Attention Deficit 

Hyperactivity Disorder

(ADHD)

National Institute of Mental Health

U.S. Department of Health and Human Services • National Institutes of Health

Contents

What is attention deficit hyperactivity disorder? _________________________ 1

What are the symptoms of ADHD in children?___________________________ 2

What causes ADHD? _________________________________________________ 3

How is ADHD diagnosed?_____________________________________________ 5

How is ADHD treated? ________________________________________________ 7

Medications______________________________________________________ 7

Psychotherapy __________________________________________________ 10

What conditions can coexist with ADHD?______________________________ 12

How can I work with my child’s school? _______________________________ 13

Do teens with ADHD have special needs? _____________________________ 14

Can adults have ADHD? _____________________________________________ 16

What efforts are under way to improve treatment?______________________ 18

Citations ___________________________________________________________ 19

For more information on attention deficit hyperactivity

disorder ____________________________________________________________ 21

Attention Deficit Hyperactivity Disorder • 

What is attention deficit 

hyperactivity disorder?

Attention deficit hyperactivity disorder (ADHD) is one of the 

most common childhood disorders and can continue through 

adolescence and adulthood. Symptoms include difficulty 

staying focused and paying attention, difficulty controlling 

behavior, and hyperactivity (over-activity). 

ADHD has three subtypes:1

• Predominantly hyperactive-impulsive 

– Most symptoms (six or more) are in the hyperactivity-impulsivity categories.

– Fewer than six symptoms of inattention are present, although inattention 

may still be present to some degree. 

• Predominantly inattentive 

– The majority of symptoms (six or more) are in the inattention category and 

fewer than six symptoms of hyperactivity-impulsivity are present, although 

hyperactivity-impulsivity may still be present to some degree.

– Children with this subtype are less likely to act out or have difficulties getting 

along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and 

parents and teachers may not notice that he or she has ADHD.

• Combined hyperactive-impulsive and inattentive

– Six or more symptoms of inattention and six or more symptoms of 

hyperactivity-impulsivity are present. 

– Most children have the combined type of ADHD.

Treatments can relieve many of the disorder’s symptoms, but there is no cure. With 

treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, 

and using new tools such as brain imaging, to better understand ADHD and to find 

more effective ways to treat and prevent it. 
 • National Institute of Mental Health

What are the symptoms of ADHD in children?

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is 

normal for all children to be inattentive, hyperactive, or impulsive sometimes, but 

for children with ADHD, these behaviors are more severe and occur more often. To 

be diagnosed with the disorder, a child must have symptoms for 6 or more months 

and to a degree that is greater than other children of the same age. 

Children who have symptoms of inattention may:

• Be easily distracted, miss details, forget things, and 

frequently switch from one activity to another

• Have difficulty focusing on one thing

• Become bored with a task after only a few minutes, 

unless they are doing something enjoyable

• Have difficulty focusing attention on organizing and 

completing a task or learning something new 

• Have trouble completing or turning in homework 

assignments, often losing things (e.g., pencils, toys, 

assignments) needed to complete tasks or activities

• Not seem to listen when spoken to

• Daydream, become easily confused, and move slowly

• Have difficulty processing information as quickly and accurately as others

• Struggle to follow instructions.

Children who have symptoms of hyperactivity may: 

• Fidget and squirm in their seats

• Talk nonstop

• Dash around, touching or playing with anything and everything in sight

• Have trouble sitting still during dinner, school, and story time

• Be constantly in motion

• Have difficulty doing quiet tasks or activities. 
Attention Deficit Hyperactivity Disorder • 

Children who have symptoms of impulsivity may:

• Be very impatient

• Blurt out inappropriate comments, show their emotions without restraint, and 

act without regard for consequences 

• Have difficulty waiting for things they want or waiting their turns in games

• Often interrupt conversations or others’ activities. 

ADHD Can Be Mistaken for Other Problems

Parents and teachers can miss the fact that children with symptoms of inattention have the 

disorder because they are often quiet and less likely to act out. They may sit quietly, seeming 

to work, but they are often not paying attention to what they are doing. They may get along 

well with other children, compared with those with the other subtypes, who tend to have social 

problems. 

But children with the inattentive kind of ADHD are not the only ones whose disorders can be 

missed. For example, adults may think that children with the hyperactive and impulsive subtypes 

just have emotional or disciplinary problems.

