Information about ADHD
ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental condition, which means that the brain of a person who has ADHD works in a different way to that of a person without ADHD. It is not a learning disability, but due to the associated symptoms, it can result in impairment in academic performance, interpersonal relationships, risk of accidental injury, health-related behaviours and compromised independence.
It occurs in 2.5% of people, and 40–60% of people diagnosed with ADHD in childhood will still have at least some symptoms in adulthood. ADHD exists in people of all genders, ages, and across different ethnicities and backgrounds. Although it used to be thought that ADHD is more prevalent in boys and men, we now know that girls and women are equally likely to have it, but they may present with different symptoms. As a result, women and girls are often diagnosed later in life, and they are more likely to be misdiagnosed than men .
Mental health comorbidities are common in patients with ADHD. Data suggests that 50-90% people with ADHD have another mental health diagnosis. Men are more likely to have problems with substance misuse, conduct, autism, tics, and difficulties with language, learning and motor development. Women are more likely to suffer from depression and anxiety disorders, and problems with emotional dysregulation.
ADHD is characterised by core symptoms of inattention, hyperactivity, and impulsivity. As people get older, hyperactivity and impulsivity tend to diminish, but they continue to experience inattention and disorganisation. ADHD also often involves difficulties with emotional regulation, and this is often what people often find most distressing about the condition.
It is important to remember that not everyone who has the signs below will have ADHD. Some of these symptoms are common at different stages of a person’s development, or can be caused by a different condition, such as anxiety, trauma, or autism.
Inattention
mind wandering
easily distracted by things in the environment around them
forgetfulness
difficulty reading books or following movies
struggle to listen to conversations
difficulties with problem-solving, timekeeping, planning and organisation • Usually more subtle in adults than in children;
fidgeting or rocking in a chair
pacing
frequently getting up
struggling with desk-based work
appearing clumsy because of excessive mobility
feeling restless and unable to relax
using alcohol or drugs to relax
Hyperactivity
Usually more subtle in adults than in children;
fidgeting or rocking in a chair
pacing
frequently getting up
struggling with desk-based work
appearing clumsy because of excessive mobility
feeling restless and unable to relax
using alcohol or drugs to relax
Adults with ADHD may be able to remain still during important situations that mean a lot to them
Impulsivity
difficulty waiting in queues
acting without thinking
unable to delay gratification
binge eating
sensation seeking
alcohol and drug use
driving offences
Impulsivity in adults often has consequences for relationships, with employers and someone’s finances
Emotional dysregulation
affective lability (exaggerated changes in mood)
temper control
emotional over reactivity
mood fluctuations
irritability
overwhelmed
dysphoric periods
temper outbursts
emotionally reactive
boredom
lack of control
strong negative response to criticism
overstimulation
What treatments are there?
ADHD is a neurodevelopmental condition which affects the way a person’s brain has formed and functions. It is therefore a condition which is long-term and something that patients live with throughout their lives. It is not something that can be cured, and treatment is focused on improving symptoms and empowering the patient to manage them.
There are three main modalities when it comes to treatment options: environmental modification, medication, and psychological interventions. Which one is right for each person will depend on their wishes and goals, any physical or mental health co-morbidities, as well as the patient’s personal circumstances.
For more information on the types of treatment available, please select below:
Environmental modifications are changes to the person’s physical environment that make it easier for them to cope with the symptoms of their ADHD. These vary from person to person based on their individual circumstances and needs. It is essential that family members educate themselves about ADHD, in order to provide a level of support and understanding to the individual. This can be achieved through formal courses, books, media and support groups.
Strategies to support individuals at work and school can include implementing movement breaks, allowing the use of fidget toys, flexible working, reduced timetable at school/college/university, wearing headphones to minimise distractions, etc. Maintaining a balanced diet, good nutrition, having regular exercise and sufficient sleep are also important in supporting patients to manage their symptoms.
According to the National Institute for Health and Care Excellence (NICE), medication is recommended if symptoms persist and cause impairment after so-called environmental modifications (see above) have been implemented and reviewed.
The aim of medication treatment is to reduce the severity of symptoms, not cure them. The improvement can vary from person to person and may differ for different symptoms. It is also important to note that medication can affect different people in different ways, and some patients will find they need to try several medicines before finding the right one for them. In some cases, patients may not respond to or tolerate any of the available medication options.
There are two different categories of medication that are used to manage ADHD: stimulant and non-stimulant medication. Stimulant medications (lisdexamfetamine, methylphenidate, dexamfetamine) are recommended as first line treatment unless the person suffers with anxiety, tics, or another condition which means that they cannot take this group of medications. Non-stimulant medication (atomoxetine and guanfacine) is used when stimulant medication is not safe, cannot be tolerated, or has been ineffective. For patients who don’t respond to or tolerate either of the above medicines, a trial of medications not initially developed to manage ADHD but found to be effective in some patients can also sometimes be tried.
Further information about ADHD and the available treatment options, with a focus on the different medication options, can be found on our Choice and Medication page
Psychological interventions can also be used for both adults and children, depending on suitability and patient preference. They can be used first line when people do not want to take medication or when they cannot take medication due to their other health problems.
The basis for psychological interventions for ADHD is a level of education about the condition and the common difficulties that people face in their education, work, relationships, free time and the effects that ADHD can have on their mental wellbeing. These can include the so-called ‘parenting courses’, which can support parents or carers to manage the difficulties their loved ones with ADHD can present with. Other psychological interventions for ADHD are based on therapies that have previously been developed for other conditions, like anxiety and depression. Many of the techniques used in these interventions are based on existing forms of psychological interventions such as cognitive-behavioural therapy (CBT) and dialectical-behavioural therapy (DBT).
