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Attention Deficit Hyperactivity Disorder
Imagine living in a fast-moving kaleidoscope, where sounds, images, and thoughts are constantly shifting. Feeling easily bored,
yet helpless to keep your mind on tasks you need to complete. Distracted by unimportant sights and sounds, your mind drives
you from one thought or activity to the next. Perhaps you are so wrapped up in a collage of thoughts and images that you don't
notice when someone speaks to you.
For many people, this is what it's like to have Attention Deficit Hyperactivity Disorder, or ADHD. They may be unable to sit still,
plan ahead, finish tasks, or be fully aware of what's going on around them. To their family, classmates or coworkers, they seem to
exist in a whirlwind of disorganized or frenzied activity. Unexpectedly--on some days and in some situations--they seem fine, often
leading others to think the person with ADHD can actually control these behaviors. As a result, the disorder can mar the person's
relationships with others in addition to disrupting their daily life, consuming energy, and diminishing self-esteem.
ADHD, once called hyperkinesis or minimal brain dysfunction, is one of the most common mental disorders among children. It
affects 3 to 5 percent of all children, perhaps as many as 2 million American children. Two to three times more boys than girls are
affected. On the average, at least one child in every classroom in the United States needs help for the disorder. ADHD often
continues into adolescence and adulthood, and can cause a lifetime of frustrated dreams and emotional pain.
But there is help...and hope. In the last decade, scientists have learned much about the course of the disorder and are now able
to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and
educational options are already available to help people with ADHD focus their attention, build self-esteem, and function in new
In addition, new avenues of research promise to further improve diagnosis and treatment. With so many American children
diagnosed as having attention disorder, research on ADHD has become a national priority. During the 1990s--which the President
and Congress have declared the "Decade of the Brain"--it is possible that scientists will pinpoint the biological basis of ADHD and
learn how to prevent or treat it even more effectively.
This booklet is provided by the National Institute of Mental Health (NIMH), the Federal agency that supports research nationwide
on the brain, mental illnesses, and mental health. Scientists supported by NIMH are dedicated to understanding the workings and
interrelationships of the various regions of the brain, and to developing preventive measures and new treatments to overcome brain
disorders that handicap people in school, work, and play.
The booklet offers up-to-date information on attention deficit disorders and the role of NIMH-sponsored research in discovering
underlying causes and effective treatments. It describes treatment options, strategies for coping, and sources of information and
support. You'll find out what it's like to have ADHD from the stories of Mark, Lisa, and Henry. You'll see their early frustrations,
their steps toward getting help, and their hopes for the future.
The individuals referred to in this brochure are not real, but their stories are representative of people who show symptoms of
Understanding The Problem
Mark, age 14, has more energy than most boys his age. But then, he's
always been overly active. Starting at age 3, he was a human tornado,
dashing around and disrupting everything in his path. At home, he
darted from one activity to the next, leaving a trail of toys behind
him. At meals, he upset dishes and chattered nonstop. He was reckless
and impulsive, running into the street with oncoming cars, no matter how
many times his mother explained the danger or scolded him. On the
playground, he seemed no wilder than the other kids. But his tendency
to overreact--like socking playmates simply for bumping into him--had
already gotten him into trouble several times. His parents didn't know
what to do. Mark's doting grandparents reassured them, "Boys will be
boys. Don't worry, he'll grow out of it." But he didn't.
At age 17, Lisa still struggles to pay attention and act appropriately.
But this has always been hard for her. She still gets embarrassed
thinking about that night her parents took her to a restaurant to
celebrate her 10th birthday. She had gotten so distracted by the
waitress' bright red hair that her father called her name three times
before she remembered to order. Then before she could stop herself, she
blurted, "Your hair dye looks awful!"
In elementary and junior high school, Lisa was quiet and cooperative but
often seemed to be daydreaming. She was smart, yet couldn't improve her
grades no matter how hard she tried. Several times, she failed exams.
Even though she knew most of the answers, she couldn't keep her mind on
the test. Her parents responded to her low grades by taking away
privileges and scolding, "You're just lazy. You could get better grades
if you only tried." One day, after Lisa had failed yet another exam, the
teacher found her sobbing, "What's wrong with me?"
Although he loves puttering around in his shop, for years Henry has had
dozens of unfinished carpentry projects and ideas for new ones he knew
he would never complete. His garage was piled so high with wood, he and
his wife joked about holding a fire sale.
Every day Henry faced the real frustration of not being able to
concentrate long enough to complete a task. He was fired from his job
as stock clerk because he lost inventory and carelessly filled out
forms. Over the years, afraid that he might be losing his mind, he had
seen psychotherapists and tried several medications, but none ever
helped him concentrate. He saw the same lack of focus in his young son
What Are the Symptoms of ADHD?
The three people you've just met, Mark, Lisa, and Henry, all have a form of
ADHD--Attention Deficit Hyperactivity Disorder. ADHD is not like a broken arm, or strep
throat. Unlike these two disorders, ADHD does not have clear physical signs that can be seen
in an x-ray or a lab test. ADHD can only be identified by looking for certain characteristic
behaviors, and as with Mark, Lisa, and Henry, these behaviors vary from person to person.
Scientists have not yet identified a single cause behind all the different patterns of
behavior--and they may never find just one. Rather, someday scientists may find that ADHD
is actually an umbrella term for several slightly different disorders.
At present, ADHD is a diagnosis applied to children and adults who consistently display
certain characteristic behaviors over a period of time. The most common behaviors fall into
three categories: inattention, hyperactivity, and impulsivity.
People who are inattentive have a hard time keeping their
mind on any one thing and may get bored with a task after only a few
minutes. They may give effortless, automatic attention to activities
and things they enjoy. But focusing deliberate, conscious attention to
organizing and completing a task or learning something new is difficult.
For example, Lisa found it agonizing to do homework. Often, she forgot
to plan ahead by writing down the assignment or bringing home the right
books. And when trying to work, every few minutes she found her mind
drifting to something else. As a result, she rarely finished and her
work was full of errors.
People who are hyperactive always seem to be in motion.
They can't sit still. Like Mark, they may dash around or talk
incessantly. Sitting still through a lesson can be an impossible task.
Hyperactive children squirm in their seat or roam around the room. Or
they might wiggle their feet, touch everything, or noisily tap their
pencil. Hyperactive teens and adults may feel intensely restless. They
may be fidgety or, like Henry, they may try to do several things at
once, bouncing around from one activity to the next.
People who are overly impulsive seem unable to curb their
immediate reactions or think before they act. As a result, like Lisa,
they may blurt out inappropriate comments. Or like Mark, they may run
into the street without looking. Their impulsivity may make it hard for
them to wait for things they want or to take their turn in games. They
may grab a toy from another child or hit when they are upset.
Not everyone who is overly hyperactive, inattentive, or impulsive has an
attention disorder. Since most people sometimes blurt out things they
didn't mean to say, bounce from one task to another, or become
disorganized and forgetful, how can specialists tell if the problem is
To assess whether a person has ADHD, specialists consider several
critical questions: Are these behaviors excessive, long-term, and
pervasive? That is, do they occur more often than in other people the
same age? Are they a continuous problem, not just a response to a
temporary situation? Do the behaviors occur in several settings or only
in one specific place like the playground or the office? The person's
pattern of behavior is compared against a set of criteria and
characteristics of the disorder. These criteria appear in a diagnostic
reference book called the Diagnostic and Statistical
Manual of Mental Disorders.
According to the diagnostic manual, there are three patterns of behavior
that indicate ADHD. People with ADHD may show several signs of being
consistently inattentive. They may have a pattern of being hyperactive
and impulsive. Or they may show all three types of behavior.