What causes ADHD?

Scientists are not sure what causes ADHD, although many studies suggest that 

genes play a large role. Like many other illnesses, ADHD probably results from a 

combination of factors. In addition to genetics, researchers are looking at possible 

environmental factors, and are studying how brain injuries, nutrition, and the social 

environment might contribute to ADHD.

Genes. Inherited from our parents, genes are the “blueprints” for who we are. 

Results from several international studies of twins show that ADHD often runs in 

families. Researchers are looking at several genes that may make people more 

likely to develop the disorder.2,3 Knowing the genes involved may one day help 

researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
 • National Institute of Mental Health

Children with ADHD who carry a particular version of a certain 

gene have thinner brain tissue in the areas of the brain associated with attention. This NIMH research showed that the difference was not permanent, however, and as children with this 

gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.4

Environmental factors. Studies suggest a potential link 

between cigarette smoking and alcohol use during pregnancy 

and ADHD in children.5,6 In addition, preschoolers who are exposed to high levels 

of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.7

Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with 

ADHD have suffered a traumatic brain injury. 

Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is 

popular, but more research discounts this theory than supports it. In one study, 

researchers gave children foods containing either sugar or a sugar substitute every 

other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.8

 Another study in 

which children were given higher than average amounts of sugar or sugar substitutes showed similar results.9

 

In another study, children who were considered sugar-sensitive by their mothers 

were given the sugar substitute aspartame, also known as Nutrasweet. Although 

all the children got aspartame, half their mothers were told their children were 

given sugar, and the other half were told their children were given aspartame. The 

mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to 

mothers who thought their children received aspartame.10

Food additives. Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an 

increase in activity.11 Research is under way to confirm the findings and to learn 

more about how food additives may affect hyperactivity.
Attention Deficit Hyperactivity Disorder • 

How is ADHD diagnosed?

Children mature at different rates and have different personalities, temperaments, 

and energy levels. Most children get distracted, act impulsively, and struggle to 

concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early 

in life, often between the ages of 3 and 6, and because 

symptoms vary from person to person, the disorder can 

be hard to diagnose. Parents may first notice that their 

child loses interest in things sooner than other children, 

or seems constantly “out of control.” Often, teachers 

notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom 

or on the playground.

No single test can diagnose a child as having ADHD. Instead, a licensed health 

professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. 

Some pediatricians can assess the child themselves, but many will refer the 

family to a mental health specialist with experience in childhood mental disorders 

such as ADHD. The pediatrician or mental health specialist will first try to rule out 

other possibilities for the symptoms. For example, certain situations, events, or 

health conditions may cause temporary behaviors in a child that seem like ADHD. 

Between them, the referring pediatrician and specialist will determine if a child: 

• Is experiencing undetected seizures that could be associated with other 

medical conditions

• Has a middle ear infection that is causing hearing problems

• Has any undetected hearing or vision problems

• Has any medical problems that affect thinking and behavior

• Has any learning disabilities 

• Has anxiety or depression, or other psychiatric problems that might cause 

ADHD-like symptoms

• Has been affected by a significant and sudden change, such as the death of a 

family member, a divorce, or parent’s job loss. 
 • National Institute of Mental Health

A specialist will also check school and medical records 

for clues, to see if the child’s home or school settings 

appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, 

babysitters, and other adults who know the child well 

also may be consulted. The specialist also will ask:

• Are the behaviors excessive and long-term, and do 

they affect all aspects of the child’s life? 

• Do they happen more often in this child compared with the child’s peers? 

• Are the behaviors a continuous problem or a response to a temporary situation? 

• Do the behaviors occur in several settings or only in one place, such as the 

playground, classroom, or home?

The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others 

would require the child to keep paying attention. Most children with ADHD are 

better able to control their behaviors in situations where they are getting individual 

attention and when they are free to focus on enjoyable activities. These types of 

situations are less important in the assessment. A child also may be evaluated to 

see how he or she acts in social situations, and may be given tests of intellectual 

ability and academic achievement to see if he or she has a learning disability.

Finally, if after gathering all this information the child meets the criteria for ADHD, 

he or she will be diagnosed with the disorder. 
Attention Deficit Hyperactivity Disorder • 

How is ADHD treated?

Currently available treatments focus on reducing the symptoms of ADHD and 

improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments. 

