Try to get at least 6-8 hours of sleep a night.
  • Practice better time management. Develop a routine. Set deadlines for everything, even for seemingly small tasks. Use timers and alarms to stay on track. Take breaks at regular intervals. Avoid piles of paperwork or procrastination by dealing with each item as it comes in. Prioritize time-sensitive tasks and write down every assignment, message, or important thought. Make lists of materials needed for each task and an outline of steps to complete these tasks. Ask for help when needed.
  • Work on your relationships. Schedule activities with friends and family and keep those engagements. Be vigilant in conversation: listen when others are speaking and try not to speak too quickly. Pause before speaking to ensure comments are appropriate to the conversation.
  • Create a supportive work environment. Make frequent use of lists, color-coding, reminders, notes-to-self, and files. If possible, choose work/classes that are motivating and interesting you. Notice how and when you work best and apply these conditions to your working environment as best you can. It can help to team up with less creative, more organized people—a partnership that can be mutually beneficial.

If the symptoms of ADHD are still getting in the way of your life, despite self-help efforts to manage them, it may be time to seek outside support. People with ADHD can benefit from a number of treatments, including behavioral coaching, individual therapy, self-help groups, vocational counseling, educational assistance, and medication. Treatment for adults with attention-deficit/hyperactivity disorder, like treatment for children, should involve a team of professionals, along with the person’s spouse, family members, friends and co-workers. For mental health provider options, please call our referral service INTERFACE at 617-332-3666 x1.

Treatment for ADHD

Research has shown that the most effective treatment of ADHD is a combination of multiple approaches and interventions across various settings. Some of those interventions are:

  • Parent Training/Education regarding ADHD
  • Behavioral Intervention Strategies
  • Individual therapy
  • Medication evaluations and management
  • Appropriate educational programs

In regard to treatment for children and adolescents, it is important for parents to be educated about ADHD and be taught strategies for managing their child's inattentive and/or hyperactive behavior(s) and unique learning style.  Behavioral interventions and parent/teacher trainings can help reduce symptoms of ADHD by teaching parents and teachers to use positive reinforcement and other behavioral strategies.

In addition to behavioral interventions, children and adolescents may be eligible for special education services if an ADHD diagnosis is preventing them from making effective progress at school. Parents or teachers can request that public schools conduct an evaluation to determine whether the child or adolescent is eligible for special education services.

Consistency and having a structured environment is also important when treating someone with ADHD. Because the symptoms of ADHD can cause problems with self-control and distractibility, predictable routines and structure can help adults and children manage symptoms. In some cases, medication may be a necessary part of treatment. Adderall and other stimulants have been found to have beneficial effects on the core symptoms of ADHD in about 75% of cases for both children and adults.

It can be challenging and difficult for individuals and families to cope with ADHD, but it is treatable.  Once a licensed professional diagnoses a child, adolescent, or adult with ADHD, treatment options can be discussed.  Treatment may or may not include medication, but always includes a combination of approaches, interventions, and services to help individuals reach their potential.

Resource Organizations » Attention Deficit Hyperactivity Disorder (ADHD)

In Massachusetts

Children & Adults with Attention Deficit/ Hyperactivity Disorder (CHADD)

Local Chapter: 508-651-2423

National Office: 301-306-7070

Email: metrowest@chadd.net

CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) is the nation's leading non-profit organization serving individuals with AD/HD and their families. CHADD provides information on ADHD through its website and the bi-monthly Attention! magazine, and also sponsors an annual conference. The organization has over 16,000 members in 200 local chapters, which offer support for individuals, parents, teachers, professionals, and others. CHADD's National Resource Center on AD/HD (see separate profile) is a clearinghouse for evidence-based information about AD/HD.

College Internship Program - Berkshire

Toll-Free: 877-566-9247 (8-4pm ET)

Local: 413-243-2576

Email: admissions@cipworldwide.org

The College Internship Program at the Berkshire Center provides individualized, post-secondary academic, internship and independent living experiences for young adults with Asperger's Syndrome, ADHD and other Learning Differences.

Massachusetts Act Early

The Massachusetts Act Early Coalition works to strengthen state and community systems for the early identification and intervention for children with signs of developmental disabilities, such as autism spectrum disorders.  The coalition envisions a future that uses a family-centered model that overcomes geographic, socioeconomic, cultural, and linguistic barriers to assure equal access to developmental screening for all children in the Commonwealth. Massachusetts Act Early aims to educate parents and professionals about healthy childhood development, early warning signs of developmental disorders including autism spectrum disorder, the importance of routine developmental screening, and timely early intervention whenever there is a concern.

