ADHD

Carrie Cuffman, MD. (Cleveland Clinic)

What Is ADHD?

ADHD (attention-deficit/hyperactivity disorder) is a condition that affects how
your brain works. Despite its name, ADHD doesn’t mean that you lack attention. It
means that it’s harder for you to control your attention or direct it to certain tasks. ADHD
causes symptoms like difficulty focusing, trouble sitting still and impulsive behaviors. But
it also allows you to “get in the zone” and hyperfocus on things you really enjoy.
ADHD symptoms begin in childhood (commonly between ages 3 and 6) and may
continue into adulthood. But some people don’t get a diagnosis until they’re adults.
There’s no cure for ADHD, but treatments like medications and behavioral therapies can
help manage symptoms.

ADHD types

There are four types of ADHD that healthcare providers diagnose in children and adults:

• Inattentive ADHD. This involves difficulty focusing, finishing tasks and staying
  organized. With this type, you have few or no hyperactivity symptoms.
• Hyperactive-impulsive ADHD. This involves difficulty sitting still or having “quiet
  time.” You have excess energy and are extremely talkative. You may also
  interrupt others and act without thinking it through first. You may show less
  obvious trouble with paying attention.
• Combined presentation. This is the most common type of ADHD, and it’s what
  most people associate with the condition. You have many inattentive
  symptoms and hyperactive-impulsive symptoms.
• Unspecified presentation. This is when you have severe symptoms that interfere with daily life, but your symptoms don’t meet the official criteria for the
  types listed above. In this case, providers assign “unspecified ADHD” as the
  diagnosis.
  Providers also use the terms mild, moderate and severe to describe how much
  symptoms affect your daily life.

ADHD symptoms

ADHD symptoms fall into two big groups:

• Inattention symptoms. These symptoms affect your ability to focus on a task
  and complete it from start to finish. You might put off tasks that require focusing.
  You may also seem distracted when someone’s talking to you and lose things a
  lot.
• Hyperactivity/impulsivity symptoms. These symptoms affect your ability to sit
  still or feel comfortable staying in one place. You may also have trouble waiting
  for your turn to speak or do something.
• There are nine symptoms in each group, described below. Keep in mind that these are
  also common behaviors for many kids. Your child doesn’t necessarily have ADHD if they
  do some of these things from time to time. Healthcare providers have careful criteria for
  diagnosing ADHD.

Inattention symptoms

You may notice your child:

• Avoids tasks that require focusing for a long time
• Doesn’t pay attention to details or makes seemingly careless mistakes
• Forgets to do things they’re supposed to
• Gets easily distracted by things going on around them, or sometimes their own
  thoughts
  
• Has difficulty with organizing things, like toys in their room, supplies in their
  backpack or steps in a project
  
• Has trouble staying focused on things they’re doing, including listening to
  presentations or reading a long passage
  
• Loses things they need, like school papers or eyeglasses
  
• Seems distracted or like they’re daydreaming when someone is directly talking to
  them
  
• Starts a task easily enough but then gets sidetracked and doesn’t finish it (this
  might affect things like doing their chores or completing their homework)

Hyperactivity/impulsivity symptoms

You may notice your child:

• Fidgets or makes small movements with their hands or feet, especially when
  sitting down to eat or do homework
• Gets up when they’re supposed to stay seated
• Has a hard time playing or doing other tasks quietly
• Has difficulty waiting for their turn to do something
• Interrupts what others are doing — for example, jumping into a game other kids are playing or grabbing someone’s toy without permission
• Jumps, climbs, runs or feels restless when they’re supposed to stay in one place
• Seems like they’re always “on the go” or “driven by a motor”
• Speaks out of turn or finishes others’ sentences
• Talks more than you’d expect

Complications of this condition

ADHD can affect how your child feels about themselves and how they engage with the
world around them. Without proper treatment, your child may have:

• Low self-esteem
• Poor grades and an inability to reach their full potential
  
• Difficulty in social situations, partly due to peers teasing them or not wanting to
  hang out with them
  
• An increased risk of developing substance use disorders when they’re older
  
• Frequent driving accidents and injuries
  
• Trouble getting and keeping a job when they’re older

If your child has ADHD, their provider may recommend one or more of the following:

Parent training

• Therapists teach you how to help your child build on their strengths and improve behaviors that cause them difficulty. For example, you learn how to establish a routine for your child, encourage positive behaviors and respond to negative ones.
• Social skills groups. Your child may benefit from social skills training groups.
  These groups meet for one or two hours a week, typically over a six-to-12-week
  period. Your child learns new skills for interacting with peers in a supervised
  setting.
  
• Medications (pharmacotherapy). ADHD medications improve your child’s
  ability to use directed attention, in turn improving symptoms and — more
  importantly — their quality of life and relationships. Providers monitor your child
  to see how the medicines are working and whether your child has side effects.
  They adjust medication types and doses as needed.

How can I help my child at home?

Parent training teaches you effective strategies you can use from day to day. Providers
can also give you tips tailored to your child’s unique needs. In general, here are some
things you can do to help your child. (These aren’t a substitute for treatment your
provider recommends, including any medications.)

• Organize items your child needs every day. Have a place for everything and
  keep everything in its place. This includes clothes, backpacks and school
  supplies. An organization checklist may be helpful.
• Stick to a schedule. Follow the same routine every day, from wake-up time to
  bedtime. The schedule should include time for homework and play.
• Use a calendar or planner your child can see. Create a place to write down
  important reminders, responsibilities and events. These tools may be especially
  helpful for adolescents and young adults who struggle with time management.
  
• “Catch” your child being good. Pointing out positive behaviors teaches your
  child what they should do. When parents pay attention only to inappropriate
  behaviors, those behaviors happen more. Punishing a child only teaches them
  what not to do.
  
• Discipline effectively. Create a consistent system to reward appropriate
  behavior. Respond to misbehavior with alternatives such as a “time out” or loss of
  privileges.
  
• Pick out a homework area. Set up a home workstation in a quiet area without
  clutter or distractions.
• Set a timer. Have a timeframe for working on homework. If your child doesn’t finish, take a break and set a new time to finish.
• Praise effort and completion. Reward your child’s completed work instead of pointing out what they didn’t finish.