Attention deficit hyperactivity disorder (ADHD)

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is mainly diagnosed in childhood, though sometimes it is not recognised until adulthood. When diagnosed in childhood, ADHD often persists into adolescence and adulthood and has lifelong impacts.

ADHD is sometimes also known as Attention Deficit Disorder (ADD) or Hyperkinetic Disorder, however ADHD is the most up to date terminology for the condition.

Symptoms of ADHD

ADHD is characterised by hyperactivity, impulsivity, and difficulties with attention.

Hyperactivity can include being unable to sit still, fidgeting, or finding it difficult to participate in activities quietly. Sometimes, people with ADHD can appear to be ‘on the go’ or act as if ‘driven by a motor’.

Impulsivity can include interrupting (for example, butting into conversations), having difficulty waiting your turn, or talking excessively.

Attention-related symptoms can include finding it difficult to pay close attention to details, being easily distracted, being unable to remain focused on a specific task, or having problems following instructions and organising activities.

These characteristics occur among all of us to some extent – we can all be impatient, over-enthusiastic, or find it difficult to focus. For a health professional to make a diagnosis of ADHD, these symptoms must be severe, be persistent, be present in more than one setting and cause difficulties for the individual across different areas of their lives such as at home, university, work and when socialising.

However, the extent of challenges will vary according to the environment. For example, everyday environments like work or university can pose particular challenges for people with ADHD, if the environment is not properly adjusted.

Many people with ADHD also have difficulties with regulating their emotions. They might find everyday environments emotionally challenging in ways that may be hard for others to understand and and are likely to be exposed to more emotionally difficult experiences such as bullying and social rejection.

A thorough and careful assessment is important, as stress, anxiety, and mental health or physical health conditions can also present with features similar to ADHD.

ADHD in childhood and adulthood

Although ADHD is more likely to be diagnosed in boys and men compared to girls and women, ADHD can affect people regardless of their gender. This gender gap is reducing as more women are receiving an ADHD diagnosis in adulthood.

ADHD symptoms typically start in early childhood but are not always recognised and diagnosed at this age. For some people, symptoms reduce or are less obvious by adolescence, but for others, the symptoms and impairment continue into adulthood.

The condition affects some children more severely than others, and other conditions can occur alongside ADHD such as Autistic Spectrum Disorders (ASDs), as well as conduct problems, tics, and learning difficulties such as dyslexia. Some people with ADHD may also have emotional problems such as anxiety or depression.

It is possible that symptoms can have a greater impact in adolescence and adulthood, when young people are expected to be more independent and demands start to increase.

Alternatively, ADHD might become easier to manage in adulthood, when people are more able to choose roles and environments which suit their strengths and interests.

With the right support, people with ADHD can live successful and fulfilling lives.

Getting help

If parents become concerned about a child, their GP will be able to offer advice and can refer the child to a specialist. Schools may also raise concerns and may be able to refer to a specialist or suggest visiting the GP.

Getting a diagnosis of ADHD requires a full and detailed assessment usually by either a specialist paediatrician or child and adolescent Psychiatrist – unfortunately, there is no quick and easy test for ADHD. Assessments often gather information from a number of different sources and may include observations and reports of the child’s behaviour at home and school.

If you believe you have symptoms of ADHD, you should discuss this with your GP, who can offer advice and may be able to refer you to a specialist. Unfortunately, there is no quick and easy test for ADHD.

Treatments

There are a number of different approaches to helping people with ADHD, which can be effective in managing the condition.

Following an ADHD diagnosis, UK guidelines (from NICE – the National Institute for Clinical Excellence) suggest that families or carers are given information about ADHD.

Environmental changes to minimise the impact of ADHD on day to day life are also recommended. These could include social skills training, or small changes at school, such as moving children with ADHD to the front of the class to eliminate distractions and help them to focus.

At home, parents can adopt different ways of dealing with behaviours associated with ADHD, such as adjusting the home environment and routines to work with a child or young person’s unique strengths and weaknesses.

If symptoms are still causing significant difficulties after these changes have been made then medication may be offered.

Medication has also been shown to alleviate the symptoms of ADHD, enabling children to concentrate and focus more effectively and reducing hyperactivity. Common medications used to treat the condition include Methylphenidate (Ritalin®, Equasym®, Concerta®), Lisdexamfetamine, Atomoxetine (Strattera®) and Guanfacine (Intuniv®).

These medications generally start to work shortly after each dose, and do not have a long lasting effect. They can be very effective, but as with all medication, there is a chance of side effects.

Not all children with ADHD will need medication, whilst those taking medication will also need educational or psychological treatment.