Medications

The most common type of medication used for treating ADHD 

is called a “stimulant.” Although it may seem unusual to treat 

ADHD with a medication considered a stimulant, it actually has 

a calming effect on children with ADHD. Many types of stimulant 

medications are available. A few other ADHD medications are 

non-stimulants and work differently than stimulants. For many 

children, ADHD medications reduce hyperactivity and impulsivity 

and improve their ability to focus, work, and learn. Medication also may improve 

physical coordination. 

However, a one-size-fits-all approach does not apply for all children with ADHD. 

What works for one child might not work for another. One child might have side 

effects with a certain medication, while another child may not. Sometimes several 

different medications or dosages must be tried before finding one that works for a 

particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors.

Stimulant medications come in different forms, such as a pill, capsule, liquid, or 

skin patch. Some medications also come in short-acting, long-acting, or extended 

release varieties. In each of these varieties, the active ingredient is the same, but 

it is released differently in the body. Long-acting or extended release forms often 

allow a child to take the medication just once a day before school, so they don’t 

have to make a daily trip to the school nurse for another dose. Parents and doctors 

should decide together which medication is best for the child and whether the child 

needs medication only for school hours or for evenings and weekends, too. 

A list of medications and the approved age for use follows. ADHD can be diagnosed 

and medications prescribed by M.D.s (usually a psychiatrist) and in some states 

also by clinical psychologists, psychiatric nurse practitioners, and advanced 

psychiatric nurse specialists. Check with your state’s licensing agency for specifics. 
 • National Institute of Mental Health

ADHD Medications Approved by U.S. Food and Drug Administration (FDA)* 

Trade Name Generic Name Approved Age

Adderall amphetamine 3 and older

Adderall XR amphetamine (extended release) 6 and older

Concerta methylphenidate (long acting) 6 and older

Daytrana methylphenidate patch 6 and older 

Desoxyn methamphetamine hydrochloride 6 and older

Dexedrine dextroamphetamine 3 and older

Dextrostat dextroamphetamine 3 and older

Focalin dexmethylphenidate 6 and older

Focalin XR dexmethylphenidate (extended release) 6 and older

Metadate ER methylphenidate (extended release) 6 and older

Metadate CD methylphenidate (extended release) 6 and older

Methylin methylphenidate (oral solution and chewable tablets) 6 and older

Ritalin methylphenidate 6 and older

Ritalin SR methylphenidate (extended release) 6 and older

Ritalin LA methylphenidate (long acting) 6 and older

Strattera atomoxetine 6 and older

Vyvanse lisdexamfetamine dimesylate 6 and older

*Not all ADHD medications are approved for use in adults.

NOTE: “extended release” means the medication is released gradually so that a controlled amount enters the 

body over a period of time. “Long acting” means the medication stays in the body for a long time.

Over time, this list will grow, as researchers continue to develop new medications 

for ADHD. Medication guides for each of these medications are available from 

the U.S. Food and Drug Administration (FDA) at http://www.fda.gov/cder/drug/

infopage/ADHD/default.htm.

What are the side effects of stimulant medications? 

The most commonly reported side effects are decreased appetite, sleep problems, 

anxiety, and irritability. Some children also report mild stomachaches or headaches. Most side effects are minor and disappear over time or if the dosage level is 

lowered.

• Decreased appetite. Be sure your child eats healthy meals. If this side effect 

does not go away, talk to your child’s doctor. Also talk to the doctor if you have 
Attention Deficit Hyperactivity Disorder • 

concerns about your child’s growth or weight gain while he or she is taking this 

medication. 

• Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower 

dose of the medication or a shorter-acting form. The doctor might also suggest 

giving the medication earlier in the day, or stopping the afternoon or evening 

dose. Adding a prescription for a low dose of an antidepressant or a blood 

pressure medication called clonidine sometimes helps with sleep problems. 

A consistent sleep routine that includes relaxing elements like warm milk, soft 

music, or quiet activities in dim light, may also help.

• Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing 

the medication dosage may make tics go away. Some children also may have a 

personality change, such as appearing “flat” or without emotion. Talk with your 

child’s doctor if you see any of these side effects.

Are stimulant medications safe? 

Under medical supervision, stimulant medications are considered safe. Stimulants 

do not make children with ADHD feel high, although some kids report feeling 

slightly different or “funny.” Although some parents worry that stimulant medications may lead to substance abuse or dependence, there is little evidence of this. 

