Attention-deficit/hyperactivity disorder in children and adolescents: what you need to know (2023)

What is ADHD?

ADHD is a developmental disorder associated with a persistent pattern of inattention, hyperactivity and/or impulsivity. ADHD symptoms can affect daily activities and relationships. ADHD begins in childhood and can continue into adolescence and adulthood.

What Are the Symptoms of ADHD?

People with ADHD display a continuous pattern of the following types of symptoms:

• Inattention – Difficulty paying attention
• Hyperactivity – has too much energy or moves and talks a lot
• Impulsivity - acting without thinking or problems with self-control

Some people with ADHD mainly have symptoms of inattention. Others usually have symptoms of hyperactivity-impulsivity. Some people have both types of symptoms.

Signs of inattention may include:

• They do not pay close attention to details or make seemingly careless mistakes in schoolwork or other activities
• Difficulty sustaining attention in play and tasks, including conversations, tests, or long assignments
• You find it difficult to listen properly when speaking directly
• I have trouble following directions, completing schoolwork or chores, or starting tasks, but I lose focus and get easily distracted
• Difficulty organizing tasks and activities, such as completing tasks in order, keeping materials and items organized, managing time, and meeting deadlines
• Avoiding tasks that require constant mental effort, such as homework
• Loss of items needed for work or activities, such as school supplies, books, glasses, and cell phones
• Easily distracted by irrelevant thoughts or stimuli
• Being forgetful during daily activities such as shopping and keeping appointments

Signs of hyperactivity and impulsivity can include:

• It shakes and squeezes while you sit
• Get up and move around when you are expected to remain seated, such as in a classroom
• Running, running about or climbing at inappropriate times or, in teens, often feeling restless
• Not being able to play quietly or pursue hobbies
• Being in constant motion or being in motion and/or acting as if being propelled by a motor
• Talking too much
• Answering questions before they are fully asked or finishing other people's sentences
• He has difficulty waiting his turn, for example when standing in line
• Interrupting or imposing on others, for example during conversations, games or activities

How is ADHD diagnosed in children and adolescents?

To be diagnosed with ADHD, the symptoms must have appeared before the age of 12. Children up to age 16 are diagnosed with ADHD if they have had at least six persistent symptoms of inattention and/or six persistent symptoms of hyperactivity-impulsivity in at least 6 months. Symptoms must be present in two or more environments (e.g., home or school, or with friends or relatives) and interfere with quality of social or school functioning.

Parents who think their child may have ADHD should talk to their healthcare provider. Primary care providers sometimes diagnose and treat ADHD. They may also refer people to a mental health professional, such as a psychiatrist or clinical psychologist, who can conduct a thorough examination and diagnose ADHD. Anxiety, sleep disturbances, anxiety, depression, and other physical conditions or illnesses can cause symptoms similar to those of ADHD. Therefore, a thorough evaluation is necessary to determine the cause of the symptoms.

During an evaluation, the health care provider or mental health professional may:

• Assess the child's mental health and medical history.
• Ask permission to talk to family members, teachers, and other adults who know the child well and see him in different settings to learn more about the child's behaviors and experiences at home and school.
• Use standardized behavioral assessment scales or ADHD symptom checklists to determine if a child or adolescent meets the criteria for a diagnosis of ADHD.
• Conduct psychological tests that examine working memory, executive function (skills such as planning and decision-making), visual and spatial skills, or reasoning skills. Such tests can help detect psychological or cognitive strengths and challenges, and identify or rule out potential learning disabilities.

Does ADHD look the same in all children and adolescents?

ADHD symptoms can change over time as a child grows and moves through pre- and adolescence. In young children with ADHD, hyperactivity and impulsivity are the most common symptoms. As academic and social demands increase, the symptoms of inattention become more pronounced and begin to interfere with academic performance and peer relationships. In adolescence, hyperactivity often becomes less severe and may manifest itself in restlessness or agitation. Symptoms of inattention and impulsiveness usually persist and can cause exacerbating school, organizational, and relationship problems. Teens with ADHD are also more likely to engage in impulsive, risk-taking behaviors, including substance use and unsafe sexual activity.

Inattention, restlessness, and impulsiveness persist into adulthood in many people with ADHD, but in some cases they can become less severe and less harmful over time.

What Causes ADHD?

Researchers aren't sure what causes ADHD, though many studies suggest genes play a big role. Like many other disorders, ADHD is likely due to a combination of factors. In addition to genetics, researchers are looking at possible environmental factors that may increase the risk of developing ADHD, and are studying how brain injury, diet, and the social environment may play a role in ADHD.

What Are the Treatments for ADHD in Children and Adolescents?

While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. ADHD is usually treated with medications, education or training, therapy, or a combination of therapies.