School Psychiatry Program and MADI Resource Center

For Children and Adolescents: 617-726-2725

For Adults: 617-724-7792

Email: info@schoolpsychiatry.org

Schoolpsychiatry.org is a joint project of the School Psychiatry Program and the Mood & Anxiety Disorders Institute (MADI) Resource Center, both of the Department of Psychiatry at Massachusetts General Hospital (MGH). Schoolpsychiatry.org is committed to enhancing the education and mental health of every student in every school. The Mood & Anxiety Disorders Institute (MADI) Resource Center translates the latest research advances into practical information, helping people work with their clinicians toward the most accurate diagnosis and best possible treatment results. The Center also offers resources and support to help people manage daily living with mood and anxiety disorders and cope with the disorders' effects on family relationships.

Outside Massachusetts

ADDitude

ADDitude has been the leading destination for families and adults living with ADHD and learning disabilities. Founded in 1998 by Ellen Kingsley, an award-winning journalist with a unique ability to convey credible information with empathy and inspiration, ADDitude magazine has provided clear, accurate, user-friendly information and advice from the leading experts and practitioners in mental health and learning for almost 10 years. 

Attention Deficit Disorder Association (ADDA)

(800) 939-1019

Email: info@add.org

The Attention Deficit Disorder Association (ADDA) is the world's leading adult ADHD organization. Our mission is to provide information, resources and networking opportunities to help adults with Attention Deficit Hyperactivity Disorder (ADHD) lead better lives. Our goal is to generate hope, awareness, empowerment and connections worldwide in the field of ADHD. ADDA brings together scientific perspectives and the human experience. The information and resources provided to individuals and families affected by ADHD and professionals who serve them focuses on the diagnosis, treatments, strategies and techniques for helping adults with AD/HD lead better lives.

Learning Disabilities Association of America

(412) 341-1515

Email: info@LDAAmerica.org

Learning Disabilities Association has provided support to people with learning disabilities, their parents, teachers and other professionals with cutting edge information on learning disabilities, practical solutions, and a comprehensive network of resources. They have resources and information for the following concerns: Auditory Processing Disorder, Dyscalculia, Dysgraphia, Dyslexia, Dyspraxia, Language Processing Disorder, Non-Verbal Learning Disabilities, Visual Perceptual/Visual Motor Deficit, Memory, ADD/ADHD, Executive Functioning

Learning Disabilities Worldwide

Learning Disabilities Worldwide is the world's leading web site on learning disabilities and ADHD, serving more than 200,000 parents, teachers, and other professionals each month. The site features hundreds of helpful articles, multimedia, monthly columns by noted experts, first person essays, children's writing and artwork, a comprehensive resource guide, very active forums, and a Yellow Pages referral directory of professionals, schools, and products.

Mental Health America

Toll-Free: 800-969-6642

Office: 703-684-7722

TTY: 800-433-5959

Mental Health America (formerly known as the National Mental Health Association) is the country's leading nonprofit dedicated to helping ALL people live mentally healthier lives. With more than 320 affiliates nationwide, they represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation -- everyday and in times of crisis.

National Resource Center on AD/HD: A Program of CHADD

Health Information Specialist: 800-233-4050

The National Resource Center on AD/HD is the nation's clearinghouse for science-based information about all aspects of attention-deficit/hyperactivity disorder (AD/HD). Funded through a cooperative agreement with the Centers for Disease Control and Prevention, the NRC provides information on this disorder which affects how millions of children and adults function on a daily basis. The NRC was created to meet the information needs of professionals and the general public.

Sibling Support Project

206-297-6368

Email: info@siblingsupport.org

The Sibling Support Project is a national effort dedicated to the life-long concerns of brothers and sisters of people who have special health, developmental, or mental health concerns. The Sibling Support Project believes that disabilities, illness, and mental health issues affect the lives of all family members. Consequently, they want to increase the peer support and information opportunities for brothers and sisters of people with special needs and to increase parents' and providers' understanding of sibling issues. The mission is accomplished by training local service providers on how to create community-based peer support programs for young siblings; hosting workshops, listservs, and websites for young and adult siblings; and increasing parents' and providers' awareness of siblings' unique, lifelong, and ever-changing concerns through workshops, websites, and written materials. Visit the website for local listings of "Sibshops", i.e. sibling support programs.

The Brain and Behavior Research Foundation

Main Line: 646-681-4888

Toll Free: 800-829-8289

Email: info@bbrfoundation.org

The Brain and Behavior Research Foundation (formerly NARSAD, the National Alliance for Research on Schizophrenia and Depression) is committed to alleviating the suffering of mental illness by awarding grants that will lead to advances and breakthroughs in scientific research. The BBR Foundation offers news on the research it funds as well as information (documents and videos) about these and other disorders in children and adults. It also provides guidance and resources for families coping with a child or parent with mental illness.