FDA warning on possible rare side effects

In 2007, the FDA required that all makers of ADHD medications develop Patient 

Medication Guides that contain information about the risks associated with the 

medications. The guides must alert patients that the medications may lead to possible cardiovascular (heart and blood) or psychiatric problems. The agency undertook this precaution when a review of data found that ADHD patients with existing 

heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden 

death when taking the medications. 

The review also found a slight increased risk, about 1 in 1,000, for medicationrelated psychiatric problems, such as hearing voices, having hallucinations, 

becoming suspicious for no reason, or becoming manic (an overly high mood), 

even in patients without a history of psychiatric problems. The FDA recommends 

that any treatment plan for ADHD include an initial health history, including family 

history, and examination for existing cardiovascular and psychiatric problems.

One ADHD medication, the non-stimulant atomoxetine (Strattera), carries another 

warning. Studies show that children and teenagers who take atomoxetine are more 
10 • National Institute of Mental Health

likely to have suicidal thoughts than children and teenagers with ADHD who do not 

take it. If your child is taking atomoxetine, watch his or her behavior carefully. 

A child may develop serious symptoms suddenly, so it is important to pay 

attention to your child’s behavior every day. Ask other people who spend a lot of 

time with your child to tell you if they notice changes in your child’s behavior. Call 

a doctor right away if your child shows any unusual behavior. While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment, and be sure that your child keeps all appointments with his or her doctor.

Do medications cure ADHD?

Current medications do not cure ADHD. Rather, they 

control the symptoms for as long as they are taken. 

Medications can help a child pay attention and complete 

schoolwork. It is not clear, however, whether medications 

can help children learn or improve their academic skills. 

Adding behavioral therapy, counseling, and practical 

support can help children with ADHD and their families to 

better cope with everyday problems. Research funded by 

the National Institute of Mental Health (NIMH) has shown 

that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs.12

Psychotherapy 

Different types of psychotherapy are used for ADHD. Behavioral therapy aims to 

help a child change his or her behavior. It might involve practical assistance, such 

as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or 

her own behavior. Learning to give oneself praise or rewards for acting in a desired 

way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for 

certain behaviors. In addition, clear rules, chore lists, and other structured routines 

can help a child control his or her behavior.

Therapists may teach children social skills, such as how to wait their turn, share 

toys, ask for help, or respond to teasing. Learning to read facial expressions and 

the tone of voice in others, and how to respond appropriately can also be part of 

social skills training. 
Attention Deficit Hyperactivity Disorder • 11

How can parents help?

Children with ADHD need guidance and understanding 

from their parents and teachers to reach their full potential 

and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. 

Parents and children may need special help to overcome 

bad feelings. Mental health professionals can educate parents about ADHD and 

how it impacts a family. They also will help the child and his or her parents develop 

new skills, attitudes, and ways of relating to each other.

Parenting skills training helps parents learn how to use a system of rewards and 

consequences to change a child’s behavior. Parents are taught to give immediate 

and positive feedback for behaviors they want to encourage, and 

ignore or redirect behaviors they 

want to discourage. In some cases, 

the use of “time-outs” may be used 

when the child’s behavior gets out 

of control. In a time-out, the child is 

removed from the upsetting situation and sits alone for a short time to 

calm down. 

Parents are also encouraged to 

share a pleasant or relaxing activity 

with the child, to notice and point 

out what the child does well, and to 

praise the child’s strengths and abilities. They may also learn to structure 

situations in more positive ways. 

For example, they may restrict the 

number of playmates to one or two, 

so that their child does not become 

overstimulated. Or, if the child has 

trouble completing tasks, parents 

can help their child divide large 

tasks into smaller, more manageable 

steps. Also, parents may benefit 

Tips to Help Kids Stay Organized 

and Follow Directions

Schedule. Keep the same routine every day, 

from wake-up time to bedtime. Include time for 

homework, outdoor play, and indoor activities. 

Keep the schedule on the refrigerator or on a 

bulletin board in the kitchen. Write changes on 

the schedule as far in advance as possible.

Organize everyday items. Have a place for 

everything, and keep everything in its place. 

This includes clothing, backpacks, and toys.

Use homework and notebook organizers.

Use organizers for school material and supplies. 

Stress to your child the importance of writing 

down assignments and bringing home the 

necessary books. 