According to the DSM, signs of inattention include:
- becoming easily distracted by irrelevant sights and sounds
- failing to pay attention to details and making careless mistakes
- rarely following instructions carefully and completely
- losing or forgetting things like toys, or pencils, books, and
tools needed for a task
Some signs of hyperactivity and impulsivity are:
- feeling restless, often fidgeting with hands or feet, or squirming
- running, climbing, or leaving a seat, in situations where sitting
or quiet behavior is expected
- blurting out answers before hearing the whole question
- having difficulty waiting in line or for a turn
Because everyone shows some of these behaviors at times, the DSM
contains very specific guidelines for determining when they indicate
ADHD. The behaviors must appear early in life, before age 7, and
continue for at least 6 months. In children, they must be more frequent
or severe than in others the same age. Above all, the behaviors must
create a real handicap in at least two areas of a person's life, such as
school, home, work, or social settings. So someone whose work or
friendships are not impaired by these behaviors would not be diagnosed
with ADHD. Nor would a child who seems overly active at school but
functions well elsewhere.
Can Any Other Conditions Produce These Symptoms?
The Fact is, many things can produce these behaviors. Anything from
chronic fear to mild seizures can make a child seem overactive,
quarrelsome, impulsive, or inattentive. For example, a formerly
cooperative child who becomes overactive and easily distracted after a
parent's death is dealing with an emotional problem, not ADHD. A
chronic middle ear infection can also make a child seem distracted and
uncooperative. So can living with family members who are physically
abusive or addicted to drugs or alcohol. Can you imagine a child trying
to focus on a math lesson when his or her safety and well-being are in
danger each day? Such children are showing the effects of other
problems, not ADHD.
In other children, ADHD-like behaviors may be their response to a
defeating classroom situation. Perhaps the child has a learning
disability and is not developmentally ready to learn to read and write
at the time these are taught. Or maybe the work is too hard or too
easy, leaving the child frustrated or bored.
Tyrone and Mimi are two examples of how classroom conditions can elicit
behaviors that look like ADHD. For months, Tyrone shouted answers out
in class, then became disruptive when the teacher ignored him. He
certainly seemed hyperactive and impulsive. Finally, after observing
Tyrone in other situations, his teacher realized he just wanted approval
for knowing the right answer. She began to seek opportunities to call
on him and praise him. Gradually, Tyrone became calmer and more
Mimi, a fourth grader, made loud noises during reading group that
constantly disrupted the class. One day the teacher realized that the
book was too hard for Mimi. Mimi's disruptions stopped when she
was placed in a reading group where the books were easier and she could
successfully participate in the lesson.
Like Tyrone and Mimi, some children's attention and class participation
improve when the class structure and lessons are adjusted a bit to meet
their emotional needs, instructional level, or learning style. Although
such children need a little help to get on track at school, they
probably don't have ADHD.
It's also important to realize that during certain stages of
development, the majority of children that age tend to be inattentive,
hyperactive, or impulsive--but do not have ADHD. Preschoolers have lots
of energy and run everywhere they go, but this doesn't mean they are
hyperactive. And many teenagers go through a phase when they are messy,
disorganized, and reject authority. It doesn't mean they will have a
lifelong problem controlling their impulses.
ADHD is a serious diagnosis that may require long-term treatment with
counseling and medication. So it's important that a doctor first look
for and treat any other causes for these behaviors.
What Can Look Like ADHD?
- Underachievement at school due to a learning disability
- Attention lapses caused by petit mal seizures
- A middle ear infection that causes an intermittent hearing problem
- Disruptive or unresponsive behavior due to anxiety or depression
Can Other Disorders Accompany ADHD?
One of the difficulties in diagnosing ADHD is that it is often
accompanied by other problems. For example, many children with ADHD
also have a specific learning disability (LD), which means they have
trouble mastering language or certain academic skills, typically reading
and math. ADHD is not in itself a specific learning disability. But
because it can interfere with concentration and attention, ADHD can make
it doubly hard for a child with LD to do well in school.
A very small proportion of people with ADHD have a rare disorder called
Tourette's syndrome. People with Tourette's have tics and other
movements like eye blinks or facial twitches that they cannot control.
Others may grimace, shrug, sniff, or bark out words. Fortunately, these
behaviors can be controlled with medication. Researchers at NIMH and
elsewhere are involved in evaluating the safety and effectiveness of
treatment for people who have both Tourette's syndrome and ADHD.
More serious, nearly half of all children with ADHD--mostly boys--tend
to have another condition, called oppositional defiant disorder. Like
Mark, who punched playmates for jostling him, these children may
overreact or lash out when they feel bad about themselves. They may be
stubborn, have outbursts of temper, or act belligerent or defiant.
Sometimes this progresses to more serious conduct disorders. Children
with this combination of problems are at risk of getting in trouble at
school, and even with the police. They may take unsafe risks and break
laws--they may steal, set fires, destroy property, and drive recklessly.
It's important that children with these conditions receive help before
the behaviors lead to more serious problems.
At some point, many children with ADHD--mostly younger children and
boys--experience other emotional disorders. About one-fourth feel
anxious. They feel tremendous worry, tension, or uneasiness, even when
there's nothing to fear. Because the feelings are scarier, stronger,
and more frequent than normal fears, they can affect the child's
thinking and behavior. Others experience depression. Depression goes
beyond ordinary sadness--people may feel so "down" that they feel
hopeless and unable to deal with everyday tasks. Depression can disrupt
sleep, appetite, and the ability to think.
Because emotional disorders and attention disorders so often go hand in
hand, every child who has ADHD should be checked for accompanying
anxiety and depression. Anxiety and depression can be treated, and
helping children handle such strong, painful feelings will help them
cope with and overcome the effects of ADHD.
Of course, not all children with ADHD have an additional disorder. Nor
do all people with learning disabilities, Tourette's syndrome,
oppositional defiant disorder, conduct disorder, anxiety, or depression
have ADHD. But when they do occur together, the combination of problems
can seriously complicate a person's life. For this reason, it's
important to watch for other disorders in children who have ADHD.
What Causes ADHD?
Understandably, one of the first questions parents ask when they learn
their child has an attention disorder is "Why? What went wrong?"
Health professionals stress that since no one knows what causes ADHD, it
doesn't help parents to look backward to search for possible reasons.
There are too many possibilities to pin down the cause with certainty.
It is far more important for the family to move forward in finding ways
to get the right help.
Scientists, however, do need to study causes in an effort to identify
better ways to treat, and perhaps some day, prevent ADHD. They are
finding more and more evidence that ADHD does not stem from home
environment, but from biological causes. When you think about it, there
is no clear relationship between home life and ADHD. Not all children
from unstable or dysfunctional homes have ADHD. And not all children
with ADHD come from dysfunctional families. Knowing this can remove a
huge burden of guilt from parents who might blame themselves for their
Over the last decades, scientists have come up with possible theories
about what causes ADHD. Some of these theories have led to dead ends,
some to exciting new avenues of investigation.
One disappointing theory was that all attention disorders and learning
disabilities were caused by minor head injuries or undetectable damage
to the brain, perhaps from early infection or complications at birth.
Based on this theory, for many years both disorders were called "minimal
brain damage" or "minimal brain dysfunction." Although certain types of
head injury can explain some cases of attention disorder, the theory was
rejected because it could explain only a very small number of cases.
