Read about symptoms of attention deficit hyperactivity disorder (ADHD), which are categorised into inattentiveness, The main signs of hyperactivity and impulsiveness are: Other conditions that adults may have alongside ADHD include. ADHD symptoms nearly always show up before middle school. Kids with hyperactivity may: Symptoms of this include: Impatience; Having a This often happens so much that it causes problems in social or work settings. Understanding ADHD -- the Symptoms. The symptoms of attention deficit hyperactivity disorder -- or ADHD -- vary from person to person, but consist of some combination of inattention, hyperactivity, and impulsivity. ADHD often coexists with other conditions, such as learning.
ADHD of and include: symptoms Signs
Sign up for a free Medical News Today account to customize your medical and health news experiences. In other words, boys are more than twice as likely as girls to receive a diagnosis of ADHD. This has led to a mistaken belief among many that ADHD is a "boys' disorder" that rarely occurs in girls.
According to the Child Mind Institute , girls may remain without a diagnosis because their symptoms are often different from boys and do not tick the more obvious signs and symptoms boxes.
The person has difficulty paying attention but does not tend to be disruptive. The person may be able to focus well, but their hyperactive and impulsive behavior can cause disruption in a classroom, for example. Combined inattentive, hyperactive and impulsive: The person has all the above symptoms. The main signs and symptoms of ADHD can apply to both boys and girls, but according to some studies , girls are more likely to have the inattentive form.
Any symptoms of hyperactivity and impulsivity that girls do experience will present differently to how they present in boys. Girls with ADHD may find it hard to concentrate. They may be unable to focus for long enough to complete a task at home or school. However, if they find something interesting, they may be wholly absorbed by it.
Girls with ADHD may be easily distracted by what is happening outside, or by their own thoughts. Some girls with ADHD tend to move around and fidget, like boys, but others are quieter in their movements. They may fidget, shuffle in their chairs, or doodle. Girls may experience strong emotions, and this may leave them unable to slow down or to think about what they say.
It can be hard for them to know what is and is not socially appropriate, and this can lead to difficulties in making and keeping friends. Organizational skills may pose a challenge. Girls with ADHD may have poor time management skills, and they may find it hard to follow multi-step directions or complete a task. They may often lose items, such as a phone or important papers. A review of studies published in suggests that women and girls with ADHD are more likely to have internal symptoms that are not visible to others.
They may also develop better coping strategies than boys with the same condition. As a result, teachers, pediatricians and others who would typically notice the signs of ADHD in a boy often miss them when observing girls.
If a girl has ADHD but does not receive a diagnosis until adulthood, she may be at risk of developing other conditions or facing other challenges, such as:. Ellen Littman , co-author of Understanding Girls with ADHD , says that if a girl with ADHD does not receive a diagnosis or have treatment as she enters adolescence and young adulthood, she will almost inevitably encounter a "range of adjustment problems.
Of interest, whereas clinicians are concerned as to the possibility of purposely misrepresenting or over-reporting of ADHD symptoms by college students or adults, data suggest the opposite may be operant.
These data further highlight issues around the relatively poor sensitivity of recalling symptoms and establishing the diagnosis of ADHD by adult self-report, particularly when not anchoring symptoms in childhood. The diagnosis of ADHD is made clinically with scales used in an ancillary manner.
A number of diagnostic and follow-up scales are available see www. Although these tools quantify behavior deviating from norms, they should not be used alone to make or refute the diagnosis. Diagnosing adults involves careful querying for developmentally appropriate criteria from the DSM-IV-TR concerning the childhood onset, persistence, and current presence of symptoms Diagnostic aids are available for adult ADHD 36 , Follow-up studies show that prominent symptoms and impairment related to the disorder persist into adulthood in approximately one-half of cases 39 , There appears to be developmental variance in the ADHD symptom profile across the life span 31 , 32 , 39 - Longitudinally derived data in ADHD youth growing up indicate that the symptom cluster of hyperactivity and impulsivity decays over time, while the symptoms of inattention largely persist 32 , 39 - 41 , A substantial body of literature implicates abnormalities of brain structure and function in the pathophysiology of both childhood and adult ADHD 42 - 48 , 49 - We have known for decades that ADHD youth show impaired performance on tasks assessing vigilance, motoric inhibition, organization, planning, complex problem solving, and verbal learning and memory 52 , Prominent neuropsychologically-derived executive dysfunction is associated with learning disabilities and poorer overall prognosis over time in ADHD youth Similar findings are emerging in adults with ADHD While neuropsychological testing is not used clinically to diagnose ADHD in adults, such testing aids in identifying learning disabilities, sub average intelligence, and specific information processing deficits.
Structural imaging studies have documented diffuse abnormalities in children and adults with ADHD. A large study by Castellanos and colleagues 55 reported smaller total cerebrum, cerebellum, and the four cerebral lobes that did not change over time. The DLPFC controls working memory that involves the ability to retain information while processing new information. These differences are thought to account for deficits in goal-directed and on task behavior in ADHD.
