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ADHD

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.

Common symptoms of ADHD include:

  • a short attention span or being easily distracted
  • restlessness, constant fidgeting or overactivity
  • being impulsive

ADHD can occur in people of any intellectual ability, although it is more common in people with learning difficulties. People with ADHD may also have additional problems, such as sleep and anxiety disorders.

Symptoms of ADHD tend to be first 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 in children between the ages of 6 and 12.

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

Read more about the symptoms of ADHD.

Getting help 

Many children go through phases where they are restless or inattentive. This is often completely normal and does not 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 are an adult and you think you may have ADHD, but you were not diagnosed with the condition as a child.

Read more about diagnosing ADHD.

What causes ADHD?

The exact cause of ADHD is unknown, but the condition has been shown to run in families, and research has 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

Read more about the causes of ADHD.

How common is ADHD?

ADHD is the most common behavioural disorder in the UK. It's unknown exactly how many people have the condition, but most estimates suggest if affects around 2-5% of school-aged children and young people.

Childhood ADHD is more commonly diagnosed in boys than girls.

Girls with ADHD often have a form of the condition where the main symptoms relate to problems with attention rather than hyperactivity, which can cause less noticeable symptoms. It is therefore possible that ADHD could be underdiagnosed in girls, and could be more common than previously thought.

How ADHD is treated

There is no cure for ADHD, but 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.

Read more about treating ADHD.

Living with ADHD

Looking after a child with ADHD can be challenging, but it is important to remember that they cannot 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.

Read about living with ADHD for information on ways to cope with these issues.

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ADHD

The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into symptoms of inattentiveness, hyperactivity and impulsiveness.

The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into two sets of behavioural problems.

These categories are:

  • inattentiveness
  • hyperactivity and impulsiveness

Most people with ADHD have problems that fall into both these categories, but this is not always the case.

For example, some people with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD), and it can sometimes go unnoticed because the symptoms may be less obvious.

Symptoms in children and teenagers

The symptoms of ADHD in children and teenagers are well defined, and they are usually noticeable before the age of six. They occur in more than one situation, such as at home and at school.

The main signs of each behavioural problem are detailed below.

Inattentiveness

The main signs of inattentiveness are:

  • having a short attention span and being easily distracted
  • making careless mistakes  for example, in schoolwork
  • appearing forgetful or losing things
  • being unable to stick at tasks that are tedious or time-consuming
  • appearing to be unable to listen to or carry out instructions
  • constantly changing activity or task
  • having difficulty organising tasks

Hyperactivity and impulsiveness

The main signs of hyperactivity and impulsiveness are:

  • being unable to sit still, especially in calm or quiet surroundings
  • constantly fidgeting
  • being unable to concentrate on tasks
  • excessive physical movement
  • excessive talking
  • being unable to wait their turn
  • acting without thinking
  • interrupting conversations
  • little or no sense of danger

These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

Related conditions in children and teenagers

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:

  • anxiety disorder  which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
  • oppositional defiant disorder (ODD) – this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
  • conduct disorder  this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
  • depression
  • sleep problems  finding it difficult to get to sleep at night, and having irregular sleeping patterns
  • autistic spectrum disorder (ASD)  this affects social interaction, communication, interests and behaviour
  • epilepsy  a condition that affects the brain and causes repeated fits or seizures
  • Tourette’s syndrome  a condition of the nervous system, characterised by a combination of involuntary noises and movements called tics
  • learning difficulties – such as dyslexia

Symptoms in adults

In adults, the symptoms of ADHD are more difficult to define. This is largely due to a lack of research into adults with ADHD.

ADHD is a developmental disorder; it is believed that it cannot develop in adults without it first appearing during childhood. However, it is known that symptoms of ADHD often persist from childhood into a person's teenage years, and then adulthood. Any additional problems or conditions experienced by children with ADHD, such as depression or dyslexia, may also continue into adulthood.

By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives.

The symptoms in children and teenagers, which are listed above, is sometimes also applied to adults with possible ADHD. However, some specialists say that the way in which inattentiveness, hyperactivity and impulsiveness affect adults can be very different from the way they affect children.