Not everyone with ADHD or LD has a history of head trauma or birth
Another theory was that refined sugar and food additives make children
hyperactive and inattentive. As a result, parents were encouraged to
stop serving children foods containing artificial flavorings,
preservatives, and sugars. However, this theory, too, came under
question. In 1982, the National Institutes of Health (NIH), the Federal
agency responsible for biomedical research, held a major scientific
conference to discuss the issue. After studying the data, the
scientists concluded that the restricted diet only seemed to help about
5 percent of children with ADHD, mostly either young children or
children with food allergies.
ADHD Is Not Usually Caused by:
- too much TV
- food allergies
- excess sugar
- poor home life
- poor schools
In recent years, as new tools and techniques for studying the brain have
been developed, scientists have been able to test more theories about
what causes ADHD.
Using one such technique, NIMH scientists demonstrated a link between a
person's ability to pay continued attention and the level of activity in
the brain. Adult subjects were asked to learn a list of words. As they
did, scientists used a PET (positron emission tomography) scanner to
observe the brain at work. The researchers measured the level of
glucose used by the areas of the brain that inhibit impulses and control
attention. Glucose is the brain's main source of energy, so measuring
how much is used is a good indicator of the brain's activity level. The
investigators found important differences between people who have ADHD
and those who don't. In people with ADHD, the brain areas that control
attention used less glucose, indicating that they were less active. It
appears from this research that a lower level of activity in some parts
of the brain may cause inattention.
The next step will be to research WHY there is less activity in these
areas of the brain. Scientists at NIMH hope to compare the use of
glucose and the activity level in mild and severe cases of ADHD. They
will also try to discover why some medications used to treat ADHD work
better than others, and if the more effective medications increase
activity in certain parts of the brain.
Researchers are also searching for other differences between those who
have and do not have ADHD. Research on how the brain normally develops
in the fetus offers some clues about what may disrupt the process.
Throughout pregnancy and continuing into the first year of life, the
brain is constantly developing. It begins its growth from a few
all-purpose cells and evolves into a complex organ made of billions of
specialized, interconnected nerve cells. By studying brain development
in animals and humans, scientists are gaining a better understanding of
how the brain works when the nerve cells are connected correctly and
incorrectly. Scientists are
tracking clues to determine what might prevent nerve cells from forming
the proper connections. Some of the Factors they are studying include
drug use during pregnancy, toxins, and genetics.
Research shows that a mother's use of cigarettes, alcohol, or other
drugs during pregnancy may have damaging effects on the unborn child.
These substances may be dangerous to the fetus's developing brain. It
appears that alcohol and the nicotine in cigarettes may distort
developing nerve cells. For example, heavy alcohol use during pregnancy
has been linked to fetal alcohol syndrome (FAS), a condition that can
lead to low birth weight, intellectual impairment, and certain physical
defects. Many children born with FAS show much the same hyperactivity,
inattention, and impulsivity as children with ADHD.
Drugs such as cocaine--including the smokable form known as crack--seem
to affect the normal development of brain receptors. These brain cell
parts help to transmit incoming signals from our skin, eyes, and ears,
and help control our responses to the environment. Current research
suggests that drug abuse may harm these receptors. Some scientists
believe that such damage may lead to ADHD.
Toxins in the environment may also disrupt brain development or brain
processes, which may lead to ADHD. Lead is one such possible toxin. It
is found in dust, soil, and flaking paint in areas where leaded gasoline
and paint were once used. It is also present in some water pipes. Some
animal studies suggest that children exposed to lead may develop
symptoms associated with ADHD, but only a few cases have actually been
Other research shows that attention disorders tend to run in families,
so there are likely to be genetic influences. Children who have ADHD
usually have at least one close relative who also has ADHD. And at
least one-third of all fathers who had ADHD in their youth bear children
who have ADHD. Even more convincing: the majority of identical twins
share the trait. At the National Institutes of Health, researchers are
also on the trail of a gene that may be involved in transmitting ADHD in
a small number of families with a genetic thyroid disorder.
In third grade, Mark's teacher threw up her hands and said, "Enough!"
In one morning, Mark had jumped out of his seat to sharpen his pencil
six times, each time accidentally charging into other children's desks
and toppling books and papers. He was finally sent to the principal's
office when he began kicking a desk he had overturned. In sheer
frustration, his teacher called a meeting with his parents and the
But even after they developed a plan for managing Mark's behavior in
class, Mark showed little improvement. Finally, after an extensive
assessment, they found that Mark had an attention deficit that included
hyperactivity. He was put on a medication called Ritalin to control the
hyperactivity during school hours. Although Ritalin failed to help,
another drug called Dexedrine did. With a psychologist's help, his
parents learned to reward desirable behaviors, and to have Mark take
"time out" when he became too disruptive. Soon Mark was able to sit
still and focus on learning.
Because Lisa wasn't disruptive in class, it took a long time for
teachers to notice her problem. Lisa was first referred to the school
evaluation team when her teacher realized that she was a bright girl
with failing grades. The team ruled out a learning disability but
determined that she had an attention deficit, ADHD without
hyperactivity. The school psychologist recognized that Lisa was also
dealing with depression.
Lisa's teachers and the school psychologist developed a treatment plan
that included participation in a program to increase her attention span
and develop her social skills. They also recommended that Lisa receive
counseling to help her recognize her strengths and overcome her
When Henry's son entered kindergarten, it was clear that he was going to
have problems sitting quietly and concentrating. After several
disruptive incidents, the school called and suggested that his son be
evaluated for ADHD. As the boy was assessed, Henry realized that he had
grown up with the same symptoms that specialists were now finding in his
son. Fortunately, the psychologist knew that ADHD can persist in
adults. She suggested that Henry be evaluated by a professional who
worked with adults. For the first time, Henry was correctly diagnosed
and given Ritalin to aid his concentration. What a relief! All the
years that he had been unable to concentrate were due to a disorder that
could be identified, and above all, treated.
How Is ADHD Identified and Diagnosed?
Many parents see signs of an attention deficit in toddlers long before
the child enters school. For example, as a 3-year-old, Henry's son
already displayed some signs of hyperactivity. He seemed to lose
interest and dart off even during his favorite TV shows or while playing
games. Once, during a game of "catch," he left the game before the ball
even reached him!
Like Henry's son, a child may be unable to focus long enough to play a
simple game. Or, like Mark, the child may be tearing around out of
control. But because children mature at different rates, and are very
different in personality, temperament, and energy level, it's useful to
get an expert's opinion of whether the behaviors are appropriate for the
child's age. Parents can ask their pediatrician, or a child
psychologist or psychiatrist to assess whether their toddler has an
attention disorder or is just immature, has hyperactivity or is just
Seeing a child as "a chip off the old block" or "just like his dad" can
blind parents to the need for help. Parents may find it hard to see
their child's behavior as a problem when it so closely resembles their
own. In Fact, like Henry, many parents first recognize their own
disorder only when their children are diagnosed.
In many cases, the teacher is the first to recognize that a child is
hyperactive or inattentive and may consult with the school psychologist.
Because teachers work with many children, they come to know how
"average" children behave in learning situations that require attention
and self control. However, teachers sometimes fail to notice the needs
of children like Lisa who are quiet and cooperative.
Types of Professionals Who Make the Diagnosis
School-age and preschool children are often evaluated by a school
psychologist or a team made up of the school psychologist and other
specialists. But if the school doesn't believe the student has a
problem, or if the family wants another opinion, a family may need to
see a specialist in private practice. In such cases, who can the family
turn to? What kinds of specialists do they need?
||Can diagnose ADHD
||Can prescribe medications, if needed
||Provides counseling or training
|Pediatricians or family physicians
The family can start by talking with the child's pediatrician or their
family doctor. Some pediatricians may do the assessment themselves, but
more often they refer the family to an appropriate specialist they know
and trust. In addition, state and local agencies that serve families
and children, as well as some of the volunteer organizations listed in
the back of this booklet, can help identify an appropriate specialist.