Be clear and consistent. Children with ADHD 

need consistent rules they can understand and 

follow.

Give praise or rewards when rules are 

followed. Children with ADHD often receive 

and expect criticism. Look for good behavior, 

and praise it.
12 • National Institute of Mental Health

from learning stress-management techniques to increase their own ability to deal 

with frustration, so that they can respond calmly to their child’s behavior.

Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior 

changes. Finally, support groups help parents and families connect with others 

who have similar problems and concerns. Groups often meet regularly to share 

frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

What conditions can coexist with ADHD?

Some children with ADHD also have other illnesses or conditions. For example, 

they may have one or more of the following: 

• A learning disability. A child in preschool with a 

learning disability may have difficulty understanding 

certain sounds or words or have problems expressing 

himself or herself in words. A school-aged child may 

struggle with reading, spelling, writing, and math.

• Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, 

often argue with adults and refuse to obey rules.

• Conduct disorder. This condition includes behaviors in which the child may lie, 

steal, fight, or bully others. He or she may destroy property, break into homes, 

or carry or use weapons. These children or teens are also at a higher risk of 

using illegal substances. Kids with conduct disorder are at risk of getting into 

trouble at school or with the police.

• Anxiety and depression. Treating ADHD may help to decrease anxiety or some 

forms of depression.

• Bipolar disorder. Some children with ADHD may also have this condition in 

which extreme mood swings go from mania (an extremely high elevated mood) 

to depression in short periods of time. 

• Tourette syndrome. Very few children have this brain disorder, but among those 

who do, many also have ADHD. Some people with Tourette syndrome have 

nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or 

grimacing. Others clear their throats, snort, or sniff frequently, or bark out words 

inappropriately. These behaviors can be controlled with medication.
Attention Deficit Hyperactivity Disorder • 13

ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or 

other disorders or illnesses.

For more information on these disorders, visit http://www.nimh.nih.gov/health/

topics/index.shtml. 

Recognizing ADHD symptoms and seeking help early will lead to better outcomes 

for both affected children and their families.

How can I work with my child’s school?

If you think your child has ADHD, or a teacher raises concerns, you may be able 

to request that the school conduct an evaluation to determine whether he or she 

qualifies for special education services.

Start by speaking with your child’s teacher, school counselor, or the school’s student support team, to begin an evaluation. Also, each state has a Parent Training 

and Information Center and a Protection and Advocacy Agency that can help you 

get an evaluation. A team of professionals conducts the evaluation using a variety 

of tools and measures. It will look at all areas related to the child’s disability.

Once your child has been evaluated, he or she has several options, depending on 

the specific needs. If special education services are needed 

and your child is eligible under the Individuals with Disabilities 

Education Act, the school district must develop an “individualized education program” specifically for your child within 

30 days.

If your child is considered not eligible for special education 

services—and not all children with ADHD are eligible—he or 

she still can get “free appropriate public education,” available 

to all public-school children with disabilities under Section 504 

of the Rehabilitation Act of 1973, regardless of the nature or 

severity of the disability. 

The U.S. Department of Education’s Office for Civil Rights enforces Section 504 in 

programs and activities that receive Federal education funds. For more information 

on Section 504, please see http://www.ed.gov/about/offices/list/ocr/504faq.html. 
14 • National Institute of Mental Health

More information about Department of Education programs for children with disabilities is available at http://www.ed.gov/parents/needs/speced/edpicks.jhtml?src=ln.

Transitions can be difficult. Each school year brings a new teacher and new 

schoolwork, a change that can be especially hard for a child with ADHD who 

needs routine and structure. Consider telling the teachers that your child has 

ADHD when he or she starts school or moves to a new class. Additional support 

will help your child deal with the transition.

Do teens with ADHD have special needs?

Most children with ADHD continue to have symptoms as 

they enter adolescence. Some children, however, are not 

diagnosed with ADHD until they reach adolescence. This is 

more common among children with predominantly inattentive symptoms because they are not necessarily disruptive at 

home or in school. In these children, the disorder becomes 

more apparent as academic demands increase and responsibilities mount. For all teens, these years are challenging. But 

for teens with ADHD, these years may be especially difficult.

Although hyperactivity tends to decrease as a child ages, 

teens who continue to be hyperactive may feel restless and try to do too many 

things at once. They may choose tasks or activities that have a quick payoff, rather 

than those that take more effort, but provide bigger, delayed rewards. Teens with 

primarily attention deficits struggle with school and other activities in which they 

are expected to be more self-reliant. 