Medication

Stimulants are the most common type of medication used to treat ADHD. Research shows that these drugs can be extremely effective. Like all medications, they can have side effects and require a person's healthcare provider to monitor how he or she is responding to the drug. Non-stimulant medications are also available. Health care providers may sometimes prescribe antidepressants to treat children with ADHD, although the Food and Drug Administration (FDA) has not specifically approved these medications to treat ADHD. Sometimes a person has to try different medications or dosages before discovering what works for him or her.

For general information on stimulants and other medications used to treat mental disorders, seeNIMH Mental Health Medication Website. OfFDA-websitefeatures the latest drug approvals, alerts, and patient information guides.

Psychotherapy and psychosocial interventions

Various psychosocial interventions have been shown to help children and their families manage symptoms and improve daily functioning.

• Behavioral therapyit is intended to help someone change their behavior. It may include practical help, such as help organizing tasks or completing schoolwork, teaching social skills, or monitoring one's behavior and receiving praise or rewards for acting in the desired way.
• Cognitive behavioral therapyhelps a person become more aware of attention and concentration problems and work on skills to improve focus.
• Family and Marriage Therapycan help family members deal with disruptive behavior, encourage behavior changes, and improve interaction with children.

All types of treatment for children and adolescents with ADHD require the active role of parents. Psychotherapy that involves only individual therapy sessions with the child (without parental involvement) is not effective in managing ADHD symptoms and behavior. This type of treatment is likely more effective in treating symptoms of anxiety or depression that may co-occur with ADHD.

For general information on psychotherapies used to treat mental disorders, seeNIMH's Psychotherapies website.

Parent education and support

Mental health professionals can educate parents of a child with ADHD about the disorder and how it affects a family. They can also help parents and children develop new skills, attitudes and ways of relating. Examples include training in parenting skills, stress management techniques for parents, and support groups that help parents and families connect with others who have similar concerns.

School-based programs

Children and adolescents with ADHD typically benefit from classroom behavioral interventions and/or academic adjustments. Interventions may include behavior management plans or teaching organizational or study skills. Accommodations can include preferred classroom placements, reduced classroom workload, or extended time for tests and exams. The school may provide accommodations through what is known as a 504 plan or, for children who qualify for special education services, an Individualized Education Plan (IEP).

For more information on special education services and the Persons with Disabilities Education Act (IDEA), please visitIDEA website of the United States Department of Education.

Complementary health approaches

Unlike specific psychotherapy and drug treatments that have been scientifically proven to improve ADHD symptoms, complementary health approaches to ADHD, such as natural products, do not qualify as evidence-based interventions. For more information, please visitWebsite of the National Center for Complementary and Integrative Health.

How can I find help for my child?

De Substance Abuse and Mental Health Services Administration (SAMHSA) biedt deBehavioral health treatment services finder, an online tool for finding mental health services and treatment programs in your state. For more resources, visitNIMH Mental Illness Help Siteor seeNIMH Fact Sheet Children and Mental Health.

If you or someone you know is in immediate danger or is considering harming themselves, call themNational Suicide Prevention Lifelinetoll-free at 1-800-273-TALK (8255). You can also send a message toText line crisis(HELLO at 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website.

How can I help my child at home?

Therapy and medication are the most effective treatments for ADHD. In addition to these treatments, other strategies can help manage symptoms. Encourage your child to:

• Exercise regularly, especially if they seem hyper or restless.
• Eat regular, healthy meals.
• Get a lot of sleep.
• Stick to a routine.
• Use task organizers and notebooks to write down tasks and reminders.
• Take medications as prescribed.

In addition, you can help your child or teen by being clear and consistent and providing rules that they can understand and follow. Also keep in mind that children with ADHD often accept and expect criticism. You can look for good behavior, praise it and reward it if the rules are followed.

What should I know about my child's participation in clinical trials?

Clinical trials are research studies that test new ways to prevent, detect, or treat diseases and conditions. While individuals may benefit from participating in a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others can be better served in the future.

Researchers at the NIMH and around the country conduct many studies with patients and healthy volunteers. Pediatric clinical trials are designed with the understanding that children and adults respond differently, both physically and mentally, to medications and treatments. Talk to your healthcare provider about clinical trials, their benefits and risks, and whether a trial is right for your child. For more information visitNIMH Clinical Trial Website.

Where can I find more information about ADHD?

The Centers for Disease Control and Prevention (CDC) is the nation's largest health promotion, prevention, and preparedness agency. Information can be found atThe CDC websiteabout ADHD symptoms, diagnosis and treatment options, and additional resources for families and caregivers.

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For more information

Medline Plus(National Library of Medicine) (in Spanish)
ClinicalTrials.gov(in Spanish)

US DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Health Institutes
NIH Publication No. 21-MH-8159
Revised in 2021