Knowing the differences in qualifications and services can help the
family choose someone who can best meet their needs. Besides school
psychologists, there are several types of specialists qualified to
diagnose and treat ADHD. Child psychiatrists are doctors who specialize
in diagnosing and treating childhood mental and behavioral disorders. A
psychiatrist can provide therapy and prescribe any needed medications.
Child psychologists are also qualified to diagnose and treat ADHD. They
can provide therapy for the child and help the family develop ways to
deal with the disorder. But psychologists are not medical doctors and
must rely on the child's physician to do medical exams and prescribe
medication. Neurologists, doctors who work with disorders of the brain
and nervous system, can also diagnose ADHD and prescribe medicines. But
unlike psychiatrists and psychologists, neurologists usually do not
provide therapy for the emotional aspects of the disorder. Adults who
think they may have ADHD can also seek a psychologist, psychiatrist, or
neurologist. But at present, not all specialists are skilled in
identifying or treating ADHD in adults.
Within each specialty, individual doctors and mental health
professionals differ in their experience with ADHD. So in selecting a
specialist, it's important to find someone with specific training and
experience in diagnosing and treating the disorder.
Steps In Making a Diagnosis
Whatever the specialist's expertise, his or her first task is to gather
information that will rule out other possible reasons for the child's
behavior. In ruling out other causes, the specialist checks the child's
school and medical records. The specialist tries to sense whether the
home and classroom environments are stressful or chaotic, and how the
child's parents and teachers deal with the child. They may have a
doctor look for such problems as emotional disorders, undetectable
(petit mal) seizures, and poor vision or hearing. Most schools
automatically screen for vision and hearing, so this information is
often already on record. A doctor may also look for allergies or
nutrition problems like chronic "caffeine highs" that might make the
child seem overly active.
Next the specialist gathers information on the child's ongoing behavior
in order to compare these behaviors to the symptoms and diagnostic
criteria listed in the DSM ("Diagnostic and Statistical Manual of Mental
Disorders"). This involves talking with the child and if possible,
observing the child in class and in other settings.
The child's teachers, past and present, are asked to rate their
observations of the child's behavior on standardized evaluation forms to
compare the child=FEs behaviors to those of other children the same age.
Of course, rating scales are subjective--they only capture the teacher's
personal perception of the child. Even so, because teachers get to know
so many children, their judgment of how a child compares to others is
The specialist interviews the child's teachers, parents, and other
people who know the child well, such as school staff and baby-sitters.
Parents are asked to describe their child's behavior in a variety of
situations. They may also fill out a rating scale to indicate how
severe and frequent the behaviors seem to be.
In some cases, the child may be checked for social adjustment and mental
health. Tests of intelligence and learning achievement may be given to
see if the child has a learning disability and whether the disabilities
are in all or only certain parts of the school curriculum.
In looking at the data, the specialist pays special attention to the
child's behavior during noisy or unstructured situations, like parties,
or during tasks that require sustained attention, like reading, working
math problems, or playing a board game. Behavior during free play or
while getting individual attention is given less importance in the
evaluation. In such situations, most children with ADHD are able to
control their behavior and perform well.
The specialist then pieces together a profile of the child's behavior.
Which ADHD-like behaviors listed in the DSM does the child show? How
often? In what situations? How long has the child been doing them?
How old was the child when the problem started? Are the behaviors
seriously interfering with the child's friendships, school activities,
or home life? Does the child have any other related problems? The
answers to these questions help identify whether the child's
hyperactivity, impulsivity, and inattention are significant and
long-standing. If so, the child may be diagnosed with ADHD.
Adults are diagnosed for ADHD based on their performance at home and at
work. When possible, their parents are asked to rate the person's
behavior as a child. A spouse or roommate can help rate and evaluate
current behaviors. But for the most part, adults are asked to describe
their own experiences. One symptom is a sense of frustration. Since
people with ADHD are often bright and creative, they often report
feeling frustrated that they're not living up to their potential. Many
also feel restless and are easily bored. Some say they need to seek
novelty and excitement to help channel the whirlwind in their minds.
Although it may be impossible to document when these behaviors first
started, most adults with ADHD can give examples of being inattentive,
impulsive, overly active, impatient, and disorganized most of their
Until recent years, adults were not thought to have ADHD, so many adults
with ongoing symptoms have never been diagnosed. People like Henry go
for decades knowing that something is wrong, but not knowing what it is.
Psychotherapy and medication for anxiety, depression, or
manic-depression fail to help much, simply because the ADHD itself is
not being addressed. Yet half the children with ADHD continue to have
symptoms through adulthood. The recent awareness of adult ADHD means
that many people can finally be correctly diagnosed and treated.
A correct diagnosis lets people move forward in their lives. Once the
disorder is known, they can begin to receive whatever combination of
educational, medical, and emotional help they need.
An effective treatment plan helps people with ADHD and their families at
many levels. For adults with ADHD, the treatment plan may include
medication, along with practical and emotional support. For children
and adolescents, it may include providing an appropriate classroom
setting, the right medication, and helping parents to manage their
What Are the Educational Options?
Children with ADHD have a variety of needs. Some children are too
hyperactive or inattentive to function in a regular classroom, even with
medication and a behavior management plan. Such children may be placed
in a special education class for all or part of the day. In some
schools, the special education teacher teams with the classroom teacher
to meet each child's unique needs. However, most children are able to
stay in the regular classroom. Whenever possible, educators prefer to
not to segregate children, but to let them learn along with their peers.
Children with ADHD often need some special accommodations to help them
learn. For example, the teacher may seat the child in an area with few
distractions, provide an area where the child can move around and
release excess energy, or establish a clearly posted system of rules and
reward appropriate behavior. Sometimes just keeping a card or a picture
on the desk can serve as a visual reminder to use the right school
behavior, like raising a hand instead of shouting out, or staying in a
seat instead of wandering around the room. Giving a child like Lisa
extra time on tests can make the difference between passing and failing,
and gives her a fairer chance to show what she's learned. Reviewing
instructions or writing assignments on the board, and even listing the
books and materials they will need for the task, may make it possible
for disorganized, inattentive children to complete the work.
Many of the strategies of special education are simply good teaching
methods. Telling students in advance what they will learn, providing
visual aids, and giving written as well as oral instructions are all
ways to help students focus and remember the key parts of the lesson.
Students with ADHD often need to learn techniques for monitoring and
controlling their own attention and behavior. For example, Mark's
teacher taught him several alternatives for when he loses track of what
he's supposed to do. He can look for instructions on the blackboard,
raise his hand, wait to see if he remembers, or quietly ask another
child. The process of finding alternatives to interrupting the teacher
has made him more self-sufficient and cooperative. And because he now
interrupts less, he is beginning to get more praise than reprimands.
In Lisa's class, the teacher frequently stops to ask students to notice
whether they are paying attention to the lesson or if they are thinking
about something else. The students record their answer on a chart. As
students become more consciously aware of their attention, they begin to
see progress and feel good about staying better focused. The process
helped make Lisa aware of when she was drifting off, so she could return
her attention to the lesson faster. As a result, she became more
productive and the quality of her work improved.
Because schools demand that children sit still, wait for a turn, pay
attention, and stick with a task, it's no surprise that many children
with ADHD have problems in class. Their minds are fully capable of
learning, but their hyperactivity and inattention make learning
difficult. As a result, many students with ADHD repeat a grade or drop
out of school early. Fortunately, with the right combination of
appropriate educational practices, medication, and counseling, these
outcomes can be avoided.