Teens also become more responsible for their own health decisions. When a child 

with ADHD is young, parents are more likely to be responsible for ensuring that 

their child maintains treatment. But when the child reaches adolescence, parents 

have less control, and those with ADHD may have difficulty sticking with treatment. 
Attention Deficit Hyperactivity Disorder • 15

To help them stay healthy and provide needed structure, teens with ADHD should 

be given rules that are clear and easy to understand. Helping them stay focused 

and organized—such as posting a chart listing household chores and responsibilities with spaces to check off completed items—also may help.

Teens with or without ADHD want to be independent and try 

new things, and sometimes they will break rules. If your teen 

breaks rules, your response should be as calm and matter-offact as possible. Punishment should be used only rarely. Teens 

with ADHD often have trouble controlling their impulsivity and 

tempers can flare. Sometimes, a short time-out can be calming.

If your teen asks for later curfews and use of the car, listen to 

the request, give reasons for your opinions, and listen to your 

child’s opinion. Rules should be clear once they are set, but communication, 

negotiation, and compromise are helpful along the way. Maintaining treatments, 

such as medication and behavioral or family therapy, also can help with managing 

your teenager’s ADHD. 

What about teens and driving?

Although many teens engage in risky behaviors, those with ADHD, especially 

untreated ADHD, are more likely to take more risks. In fact, in their first few years 

of driving, teens with ADHD are involved in nearly four times as many car accidents as those who do not have ADHD. They are also more likely to cause injury 

in accidents, and they get three times as many speeding tickets as their peers.13

Most states now use a graduated licensing system, in which young drivers, both 

with and without ADHD, learn about progressively more challenging driving situations.14 The licensing system consists of three stages—learner’s permit, during 

which a licensed adult must always be in the car with the driving teen; intermediate (provisional) license; and full licensure. Parents should make sure that their 

teens, especially those with ADHD, understand and follow the rules of the road. 

Repeated driving practice under adult supervision is especially important for teens 

with ADHD.
16 • National Institute of Mental Health

Can adults have ADHD?

Some children with ADHD continue to have it as adults. And 

many adults who have the disorder don’t know it. They may 

feel that it is impossible to get organized, stick to a job, or 

remember and keep appointments. Daily tasks such as getting up in the morning, preparing to leave the house for work, 

arriving at work on time, and being productive on the job can be especially challenging for adults with ADHD.

These adults may have a history of failure at school, problems at work, or difficult 

or failed relationships. Many have had multiple traffic accidents. Like teens, adults 

with ADHD may seem restless and may try to do several things at once, most of 

them unsuccessfully. They also tend to prefer “quick fixes,” rather than taking the 

steps needed to achieve greater rewards.

How is ADHD diagnosed in adults?

Like children, adults who suspect they have ADHD should be evaluated by a 

licensed mental health professional. But the professional may need to consider a 

wider range of symptoms when assessing adults for ADHD because their symptoms tend to be more varied and possibly not as clear cut as symptoms seen in 

children. 

To be diagnosed with the condition, an adult must have ADHD symptoms that 

began in childhood and continued throughout adulthood.15 Health professionals use certain rating scales to determine if an adult meets the diagnostic criteria 

for ADHD. The mental health professional also will look at the person’s history of 

childhood behavior and school experiences, and will interview spouses or partners, parents, close friends, and other associates. The person will also undergo a 

physical exam and various psychological tests. 

For some adults, a diagnosis of ADHD can bring a sense of relief. Adults who have 

had the disorder since childhood, but who have not been diagnosed, may have 

developed negative feelings about themselves over the years. Receiving a diagnosis allows them to understand the reasons for their problems, and treatment will 

allow them to deal with their problems more effectively. 
Attention Deficit Hyperactivity Disorder • 17

How is ADHD treated in adults?

Much like children with the disorder, adults with ADHD are treated with medication, psychotherapy, or a combination of treatments.

Medications. ADHD medications, including extended-release forms, often are 

prescribed for adults with ADHD, but not all of these medications are approved 

for adults.16 However, those not approved for adults still may be prescribed by a 

doctor on an “off-label” basis.

