Information about ADHD

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 can result in impairment in academic performance, interpersonal relationships, risk for 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.

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

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 offenses

Impulsivity in adults often has consequences for relationships, with employers and someone’s finances

ADHD often involves difficulties with emotional regulation and this is often what people often find most distressing about the condition

Emotional dysregulation

affective lability

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

Source data from Attention-Deficit Hyperactivity Disorder in Adults, Wender P. H., 1995, Oxford University Press.

ADHD and mental health

50-90% people with ADHD have a 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 emotion dysregulation. Unfortunately, women are often diagnosed later in life and they are more likely than men to be misdiagnosed.

Assessment for ADHD

In order to make a diagnosis of ADHD, a healthcare professional should complete the following with the person being assessed:

a full clinical and psychosocial assessment of the person; this should include discussion about behaviour and symptoms in the different domains and settings of the person’s everyday life

a full developmental and psychiatric history

observer reports from family members or close friends

assessment of the person's mental state.

An assessment of the person’s needs, other mental health conditions, social, family and educational or occupational circumstances and physical health will be undertaken as part of the diagnostic process.

After the assessment has been completed, the result of the assessment will be discussed. This will include the following information:

an explanation of the result of the assessment and whether or not ADHD is the most likely explanation for the person’s difficulties

a discussion around suggested referrals to other services. This might include referral to mental health services, secondary care services for further investigation and/or employment support

a discussion about the treatment options available for ADHD

when a person is diagnosed with ADHD and has a driving license, they will be advised to inform the DVLA of the diagnosis

following the ADHD assessment, a report will be completed and sent to the person, their GP and any other people involved in their care (with their consent)

Treatment for ADHD

Medication

For adults, the first choice of treatment is medication. After ADHD psychoeducation, medication is the second choice treatment for children. Medication provides a clear reduction of relevant symptoms in a clear majority of cases. The aim of treatment is to bring symptoms down by 50% of original severity.

ADHD medication can be split into categories of stimulant and non-stimulant medication. Stimulant medications are recommended first line treatment unless the person suffers with anxiety, tics or another condition which means that they cannot take this group of medications.

Further information about ADHD and the available treatment options can be found on our Choice and Medication page

Before starting medication, a person must have a detailed cardiovascular history and an examination should be completed including pulse and blood pressure readings. Medication has to be increased over a period of weeks or months to a dose that is effective and that has tolerable side effects for the individual. Medication should be started by a specialist with training in the assessment and treatment of ADHD. Once the medication has been optimised, management of the treatment can be transferred to the person’s GP under a Shared Care Agreement between the patient, the ADHD specialist and the GP.

The ADHD specialist will need to continue to assess the person at 6-12 month intervals in order to ensure the ongoing safety and effectiveness of the medication.

However, evidence shows a lack of long-term sufficiency of medication as a sole treatment for ADHD. Also, medication alone is rarely adequate for people with complex needs and other mental health difficulties. Medication is not enough to enhance the skills and competencies needed to counter the long-range impairments linked to ADHD.

Psychological interventions

Psychological interventions are the second choice of treatment after medications. They can also 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. 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).