Right to a Free Public Education
Although parents have the option of taking their child to a private
practitioner for evaluation and educational services, most children with
ADHD qualify for free services within the public schools. Steps are
taken to ensure that each child with ADHD receives an education that
meets his or her unique needs. For example, the special education
teacher, working with parents, the school psychologist, school
administrators, and the classroom teacher, must assess the child's
strengths and weaknesses and design an Individualized Educational
Program (IEP). The IEP outlines the specific skills the child needs to
develop as well as appropriate learning activities that build on the
child's strengths. Parents play an important role in the process. They
must be included in meetings and given an opportunity to review and
approve their child's IEP.
Many children with ADHD or other disabilities are able to receive such
special education services under the Individuals with Disabilities
Education Act (IDEA). The Act guarantees appropriate services and a
public education to children with disabilities from ages 3 to 21.
Children who do not qualify for services under IDEA can receive help
under an earlier law, the National Rehabilitation Act, Section 504,
which defines disabilities more broadly. Qualifying for services under
the National Rehabilitation Act is often called "504 eligibility."
Because ADHD is a disability that affects children's ability to learn
and interact with others, it can certainly be a disabling condition.
Under one law or another, most children can receive the services they
Some Coping Strategies for Teens and Adults With ADHD
(Adapted from: Weinstein, C. Cognitive Remediation Strategies.
"Journal of Psychotherapy Practice and Research" 3(1):44-57, 1994)
- When necessary, ask the teacher or boss to repeat instructions,
rather than guess.
- Break large assignments or job tasks into small, simple tasks.
Set a deadline for each task and reward yourself as you complete
- Each day, make a list of what you need to do. Plan the best order
for doing each task. Then make a schedule for doing them. Use a
calendar or daily planner to keep yourself on track.
- Work in a quiet area. Do one thing at a time. Give yourself
- Write things you need to remember in a notebook with dividers.
Write different kinds of information like assignments,
appointments, and phone numbers--in different sections. Keep
the book with you all of the time.
- Post notes to yourself to help remind yourself of things you need
to do. Tape notes on the bathroom mirror, on the refrigerator, in
your school locker, or dashboard of your car--wherever you're
likely to need the reminder.
- Store similar things together. For example, keep all your
Nintendo disks in one place, and tape cassettes in another. Keep
canceled checks in one place, and bills in another.
- Create a routine. Get yourself ready for school or work at the
same time, in the same way, every day.
- Exercise, eat a balanced diet, and get enough sleep.
What Treatments Are Available?
For decades, medications have been used to treat the symptoms of ADHD.
Three medications in the class of drugs known as stimulants seem to be
the most effective in both children and adults. These are
methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat),
and pemoline (Cylert). For many people, these medicines dramatically
reduce their hyperactivity and improve their ability to focus, work, and
learn. The medications may also improve physical coordination, such as
handwriting and ability in sports. Recent research by NIMH suggests
that these medicines may also help children with an accompanying conduct
disorder to control their impulsive, destructive behaviors.
Ritalin helped Henry focus on and complete tasks for the first time.
Dexedrine helped Mark to sit quietly, focus his attention, and
participate in class so he could learn. He also became less impulsive
and aggressive. Along with these changes in his behavior, Mark began to
make and keep friends.
Unfortunately, when people see such immediate improvement, they often
think medication is all that's needed. But these medicines don't cure
the disorder, they only temporarily control the symptoms. Although the
drugs help people pay better attention and complete their work, they
can't increase knowledge or improve academic skills. The drugs alone
can't help people feel better about themselves or cope with problems.
These require other kinds of treatment and support.
For lasting improvement, numerous clinicians recommend that medications
should be used along with treatments that aid in these other areas.
There are no quick cures. Many experts believe that the most
significant, long-lasting gains appear when medication is combined with
behavioral therapy, emotional counseling, and practical support. Some
studies suggest that the combination of medicine and therapy may be more
effective than drugs alone. NIMH is conducting a large study to check
Use of Stimulant Drugs
Stimulant drugs, such as Ritalin, Cylert, and Dexedrine, when used with
medical supervision, are usually considered quite safe. Although they
can be addictive to teenagers and adults if misused, these medications
are not addictive in children. They seldom make children "high" or
jittery. Nor do they sedate the child. Rather, the stimulants help
children control their hyperactivity, inattention, and other behaviors.
Different doctors use the medications in slightly different ways.
Cylert is available in one form, which naturally lasts 5 to 10 hours.
Ritalin and Dexedrine come in short-term tablets that last about 3
hours, as well as longer-term preparations that last through the school
day. The short-term dose is often more practical for children who need
medication only during the school day or for special situations, like
attending church or a prom, or studying for an important exam. The
sustained-release dosage frees the child from the inconvenience or
embarrassment of going to the office or school nurse every day for a
pill. The doctor can help decide which preparation to use,
and whether a child needs to take the medicine during school hours only
or in the evenings and on weekends, too.
Nine out of 10 children improve on one of the three stimulant drugs. So
if one doesn't help, the others should be tried. Usually a medication
should be tried for a week to see if it helps. If necessary, however,
the doctor will also try adjusting the dosage before switching to a
Other types of medication may be used if stimulants don't work or if the
ADHD occurs with another disorder. Antidepressants and other
medications may be used to help control accompanying depression or
anxiety. In some cases, antihistamines may be tried. Clonidine, a drug
normally used to treat hypertension, may be helpful in people with both
ADHD and Tourette's syndrome. Although stimulants tend to be more
effective, clonidine may be tried when stimulants don't work or can't be
used. Clonidine can be administered either by pill or by skin patch and
has different side effects than stimulants. The doctor works closely
with each patient to find the most appropriate medication.
Sometimes, a child's ADHD symptoms seem to worsen, leading parents to
wonder why. They can be assured that a drug that helps rarely stops
working. However, they should work with the doctor to check that the
child is getting the right dosage. Parents should also make sure that
the child is actually getting the prescribed daily dosage at home or at
school--it's easy to forget. They also need to know that new or
exaggerated behaviors may also crop up when a child is under stress.
The challenges that all children face, like changing schools or entering
puberty, may be even more stressful for a child with ADHD.
Some doctors recommend that children be taken off a medication now and
then to see if the child still needs it. They recommend temporarily
stopping the drug during school breaks and summer vacations, when
focused attention and calm behavior are usually not as crucial. These
"drug holidays" work well if the child can still participate at camp or
other activities without medication.
Children on medications should have regular checkups. Parents should
also talk regularly with the child's teachers and doctor about how the
child is doing. This is especially important when a medication is first
started, re-started, or when the dosage is changed.
The Medication Debate
As useful as these drugs are, Ritalin and the other stimulants have
sparked a great deal of controversy. Most doctors feel the potential
side effects should be carefully weighed against the benefits before
prescribing the drugs. While on these medications, some children may
lose weight, have less appetite, and temporarily grow more slowly.
Others may have problems falling asleep. Some doctors believe that
stimulants may also make the symptoms of Tourette's syndrome worse,
although recent research suggests this may not be true. Other doctors
say if they carefully watch the child's height, weight, and overall
development, the benefits of medication far outweigh the potential side
effects. Side effects that do occur can often be handled by reducing
It's natural for parents to be concerned about whether taking a medicine
is in their child's best interests. Parents need to be clear about the
benefits and potential risks of using these drugs. The child's
pediatrician or psychiatrist can provide advice and answer questions.
