Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and/or impulsivity that interfere with functioning or development. ADHD is typically identified in childhood but frequently persists into adolescence and adulthood. Recent national surveys estimate that roughly 1 in 9 children and a substantial number of adults have been diagnosed with ADHD.

What Is ADHD?

ADHD is defined in diagnostic manuals (DSM-5) as a persistent pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level and that negatively impacts social, academic, or occupational functioning. Symptoms must be present for at least 6 months and occur in two or more settings (for example, home and school/work).

Types of ADHD

• Predominantly inattentive presentation — difficulty sustaining attention, organizing, following instructions.
• Predominantly hyperactive-impulsive presentation — fidgeting, difficulty staying seated, interrupting.
• Combined presentation — features of both inattention and hyperactivity-impulsivity.

15 Early Signs & Red Flags

1. Fails to pay close attention to details; careless mistakes
2. Often has trouble sustaining attention on tasks or play
3. Seems not to listen when spoken to directly
4. Difficulty following through on instructions and finishing tasks
5. Often loses things needed for tasks (keys, homework)
6. Avoids or dislikes tasks requiring sustained mental effort
7. Easily distracted by extraneous stimuli
8. Becomes forgetful in daily activities
9. Fidgets, taps hands or feet, or squirms in seat
10. Leaves seat when remaining seated is expected
11. Runs about or climbs in inappropriate situations (children)
12. Unable to play quietly
13. Talks excessively
14. Blurts out answers; difficulty waiting turn
15. Frequent impulsive or risky behavior relative to peers

Core Symptoms (Inattention, Hyperactivity, Impulsivity)

Inattention

• Difficulty sustaining focus, especially on monotonous tasks
• Poor organization and time management
• Forgetfulness and losing items

Hyperactivity & Impulsivity

• High motor activity, restlessness, inability to stay seated
• Impulsive decision-making and interrupting others
• Difficulty delaying gratification

Diagnosis: Criteria, Screening & When to Refer

Diagnosis is clinical and requires a structured history, symptom checklist, and information from multiple settings (parents, teachers, employers). Standardized tools (conners rating scales, Vanderbilt, DSM-5 symptom checklists, MoCA for adults where cognitive issues suspected) support assessment. Symptoms must: be present before age 12 (per DSM-5 guidance), persist for ≥6 months, and cause impairment in two or more settings.

Primary care clinicians and pediatricians often initiate evaluation; refer to child/adolescent psychiatrists, developmental pediatricians, or adult ADHD specialists when diagnosis is unclear, comorbidities exist, or medication management is needed. NICE and AAP guidelines provide structured diagnostic and assessment pathways.

Treatment Options: Behavioral & Pharmacologic

Behavioral Interventions

• Parent-training programs for young children
• Behavioral classroom interventions and teacher training
• Cognitive-behavioral therapy (CBT) for adolescents & adults
• Organizational skills coaching, time management training

Medications

Medications are highly effective for core symptoms for many people and fall into two main categories:

• Stimulants — methylphenidate (short- and long-acting), amphetamine salts (lisdexamfetamine, mixed salts). These are first-line pharmacologic treatments in many guidelines and have robust evidence for symptom reduction.
• Non-stimulants — atomoxetine, guanfacine, clonidine; used when stimulants are ineffective, cause intolerable side effects, or are contraindicated.

Monitoring & Safety

• Baseline assessment: cardiac history, blood pressure, weight/height (children), and ongoing monitoring for efficacy and side effects
• Consider growth monitoring in children on long-term stimulant therapy
• Shared decision-making about risks, benefits, and formulation choice (short vs long-acting)

School, Workplace & Daily-Life Strategies

• Individualized Education Plans (IEP) or 504 plans for students
• Classroom accommodations: preferential seating, task chunking, extended time
• Workplace adjustments: flexible scheduling, task prioritization, quiet workspace
• Use checklists, timers, visual organizers, and phone reminders
• Coaching for time management and executive skills

Common Comorbidities

• Learning disorders (dyslexia, dyscalculia)
• Oppositional defiant disorder (ODD) and conduct disorder
• Anxiety and depressive disorders
• Sleep disorders (insomnia, delayed sleep phase)
• Substance use disorders (in adolescents and adults)

Lifestyle, Sleep & Nutrition

• Prioritize consistent sleep schedule and treat sleep apnea where present
• Regular physical activity improves attention and mood
• Balanced diet, avoid excessive simple sugars; consider omega-3 supplementation when indicated
• Minimize screen-time before sleep; structure daily routines to reduce decision fatigue

Adult ADHD: Diagnosis & Management

ADHD in adults often presents as chronic disorganization, poor time management, relationship difficulties, and workplace impairment. Diagnosis requires retrospective childhood symptom evidence plus current impairment. Treatment mirrors that for younger patients: a combination of CBT/coaching and medication when appropriate. Recent analyses estimate millions of U.S. adults have current ADHD diagnoses and many receive their diagnosis in adulthood. Access to adult ADHD assessment and care is an important public health priority.

Final Thoughts

ADHD is a lifelong, treatable condition. Accurate assessment, evidence-based treatments (behavioral strategies, educational supports, and medication when indicated), and ongoing monitoring produce meaningful improvements in functioning. Care should be individualized, age-appropriate, and coordinated between families, schools/employers, and clinicians.