The most commonly used medications generally start to work shortly after each dose, and do not have a long-lasting effect. They can be very effective, but as with all medication, there is a chance of side effects.

Not all children and young people with ADHD will need medication, whilst those taking medication will also need educational or psychological treatment. Some children will take medications every day. Others might, for example, take these only on school days if school is the main environment which continues to be challenging. A prescribing doctor will advise you on these issues.

Some research shows that adults with ADHD can be supported by combining talking therapy (such as cognitive behavioural therapy) with ADHD medication.

Tips for parents and carers

Remember that children and young people with ADHD are not being wilful or deliberately difficult. Try to keep in mind that ADHD is a neurodevelopmental condition, and these behaviours are part of it.
Learning about ADHD and understanding why a child or young person reacts to things in ways you might not expect, can help you learn to respond to this in ways that minimise conflict.
Praise children and young people with ADHD when they do well and look for their strengths – it will boost their self-confidence and make you feel better. Children and young people with ADHD will often receive a lot of criticism from others. Try to make sure that you make positive comments more often than critical or corrective comments.
Use rewards and discipline – reward charts for positive behaviour and effective, consistent discipline for difficult behaviour can help support a child or young person.
Keep instructions simple and consistent – children and young people with ADHD can find it difficult to process many things at the same time. Try to break up long strings of instructions into one instruction at a time.
Write things down and use visual reminders. Stress the importance of writing down homework tasks – and bringing homework books home too. It will make it much easier to keep on top of tasks and what is required.
Try to keep things consistent and have a routine. If everything has its place and a child or young person is encouraged to use that place, it will be easier for them to remember where things are and be more organised.
Adapt your expectations and family and classroom routines to accommodate a child or young person’s needs.
Get support – many parents, children and young people find it helpful to join local or online support groups where you can discuss issues with others. Remember to only follow medical advice from a healthcare professional.
ADHD is largely genetic, and many parents find that they recognise traits in themselves after their child receives a diagnosis. If this happens, this doesn’t necessarily mean you have ADHD yourself, but if you are concerned, you can seek advice by speaking to your GP.

Tips for children and young people with ADHD

Try to treat yourself with kindness; try and think of some of the positive aspects about who you are and write them down so you can refer to them when you need to.
Don’t be afraid to ask for help. Try to find a trusted adult at school and/or at home you can reach out to when you need extra support, or if you need an adjustment (for example, if you have a teacher who only gives instructions verbally, you can request that they prepare a written version for you).
Remember that there is a lot of misinformation about ADHD among people, even from some adults and teachers. People with ADHD can achieve anything that someone without ADHD can, they might just take a different route than others, so don’t let anyone tell you otherwise!
Building friendships with other children and young people with ADHD, or related conditions like autism, can sometimes be easier than building friendships with ‘neurotypical’ people without ADHD or other ‘neurodivergent’ conditions – you may find you are able to understand each other better as your brains may work in a similar way.
Remember that ADHD is a condition that you can try to manage, but you might not always be able to control. Doing your best is what counts, and understanding that everyone has bad days, even adults with ADHD.

Homework tips for young people with ADHD

Tasks that need a lot of concentration, like homework, can be especially difficult for young people with ADHD. Here a few ideas that can help:

Keep a homework diary and write down everything you need to do. It might help to ask your teacher to check your diary to make sure you have all the information you need. Remember to take your homework diary home with you.
Find a quiet place to do your homework with few distractions.
Get everything you need ready before you start. It might help to keep all your stationery and books in one specific place.
Take time to read instructions carefully so you know what to do. Check the instructions again as you start to make sure you know exactly what to do.
Break long tasks into smaller sections.
Take short breaks every 20 minutes or so to give your brain a rest.

Resources

Let’s talk about ADHD

The ADHD research team at Cardiff University worked with children with ADHD and their families and carers to create an animation about what it’s like to have ADHD. Read more about the animation.

Piece of Mind podcast: ADHD in women and girls

Dr Joanna Martin and Ellie, a non-binary young person, to discuss how research at Cardiff University is aiming to learn more about ADHD.

Piece of Mind podcast: ADHD

Zoe Piper, founder of ADHD Connections, and Professor Anita Thapar sit down with Piece of Mind host Bozo Lugonja to discuss the latest research in ADHD.

Separating facts from fiction

Professor Anita Thapar discusses some of the myths and misunderstandings around the condition, focusing on what has been learnt from science, and how this might help clinical and educational practice.

Professor Anita Thapar answers questions on ADHD

Claire has a daughter with extreme ADHD and puts her questions to Professor Anita Thapar, one of the principal investigators at NCMH and a clinical professor at Cardiff University. This video was produced as part of the Challenge Cardiff series.