Another debate is whether Ritalin and other stimulant drugs are
prescribed unnecessarily for too many children. Remember that many
things, including anxiety, depression, allergies, seizures, or problems
with the home or school environment can make children seem overactive,
impulsive, or inattentive. Critics argue that many children who do not
have a true attention disorder are medicated as a way to control their
Medication and Self-Esteem
When a child's schoolwork and behavior improve soon after starting
medication, the child, parents, and teachers tend to applaud the drug
for causing the sudden change. But these changes are actually the
child's own strengths and natural abilities coming out from behind a
cloud. Giving credit to the medication can make the child feel
incompetent. The medication only makes these changes possible. The
child must supply the effort and ability. To help children feel good
about themselves, parents and teachers need to praise the child, not the
It's also important to help children and teenagers feel comfortable
about a medication they must take every day. They may feel that because
they take medicine they are different from their classmates or that
there's something seriously wrong with them. CH.A.D.D. (which stands
for Children and Adults with Attention Deficit Disorders), a leading
organization for people with attention disorders, suggests several ways
that parents and teachers can help children view the medication in a
Myths About Stimulant Medication
- Compare the pills to eyeglasses, braces, and allergy medications
used by other children in their class. Explain that their
medicine is simply a tool to help them focus and pay attention.
Point out that they're lucky their problem can be helped.
Encourage them to identify ways the medicine makes it easier to do
things that are important to them, like make friends, succeed at
school, and play.
Myth: Stimulants can lead to drug addiction later in life.
Fact: Stimulants help many children focus and be more successful at
school, home, and play. Avoiding negative experiences now may
actually help prevent addictions and other emotional problems
Myth: Responding well to a stimulant drug proves a person has ADHD.
Fact: Stimulants allow many people to focus and pay better
attention, whether or not they have ADHD. The improvement
is just more noticeable in people with ADHD.
Myth: Medication should be stopped when the child reaches
Fact: Not so! About 80 percent of those who needed medication as
children still need it as teenagers. Fifty percent need
medication as adults.
Treatments To Help People With ADHD and Their Families Learn To Cope
Life can be hard for children with ADHD. They're the ones who are so
often in trouble at school, can't finish a game, and lose friends. They
may spend agonizing hours each night struggling to keep their mind on
their homework, then forget to bring it to school.
It's not easy coping with these frustrations day after day. Some
children release their frustration by acting contrary, starting fights,
or destroying property. Some turn the frustration into body ailments,
like the child who gets a stomachache each day before school. Others
hold their needs and fears inside, so that no one sees how badly they
It's also difficult having a sister, brother, or classmate who gets
angry, grabs your toys, and loses your things. Children who live with
or share a classroom with a child who has ADHD get frustrated, too.
They may feel neglected as their parents or teachers try to cope with
the hyperactive child. They may resent their brother or sister never
finishing chores, or being pushed around by a classmate. They want to
love their sibling and get along with their classmate, but sometimes
it's so hard!
It's especially hard being the parent of a child who is full of
uncontrolled activity, leaves messes, throws tantrums, and doesn't
listen or follow instructions. Parents often feel powerless and at a
loss. The usual methods of discipline, like reasoning and scolding,
don't work with this child, because the child doesn't really choose to
act in these ways. It's just that their self-control comes and goes.
Out of sheer frustration, parents sometimes find themselves spanking,
ridiculing, or screaming at the child, even though they know it's not
appropriate. Their response leaves everyone more upset than before.
Then they blame themselves for not being better parents. Once children
are diagnosed and receiving treatment, some of the emotional upset
within the family may fade.
Medication can help to control some of the behavior problems that may
have lead to family turmoil. But more often, there are other aspects of
the problem that medication can't touch. Even though ADHD primarily
affects a person's behavior, having the disorder has broad emotional
repercussions. For some children, being scolded is the only attention
they ever get. They have few experiences that build their sense of
worth and competence. If they're hyperactive, they're often told
they're bad and punished for being disruptive. If they are too
disorganized and unfocused to complete tasks, others may call them lazy.
If they impulsively grab toys, butt in, or shove classmates, they may
lose friends. And if they have a related conduct disorder, they may get
in trouble at school or with the law. Facing the daily frustrations
that can come with having ADHD can make people fear that they are
strange, abnormal, or stupid.
Often, the cycle of frustration, blame, and anger has gone on so long
that it will take some time to undo. Both parents and their children
may need special help to develop techniques for managing the patterns of
behavior. In such cases, mental health professionals can counsel the
child and the family, helping them to develop new skills, attitudes, and
ways of relating to each other. In individual counseling, the therapist
helps children or adults with ADHD learn to feel better about
themselves. They learn to recognize that having a disability does not
reflect who they are as a person. The therapist can also help people
with ADHD identify and build on their strengths, cope with daily
problems, and control their attention and aggression. In group
counseling, people learn that they are not alone in their frustration
and that others want to help. Sometimes only the individual with ADHD
needs counseling support. But in many cases, because the problem
affects the family as well as the person with ADHD, the entire family
may need help. The therapist assists the family in finding better ways
to handle the disruptive behaviors and promote change. If the child is
young, most of the therapist's work is with the parents, teaching them
techniques for coping with and improving their child's behavior.
Several intervention approaches are available and different therapists
tend to prefer one approach or another. Knowing something about the
various types of interventions makes it easier for families to choose a
therapist that is right for their needs.
Psychotherapy works to help people with ADHD to like and accept
themselves despite their disorder. In psychotherapy, patients talk with
the therapist about upsetting thoughts and feelings, explore
self-defeating patterns of behavior, and learn alternative ways to
handle their emotions. As they talk, the therapist tries to help them
understand how they can change. However, people dealing with ADHD
usually want to gain control of their symptomatic behaviors more
directly. If so, more direct kinds of intervention are needed.
Cognitive-behavioral therapy helps people work on immediate
issues. Rather than helping people understand their feelings and
actions, it supports them directly in changing their behavior. The
support might be practical assistance, like helping Henry learn to think
through tasks and organize his work. Or the support might be to
encourage new behaviors by giving praise or rewards each time the person
acts in the desired way. A cognitive-behavioral therapist might use
such techniques to help a belligerent child like Mark learn to control
his fighting, or an impulsive teenager like Lisa to think before she
Social skills training can also help children learn new behaviors.
In social skills training, the therapist discusses and models
appropriate behaviors like waiting for a turn, sharing toys, asking for
help, or responding to teasing, then gives children a chance to
practice. For example, a child might learn to "read" other people's
facial expression and tone of voice, in order to respond more
appropriately. Social skills training helped Lisa learn to join in
group activities, make appropriate comments, and ask for help. A child
like Mark might learn to see how his behavior affects others and develop
new ways to respond when angry or pushed.
Support groups connect people who have common concerns. Many
adults with ADHD and parents of children with ADHD find it useful to
join a local or national support group. Many groups deal with issues of
children's disorders, and even ADHD specifically. The national
associations listed at the back of this booklet can explain how to
contact a local chapter. Members of support groups share frustrations
and successes, referrals to qualified specialists, and information about
what works, as well as their hopes for themselves and their children.
There is strength in numbers--and sharing experiences with others who
have similar problems helps people know that they aren't alone.
Parenting skills training, offered by therapists or in special
classes, gives parents tools and techniques for managing their child's
behavior. One such technique is the use of "time out" when the child
becomes too unruly or out of control. During time outs, the child is
removed from the agitating situation and sits alone quietly for a short
time to calm down. Parents may also be taught to give the child
"quality time" each day, in which they share a pleasurable or relaxed
activity. During this time together, the parent looks for opportunities
to notice and point out what the child does well, and praise his or her
strengths and abilities.
An effective way to modify a child's behavior is through a system of
rewards and penalties. The parents (or teacher) identify a few
desirable behaviors that they want to encourage in the child--such as
asking for a toy instead of grabbing it, or completing a simple task.