Although not FDA-approved specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Older antidepressants, 

called tricyclics, sometimes are used because they, like stimulants, affect the 

brain chemicals norepinephrine and dopamine. A newer antidepressant, venlafaxine (Effexor), also may be prescribed for its effect on the brain chemical norepinephrine. And in recent clinical trials, the antidepressant bupropion (Wellbutrin), 

which affects the brain chemical dopamine, showed benefits for adults with 

ADHD.17

Adult prescriptions for stimulants and other medications require special considerations. For example, adults often require other medications for physical problems, 

such as diabetes or high blood pressure, or for anxiety and depression. Some of 

these medications may interact badly with stimulants. An adult with ADHD should 

discuss potential medication options with his or her doctor. These and other 

issues must be taken into account when a medication is prescribed.

Education and psychotherapy. A professional counselor or therapist can help 

an adult with ADHD learn how to organize his or her life with tools such as a large 

calendar or date book, lists, reminder notes, and by assigning a special place for 

keys, bills, and paperwork. Large tasks can be broken down into more manageable, smaller steps so that completing each part of the task provides a sense of 

accomplishment. 

Psychotherapy, including cognitive behavioral therapy, also can help change 

one’s poor self-image by examining the experiences that produced it. The therapist encourages the adult with ADHD to adjust to the life changes that come with 

treatment, such as thinking before acting, or resisting the urge to take unnecessary risks. 
18 • National Institute of Mental Health

What efforts are under way to 

improve treatment?

This is an exciting time in ADHD research. The expansion of 

knowledge in genetics, brain imaging, and behavioral research 

is leading to a better understanding of the causes of the 

disorder, how to prevent it, and how to develop more effective 

treatments for all age groups. 

NIMH has studied ADHD treatments for school-aged children in a large-scale, 

long-term study called the Multimodal Treatment Study of Children with ADHD 

(MTA study). NIMH also funded the Preschoolers with ADHD Treatment Study 

(PATS), which involved more than 300 preschoolers who had been diagnosed 

with ADHD. The study found that low doses of the stimulant methylphenidate are 

safe and effective for preschoolers, but the children are more sensitive to the side 

effects of the medication, including slower than average growth rates.18 Therefore, 

preschoolers should be closely monitored while taking ADHD medications.19,20

PATS is also looking at the genes of the preschoolers, to see if specific genes 

affected how the children responded to methylphenidate. Future results may help 

scientists link variations in genes to differences in how people respond to ADHD 

medications. For now, the study provides valuable insights into ADHD.21

Other NIMH-sponsored clinical trials on children and adults with ADHD are under 

way. In addition, NIMH-sponsored scientists continue to look for the biological 

basis of ADHD, and how differences in genes and brain structure and function may 

combine with life experiences to produce the disorder. 
Attention Deficit Hyperactivity Disorder • 19

Citations

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Text Revision. Washington, DC: American Psychiatric Association.

2	 Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P. Molecular

genetics of attention-deficit/hyperactivity disorder. Biological Psychiatry, 2005; 57:1313-1323.

3	 Khan SA, Faraone SV. The genetics of attention-deficit/hyperactivity disorder: A literature review of

2005. Current Psychiatry Reports, 2006 Oct; 8:393-397.

4	 Shaw P, Gornick M, Lerch J, Addington A, Seal J, Greenstein D, Sharp W, Evans A, Giedd JN,

Castellanos FX, Rapoport JL. Polymorphisms of the dopamine D4 receptor, clinical outcome and

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5	 Linnet KM, Dalsgaard S, Obel C, Wisborg K, Henriksen TB, Rodriguez A, Kotimaa A, Moilanen I,

Thomsen PH, Olsen J, Jarvelin MR. Maternal lifestyle factors in pregnancy risk of attention-deficit/

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7	 Braun J, Kahn RS, Froehlich T, Auinger P, Lanphear BP. Exposures to environmental toxicants and

attention-deficit/hyperactivity disorder in U.S. children. Environmental Health Perspectives, 2006

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8	 Wolraich M, Milich R, Stumbo P, Schultz F. The effects of sucrose ingestion on the behavior of

hyperactive boys. Pediatrics, 1985 Apr; 106(4):657-682.

9	 Wolraich ML, Lindgren SD, Stumbo PJ, Stegink LD, Appelbaum MI, Kiritsy MC. Effects of diets

high in sucrose or aspartame on the behavior and cognitive performance of children. New 

England Journal of Medicine, 1994 Feb 3; 330(5):301-307.