For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases. Also, adult symptoms of ADHD tend to be far more subtle than childhood symptoms.

Therefore, some specialists have suggested the following list of symptoms associated with ADHD in adults:

  • carelessness and lack of attention to detail
  • continually starting new tasks before finishing old ones
  • poor organisational skills
  • inability to focus or prioritise
  • continually losing or misplacing things
  • forgetfulness
  • restlessness and edginess
  • difficulty keeping quiet and speaking out of turn
  • blurting out responses and often interrupting others
  • mood swings, irritability and a quick temper
  • inability to deal with stress
  • extreme impatience
  • taking risks in activities, often with little or no regard for personal safety or the safety of others  for example, driving dangerously

Additional problems in adults with ADHD

As with ADHD in children and teenagers, ADHD in adults can occur alongside several related problems or conditions.

One of the most common conditions is depression. Other conditions that adults may have alongside ADHD include:

  • personality disorders  conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others
  • bipolar disorder  a condition that affects your moods, which can swing from one extreme to another
  • obsessive-compulsive disorder (OCD)  a condition that causes obsessive thoughts and compulsive behaviour

The behavioural problems associated with ADHD can also cause problems such as difficulties with relationships, social interaction, drugs and crime. Some adults with ADHD find it hard to find and stay in a job.

Getting help

Many children go through phases where they are restless or inattentive. This is often completely normal and does not 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 your GP, if you think your child's behaviour may be different to most children their age.

It's also a good idea to speak to your GP about the possibility of having an assessment if you are an adult and you think you may have ADHD.

Read more about diagnosing ADHD.

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ADHD

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

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

If you are 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 or your child's life, such as a death or divorce in the family
  • if there is 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 thinks it is 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 were not diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since then
  • your symptoms cannot be explained by a mental health condition
  • your symptoms have a significant impact on your day-to-day life  for example, if you are 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 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 are referred to will depend on your age and what is available in your local area.

There is 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 are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition

Diagnosis in adults

Diagnosing ADHD in adults is more difficult because there is 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 although, under current diagnostic guidelines, a diagnosis of ADHD in adults cannot 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 were not 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 did not occur regularly in the past, you are not considered as having ADHD. This is because it is currently not thought that ADHD can develop for the first time in adults.

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ADHD

There is no cure for attention deficit hyperactivity disorder (ADHD), but treatment can help relieve the symptoms and make the condition much less of a problem in day-to-day life.

There is no cure for attention deficit hyperactivity disorder (ADHD), but treatment 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 the best way to treat it.

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

Medication

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

These medications are not a permanent cure for ADHD, but they can 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 were not 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 will 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 is not 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 that 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 is 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 are 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 is known as a selective noradrenaline uptake 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 is also licensed for use in adults who are continuing treatment after taking the medication as a teenager. It is not licensed for use in adults newly diagnosed with ADHD, but your GP and specialist may prescribe it under their supervision.

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.

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 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 and can last several weeks. They aim to teach parents and carers about behaviour management (see above), while increasing your confidence in your ability to help your child, as well as improving 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 and 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 is no strong evidence these work, and they should not be attempted without medical advice.

Diet

People with ADHD should eat a healthy, balanced diet. Do not cut out foods without 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).

Do not change your (or your child's) diet without medical advice.

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 should not be taken long term, as they can reach dangerous levels in your body.

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ADHD

The list below is a combination of the and brand names of medicines available in the UK. Each name provides a link to a separate website (Medicine Guides)

The list below is a combination of the and brand names of medicines available in the UK. Each name provides a link to a separate website (Medicine Guides) where you can find detailed information about the medicine. The information is provided as part of an on-going medicine information project between NHS Direct, Datapharm Communications Ltd and other organisations.

The medicines listed below hold a UK licence to allow their use in the treatment of this condition. medicines are not included.

The list is continually reviewed and updated but it may not be complete as the project is still in progress and guides for new medicines may still be in development.

If you are taking one of these medicines for a different condition, or your medicine for this condition is not mentioned here at all, speak to your prescriber, GP or pharmacist, or contact NHS Direct on 0845 46 47.

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