The child is told exactly what is expected in order to earn the reward.
The child receives the reward when he performs the desired behavior and
a mild penalty when he doesn't. A reward can be small, perhaps a token
that can be exchanged for special privileges, but it should be something
the child wants and is eager to earn. The penalty might be removal of a
token or a brief "time out." The goal, over time, is to help children
learn to control their own behavior and to choose the more desired
behavior. The technique works well with all children, although children
with ADHD may need more frequent rewards.
In addition, parents may learn to structure situations in ways that will
allow their child to succeed. This may include allowing only one or two
playmates at a time, so that their child doesn't get overstimulated. Or
if their child has trouble completing tasks, they may learn to help the
child divide a large task into small steps, then praise the child as
each step is completed.
Parents may also learn to use stress management methods, such as
meditation, relaxation techniques, and exercise to increase their own
tolerance for frustration, so that they can respond more calmly to their
Understandably, parents who are eager to help their children want to
explore every possible option. Many newly touted treatments sound
reasonable. Many even come with glowing reports. A few are pure
quackery. Some are even developed by reputable doctors or
specialists--but when tested scientifically, cannot be proven to help.
Here are a few types of treatment that have not been scientifically
shown to be effective in treating the majority of children or adults
- restricted diets
- allergy treatments
- medicines to correct problems in the inner ear
- chiropractic adjustment and bone re-alignment
- treatment for yeast infection
- eye training
- special colored glasses
A few success stories can't substitute for scientific evidence. Until
sound, scientific testing shows a treatment to be effective, families
risk spending time, money, and hope on fads and false promises.
Today, at age 14, Mark is doing much better in school. He channels his
energy into sports and is a star player on the intramural football team.
Although he still gets into fights now and then, a child psychologist is
helping him learn to control his tantrums and frustration, and he is
able to make and keep friends. His grandparents point to him with pride
and say, "We knew he'd turn out just fine!"
Lisa is about to graduate from high school. She's better able to focus
her attention and concentrate on her work, so that now her grades are
quite good. Overcoming her depression and learning to like herself have
also given her more confidence to develop friendships and try new
Lately, she has been working with the school guidance counselor to
identify the right kind of job to look for after graduation. She hopes
to find a career that will bypass her attention problems and make the
best use of her assets and skills. She is more alert and focused and is
considering trying college in a year or two. Her counselor reminds her
that she's certainly smart enough.
These days, Henry is successful and happy in his job as a shoe salesman.
The work allows him to move around throughout the day, and the
appearance of new customers provides the variety he needs to help him
stay focused. He recently completed a course in time management, and
now keeps lists, organizes his work, and schedules his day. Now that he
has harnessed his energy, his ability to think about several things at
once allows him to be creative and productive.
He is proud that he and his wife have developed important parenting
skills for working with their son, so that he, too, is doing better at
home and at school. Henry is also pleased with his new ability to
follow through on projects. In Fact, he just finished making his son a
beautiful wooden toy chest for his birthday.
Can ADHD Be Outgrown or Cured?
Even though most people don't outgrow ADHD, people do learn to adapt and
live fulfilling lives. Mark, Lisa, and Henry are making good lives for
themselves--not by being cured, but by developing their personal
strengths. With effective combinations of medicine, new skills, and
emotional support, people with ADHD can develop ways to control their
attention and minimize their disruptive behaviors. Like Henry, they may
find that by structuring tasks and controlling their environment, they
can achieve personal goals. Like Mark, they may learn to channel their
excess energy into sports and other high energy activities. And like
Lisa, they can identify career options that build on their strengths and
As they grow up, with appropriate help from parents and clinicians,
children with ADHD become better able to suppress their hyperactivity
and to channel it into more socially acceptable behaviors, like physical
exercise or fidgeting. And although we know that half of all children
with ADHD will still show signs of the problem into adulthood, we also
know that the medications and therapy that help children also work for
All people with ADHD have natural talents and abilities that they can
draw on to create fine lives and careers for themselves. In Fact, many
people with ADHD even feel that their patterns of behavior give them
unique, often unrecognized, advantages. People with ADHD tend to be
outgoing and ready for action. Because of their drive for excitement
and stimulation, many become successful in business, sports,
construction, and public speaking. Because of their ability to think
about many things at once, many have won acclaim as artists and
inventors. Many choose work that gives them freedom to move around and
release excess energy. But some find ways to be effective in quieter,
more sedentary careers. Sally, a computer programmer, found that she
thinks best when she wears headphones to reduce distracting noises.
Like Henry, some people strive to increase their organizational skills.
Others who own their own business find it useful to hire support staff
to provide day-to-day management.
What Hope Does Research Offer?
Although no immediate cure is in sight, a new understanding of ADHD may
be just over the horizon. Using a variety of research tools and
methods, scientists are beginning to uncover new information on the role
of the brain in ADHD and effective treatments for the disorder
Such research will ultimately result in improving the personal
fulfillment and productivity of people with ADHD.
For example, the use of new techniques like brain imaging to observe how
the brain actually works is already providing new insights into the
causes of ADHD. Other research is seeking to identify conditions of
pregnancy and early childhood that may cause or contribute to these
differences in the brain. As the body of knowledge grows, scientists
may someday learn how to prevent these differences or at least how to
NIMH and the U.S. Department of Education are cosponsoring a large
national study--the first of its kind--to see which combinations of ADHD
treatment work best for different types of children. During this 5-year
study, scientists at research clinics across the country will work
together in gathering data to answer such questions as: Is combining
stimulant medication with behavior modification more effective than
either alone? Do boys and girls respond differently to treatment? How
do family stresses, income, and environment affect the severity of ADHD
and long-term outcomes? How does needing medicine affect children's
sense of competence, self-control, and self-esteem? As a result of such
research, doctors and mental health specialists may someday know who
benefits most from different types of treatment and be able to intervene
With further study, researchers may
find that ADHD actually covers a number of different disorders, each
with its own cluster of symptoms and treatment requirements. For
example, scientists are exploring whether there are any critical
differences between children with ADHD who also have anxiety,
depression, or conduct disorders and those who do not. Other
researchers are studying slight physical differences that might
distinguish one type of ADHD from another. If clusters of differences
can be found, scientists can begin to distinguish the treatment each
How do children with ADHD turn out, compared to brothers and
sisters without the disorder? As adults, how do they handle their own
children? Still other studies seek to better understand ADHD in adults.
Such studies give insights into what types of treatment or services make
a difference in helping an ADHD child grow into a caring parent and a
Animal studies are also adding to our knowledge of ADHD in humans.
Animal subjects make it possible to study some of the possible causes of
ADHD in ways that can't be studied in people. In addition, animal
research allows the safety and effectiveness of experimental new drugs
to be tested long before they can be given to humans. One
team of scientists is studying dogs to learn how new stimulant drugs
that are similar to Ritalin act on the brain.
Piece by piece, through studies of humans and animals, scientists are
beginning to understand the biological nature of attention disorders.
New research is allowing us to better understand the inner workings of
the brain as we continue to develop new medications and assess new forms
As we learn more about what actually happens inside the brain, we
approach a future where we can prevent certain brain and mental
disorders, make valid diagnoses, and treat each effectively. This is
the hope, mission, and vision of the National Institute of Mental
What Are Sources of Information and Support?
Several publications, organizations, and support groups exist to help
individuals, teachers, and families to understand and cope with
attention disorders. The following resources provide a good starting
point for gaining insight, practical solutions, and support. Other
resources are outpatient clinics of children=FEs hospitals, university
medical centers, and community mental health centers. Additional
printed information can be found at libraries and book stores.