10	 Hoover DW, Milich R. Effects of sugar ingestion expectancies on mother-child interaction. Journal 

of Abnormal Child Psychology, 1994; 22:501-515.

11	 McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok E, Porteous L,

Prince E, Sonuga-Barke E, Warner JO. Stevenson J. Food additives and hyperactive behaviour in

3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebocontrolled trial. Lancet, 2007 Nov 3; 370(9598):1560-1567.

12	 The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for

attention-deficit hyperactivity disorder. Archives of General Psychiatry, 1999; 56:1073-1086.

13	 Cox DJ, Merkel RL, Moore M, Thorndike F, Muller C, Kovatchev B. Relative benefits of stimulant

therapy with OROS methylphenidate versus mixed amphetamine salts extended release in

improving the driving performance of adolescent drivers with attention-deficit/hyperactivity

disorder. Pediatrics, 2006 Sept; 118(3):e704-e710.
20 • National Institute of Mental Health

14	 U.S. Department of Transportation, National Highway Traffic Safety Administration, Legislative

Fact Sheets. Traffic Safety Facts, Laws. Graduated Driver Licensing System. January 2006.

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Annual Review of Medicine, 2002; 53:113-131.

16	 Coghill D, Seth S. Osmotic, controlled-release methylphenidate for the treatment of attentiondeficit/hyperactivity disorder. Expert Opinions in Pharmacotherapy, 2006 Oct; 7(15):2119-2138.

17	 Wilens TE, Haight BR, Horrigan JP, Hudziak JJ, Rosenthal NE, Connor DF, Hampton KD, Richard

NE, Modell JG. Bupropion XL in adults with attention-deficit/hyperactivity disorder: a randomized,

placebo-controlled study. Biological Psychiatry, 2005 Apr 1; 57(7):793-801.

18	 Swanson J, Greenhill L, Wigal T, Kollins S, Stehli A, Davies M, Chuang S, Vitiello B, Skroballa A,

Posner K, Abikoff H, Oatis M, McCracken J, McGough J, Riddle M, Ghouman J, Cunningham

C, Wigal S. Stimulant-related reductions in growth rates in the PATS. Journal of the Academy of 

Child and Adolescent Psychiatry, 2006 Nov; 45(11):1304-1313.

19	 Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M, Swanson J, McGough J, Wigal S,

Wigal T, Vitiello B, Skroballa A, Posner K, Ghuman J, Cunningham C, Davies M, Chuang S,

Cooper T. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers

with attention-deficit/hyperactivity disorder. Journal of the Academy of Child and Adolescent 

Psychiatry, 2006 Nov; 45(11):1284-1293.

20	 Wigal T, Greenhill L, Chuang S, McGough J, Vitiello B, Skrobala A, Swanson J, Wigal S, Abikoff H,

Kollins S, McCracken J, Riddle M, Posner K, Ghuman J, Davies M, Thorp B, Stehli A. Safety and

tolerability of methylphenidate in preschool children with attention-deficit/hyperactivity disorder.

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21	 McGough J, McCracken J, Swanson J, Riddle M, Greenhill L, Kollins S, Greenhill L, Abikoff

H, Davies M, Chuang S, Wigal T, Wigal S, Posner K, Skroballa A, Kastelic E, Ghouman J,

Cunningham C, Shigawa S, Moyzis R, Vitiello B. Pharmacogenetics of methylphenidate response

in preschoolers with attention-deficit/hyperactivity disorder. Journal of the Academy of Child and 

Adolescent Psychiatry, 2006 Nov; 45(11):1314-1322.
Attention Deficit Hyperactivity Disorder • 21

For more information on attention deficit 

hyperactivity disorder

Visit the National Library of Medicine’s: 

MedlinePlus: 

http://medlineplus.gov

En Español:

http://medlineplus.gov/spanish

For information on clinical trials for ADHD:

http://www.nimh.nih.gov/health/trials/index.shtml

National Library of Medicine Clinical Trials Database:

http://www.clinicaltrials.gov

Information from NIMH is available in multiple formats. You can browse online, 

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For the most up-to-date information on this topic, please check the NIMH Web site 

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this publication, please contact the NIMH Information Center at the following 

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u.s. Department of Health and Human Services

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NIH Publication No. 08-3572

Revised 2008