The ACC is thought to be a key region of regulation involving the ability to focus on one task and choose between options. Investigators have also examined the developmental pattern of cortical maturation in ADHD. Shaw and colleagues 57 reported a delay in cortical thickness among ADHD patients. The pattern of brain development, from sensorimotor to associative areas, was similar in children with and without ADHD. However, the age of peak development was delayed in those with ADHD.
Using the same measure of cortical thickness data in adults, Makris and associates 58 have shown that cortical thickness is not normalized and that the areas of the brain that are affected in children with ADHD remain affected in adulthood. Functional magnetic resonance imaging fMRI has been used to examine brain activity during selective cognitive challenges in individuals with ADHD. The amount of brain activation observed correlated closely with the degree of efficiency on the task in both children and adults with ADHD.
They speculated that bottom-up neural systems detect the regularities and irregularities in the environment to activate the frontal brain systems to alter behavior. These systems are key regulators of maintaining sustained attention vs. Casey and Durston 60 posited that the striatum regulates what to expect type of task , the cerebellum regulates when to expect it timing of task , and the parietal lobe alerts one to novel or newer competing stimuli. Interestingly, medication may normalize some of these functional deficits.
Bush and colleagues published a study showing that 7 weeks of treatment with methylphenidate normalized activation in the ACC Those receiving medication showed increases in activation of the ACC and DLPFC at follow-up as compared to baseline and to those receiving placebo treatment. Hence, those areas of the brain that were underactive in adults without treatment normalized with treatment. The neurobiology of ADHD is strongly influenced by genetic factors. As highlighted in a special issue of Science dedicated to the human genome project, ADHD is among the most recognized genetic-based disorders in psychiatry Additional lines of evidence from twin, adoption and segregation analysis studies suggest that the familial aggregation of ADHD has a substantial genetic component.
Twin studies find greater similarity for ADHD and components of the syndrome between monozygotic twins compared with dizygotic twins 64 , Faraone and colleagues 66 in a meta-analysis of the various studies reported on the mean heritability of ADHD.
Heritability refers to the amount of genetic influence for a particular condition. A coefficient of 1 indicates an entirely genetically influenced phenomenon, while a 0 indicates no genetic influence. As with many complex neuropsychiatric conditions, multifactorial causation is thought to be involved in ADHD; an additive effect of multiple vulnerability genes interacting with environmental influences.
Pooled analyses reveal that there is not one single gene associated with ADHD The disorder is thought to result from a combination of small effects from a number of genes polygenetic. Some of the candidate genes that have been identified thus far relate to synthesis, packaging, release, detection and recycling of dopamine or catecholamines including the post-synaptic DRD4, dopamine transporter, and SNAP 25 genes; as well as others related to other neurotransmitters such as serotonin.
Clearly, more work is necessary in disentangling the relationship of candidate genes in producing specific phenocopies of ADHD, as well as response prediction to psychosocial and pharmacological intervention. The management of ADHD includes consideration of two major areas: Support groups for children and adolescents and their families, as well as adults with ADHD, provide an invaluable and inexpensive environment in which individuals are able to learn about ADHD and resources available for their children or themselves.
Support groups can be accessed by calling an ADHD hotline or a large support group organization i. Since learning disorders co-occur in one-third of ADHD youth, ADHD individuals should be screened and appropriate individualized educational plans developed. Educational adjustments should be considered in individuals with ADHD with difficulties in behavioral or academic performance. Increased structure, predictable routine, learning aids, resource room time, and checked homework are among typical educational considerations in these individuals.
Similar modifications in the home environment should be undertaken to optimize the ability to complete homework. Clinicians have at their disposal a variety of psychosocial interventions for ADHD for review see 68 , Apart from traditional psychotherapy, which addresses underlying emotions, tutors are available to help children develop strategies for improving academic performance and interpersonal relations. Tutors can assist the child with skills in organization and prioritization, as well as act as mentors, advocates, and motivational figures.
Parent training is often conducted using the antecedent behavior consequence model, and is implemented using various methods, including small and large parent training groups, parent training with individual families, videotapes, and behavioral sessions that include children In the academic setting, virtually all children with ADHD must cope with organizational and behavioral demands and expectations.
Classroom behavioral interventions often involve training the teacher in use of these methods. Antecedent interventions are based on an understanding of the range of antecedents eg, boredom, peer provocation, unclear inconsistent rules that precipitate behavioral problems. Consequence interventions involve the judicious use of punishment to encourage appropriate classroom behavior.
Accommodations should be considered to assist the child with ADHD. For instance, other behavioral strategies can be used in the classroom setting to facilitate attention These include placing the child with ADHD in proximity to the teacher, eliminating environmental distractions, and arranging seating in traditional rows rather than clusters. Lessons that involve novelty and stimulation in easy and repetitive tasks rather than new or difficult ones have been shown to benefit the child with ADHD.
Additional interventions shown to be effective in the academic setting include peer-mediated interventions and token economies. Exciting new work has shown that cognitive therapies 73 and cognitive behavioral therapy have been shown effective in medicated adults with ADHD who manifest residual ADHD symptoms 74 - Social skills remediation for improving interpersonal interactions and coaching for improving organization and study skills may be useful adjuncts to treatment, although there generalizeability remains debated.
Little data exists for the use of neurofeedback, cerebellar training, attention or memory training, or ophthalmic manipulation for the treatment of core ADHD symptoms Medications remain a mainstay of treatment for children, adolescents, and adults with ADHD see Table 1. In fact, NIH-funded multisite studies support that medication management of ADHD is the most important variable in outcome for core ADHD symptoms in context to multimodal treatment at least over the first year to two of treatment 78 - The stimulants, noradrenergic agents, and alpha agonists comprise the available agents for ADHD.
The medications used in ADHD have been observed to have pharmacological responsivity across the lifespan for school-aged children, adolescents, and adult groups with ADHD. The stimulant class medications are among first line agents for pediatric and adult groups with ADHD based on their extensive efficacy and safety data 1. The most commonly used compounds in this class include methylphenidate-based Ritalin, Concerta, Focalin, Metadate, Daytrana and others and amphetamine-based Adderall, Dexedrine, Vyvanse formulations.
Stimulants are sympathomimetic drugs which increase intrasynaptic catecholamines mainly dopamine and norepinephrine by inhibiting the presynaptic reuptake mechanism and releasing presynaptic catecholamines Whereas methylphenidate is specific for blockade of the dopamine and noradrenergic transporter proteins, amphetamines in addition to blocking the dopamine and noradrenergic transporter protein release catecholaminergic stores and cytoplasmic dopamine and noradrenaline directly into the synaptic cleft for review see 1 , Given the need to additionally treat ADHD outside of academic settings i.
Extended release preparations diminish afternoon wear-off and rebound and appear to manifest less abuse liability compared to their immediate-release counterparts 82 , The extended release stimulants include methylphenidate trade names: The literature suggests more similarities than differences in response to the various available stimulants 1 , However, based on different mechanisms of action and individual tolerability, some patients who lack a satisfactory response or manifest adverse effects to one stimulant may respond favorably to another.
Stimulants should be initiated at the lowest available dosing once daily and increased every three to seven days until a response is noted or adverse effects emerge. Stimulants appear to work in all age groups of individuals with ADHD. For instance, a controlled multi-site study in preschoolers showed improvement in ADHD symptoms and structured tasks; however, the response was less robust with a higher side effect burden compared to other age groups There has been a great interest in the use of stimulant treatment in adults with ADHD.
There have been approximately 40 studies of stimulants demonstrating moderate efficacy Currently FDA approval is only for the extended-release preparation of stimulants in adults.
Predictable short-term adverse effects include reduced appetite, insomnia, edginess, and GI upset Elevated vital signs may emerge necessitating baseline and on-drug monitoring. Although stimulants may produce anorexia and weight loss, their effect on ultimate height remains less certain 88 , Whereas a number of studies have indicated potential growth delay earlier in treatment, normalization appears to occur with chronic treatment.
Longitudinal studies suggest that the majority of ADHD youth with tics can tolerate stimulant medications 90 ; however, up to one-third of children with tics may have worsening of their tics with stimulant exposure Current consensus suggests that stimulants can be used in youth with comorbid ADHD plus tics with careful monitoring for stimulant-induced tic exacerbation. Warnings have also highlighted potential cardiovascular adverse events.
Data suggest that rates of sudden and catastrophic adverse cardiovascular effects are no higher on stimulants and nonstimulants to treat ADHD compared to the general population Based on guidelines from the American Academy of Pediatrics 93 , 94 , history and symptoms referable to structural heart disease should be queried prior to starting and during treatment with medications see Figure 2 including family history of premature death, congenital heart disease, palpitations, syncopal episodes, dizziness, or chest pain 93 , Blood pressure and pulse monitoring at baseline and periodically thereafter is recommended whereas ECG monitoring is optional 93 , Despite lingering concerns of stimulant abuse, there is a paucity of scientific data supporting that stimulant-treated ADHD individuals systematically abuse their medication 95 and the preponderance of recent data continue to suggest reductions of cigarette smoking and substance abuse associated with treatment 19 , However, data suggest that diversion of stimulants to non-ADHD youth continues to be a concern 96 , Families should closely monitor stimulant medication, and college students receiving stimulants should be advised to carefully store their medication Diagnosis of ADHD in adults can be difficult because certain ADHD symptoms are similar to those caused by other conditions, such as anxiety or mood disorders.
And many adults with ADHD also have at least one other mental health condition, such as depression or anxiety. If any of the symptoms listed above continually disrupt your life, talk to your doctor about whether you might have ADHD. Different types of health care professionals may diagnose and supervise treatment for ADHD.
Seek a provider who has training and experience in caring for adults with ADHD. While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include:. Although ADHD doesn't cause other psychological or developmental problems, other disorders often occur along with ADHD and make treatment more challenging. Mayo Clinic does not endorse companies or products.
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ADHD in girls: How is it different?
Adult ADHD treatment includes medications, psychological counseling ( psychotherapy) and treatment for any mental health conditions that. ADHD includes a combination of persistent problems, such as to have a medical evaluation first to check for other possible causes of your. Your child won't be diagnosed with the condition unless symptoms continue for more than six months and More signs of ADHD may include.