Books for Children and Teens:
Galvin, M. "Otto Learns about his Medication." New York: Magination
Press, 1988. (for young children)
Gehret, J. "Learning Disabilities and the Don't Give Up Kid."
Fairport, New York: Verbal Images Press, 1990. (for classmates and
children with learning disabilities and attention difficulties, ages
Gordon, M. "Jumpin' Johnny, Get Back to Work! A Child's Guide to
ADHD/Hyperactivity." DeWitt, New York: GSI Publications, 1991. (for
Meyer, D.; Vadasy, P.; and Fewell, R. "Living with a Brother or Sister
with Special Needs: A Book for Sibs." Seattle: University of
Washington Press, 1985.
Moss, D. "Shelly the Hyperactive Turtle." Rockville, MD: Woodbine
House, 1989. (for young children)
Nadeau, K., and Dixon, E. "Learning to Slow Down and Pay Attention."
Annandale, VA: Chesapeake Psychological Publications, 1993.
Parker, R. "Making the Grade: An Adolescent's Struggle with ADD."
Plantation, FL: Impact Publications, 1992.
Quinn, P., and Stern, J. "Putting on the Brakes: Young People's Guide
to Understanding Attention Deficit Hyperactivity Disorder." New York:
Magination Press, 1991. (for ages 8-12)
Thompson, M. "My Brother Matthew." Rockville, MD: Woodbine House,
Books for Adults With Attention Disorders:
Adelman, P., and Wren, C. "Learning Disabilities, Graduate School, and
Careers: The Student's Perspective." Lake Forest, IL: Learning
Opportunities Program, Barat College, 1990.
Hallowell, E., and Ratey, J. "Driven to Distraction." New York:
Pantheon Books, 1994.
Hartmann, T. "Attention Deficit Disorder: A New Perception."
Lancaster, PA: Underwood-Miller, 1993.
Kelly, K., and Ramundo, P. "You Mean I'm Not Lazy, Stupid, or Crazy?!"
Cincinnati, OH: Tyrell and Jeremy Press, 1993.
Weiss, G., and Hechtman, L. (eds). "Hyperactive Children Grown Up." 2d
ed. New York: Guilford Press, 1992.
Weiss, L. "Attention Deficit Disorder in Adults." Dallas, TX: Taylor
Pub. Co., 1992.
Wender, P. "The Hyperactive Child, Adolescence, and Adult: Attention
Deficit Disorder Through the Lifespan." New York: Oxford University
Books for Parents:
Anderson, W.; Chitwood, S.; and Hayden, D. "Negotiating the Special
Education Maze: A Guide for Parents and Teachers." 2d ed. Rockville,
MD: Woodbine House, 1990.
Bain, L. "A Parent's Guide to Attention Deficit Disorders." New York:
Dell Publishing, 1991.
Barkley, R. "Defiant Children." New York: Guilford Press, 1987.
Child Psychopharmacy Center, University of Wisconsin. "Stimulants and
Hyperactive Children." Madison: 1990. (Order by calling (608)
Copeland, E., and Love, V. "Attention, Please!: A Comprehensive Guide
for Successfully Parenting Children with Attention Disorders and
Hyperactivity." Atlanta, GA: SPI Press, 1991.
Fowler, M. "Maybe You Know My Kid: A Parent's Guide to Identifying,
Understanding, and Helping your Child with ADHD." New York: Birch Lane
Goldstein, S., and Goldstein, M. "Hyperactivity: Why Won't My Child
Pay Attention?" New York: J. Wiley, 1992.
Greenberg, G.; Horn, S.; and Wade F. "Attention Deficit Hyperactivity
Disorder: Questions & Answers for Parents." Champaign, IL: Research
Ingersoll, B., and Goldstein, S. "Attention Deficit Disorder and
Learning Disabilities: Realities, Myths, and Controversial Treatments."
New York: Doubleday, 1993.
Kennedy, P.; Terdal, L.; and Fusetti, L. "The Hyperactive Child Book."
New York: St. Martrin's Press, 1993.
Moss, R., and Dunlap, H. "Why Johnny Can't Concentrate: Coping with
Attention Deficit Problems." New York: Bantam Books, 1990.
Silver, L. "Dr. Silver's Advice to Parents on Attention-Deficit
Hyperactivity Disorder." Washington, DC: American Psychiatric Press,
Vail, P. "Smart Kids with School Problems." New York: EP Dutton,
Wilson, N. "Optimizing Special Education: How Parents Can Make a
Difference." New York: Insight Books, 1992.
Windell, J. "Discipline: A Sourcebook of 50 Failsafe Techniques for
Parents." New York: Collier Books, 1991.
For individuals with a computer and modem, there are on-line bulletin
boards where parents, adults with ADHD, and medical professionals share
experiences, offer emotional support, and ask and respond to questions.
Two such on-line services include CompuServe (800) 848-8990 and
America Online (800) 827-6364. You may also wish to check with other
national and local on-line communications companies to see if they offer
Resources for Teachers and Specialists:
Barkley, R. "Attention Deficit Hyperactivity Disorder" (four 40-minute
videocassettes in VHS format). New York: Guilford Publications, 1990.
Copeland, E., and Love, V. "Attention Without Tension: A Teacher's
Handbook on Attention Disorders." Atlanta, GA: 3 C's of Childhood,
Harris, K., and Graham, S. "Helping Young Writers Master the Craft."
Cambridge, MA: Brookline Books, 1992.
Johnson, D. "I Can't Sit Still-Educating and Affirming Inattentive and
Hyperactive Children: Suggestions for Parents, Teachers, and Other Care
Providers of Children to Age 10. Santa Cruz, CA: ETR Associates, 1992.
Parker, H. "The ADD Hyperactivity Handbook for Schools." Plantation,
FL: Impact Publications, 1992.
Related Materials Available from NIH:
Attention Deficit Disorder Information Packet and "Know Your Brain Fact
Sheet." Both are available from NIH Neurological Institute, P.O. Box
5801; Bethesda, MD 20824 (800) 352-9424.
"Learning Disabilities" (NIH Pub. No. 93-3611) and "Plain Talk about
Depression' (NIH Pub. No. 93-3561). These are available by contacting:
NIMH, Room 7C-02, 5600 Fishers Lane, Rockville, MD 20857.
Support Groups and Organizations
Attention Deficit Information Network (Ad-IN)
475 Hillside Avenue
Needham, MA 02194
Provides up-to-date information on current research, regional
meetings. Offers aid in finding solutions to practical problems
faced by adults and children with an attention disorder.
300 NW 70th Avenue
Plantation, FL 33317
Distributes books, tapes, videos, assessment on attention deficit
hyperactivity disorders. A central location for ordering many of
the books listed above. Call for catalog.
Center for Mental Health Services
Office of Consumer, Family, and Public Information
5600 Fishers Lane, Room 15-105
Rockville, MD 20857
This national center, a component of the U.S. Public Health
Service, provides a range of information on mental health,
treatment, and support services.
Children and Adults with Attention Deficit Disorders (CH.A.D.D.)
499 NW 70th Avenue, Suite 109
Plantation, FL 33317
A major advocate and key information source for people dealing
with attention disorders. Sponsors support groups and publishes
two newsletters concerning attention disorders for parents and
Council for Exceptional Children
11920 Association Drive
Reston, VA 22091
Provides publications for educators. Can also provide referral to
ERIC (Educational Resource Information Center) Clearinghouse for
Handicapped and Gifted Children.
Federation of Families for Children's Mental Health
1021 Prince Street
Alexandria, VA 22314
Provides information, support, and referrals through federation
chapters throughout the country. This national parent-run
organization focuses on the needs of children with broad mental
HEATH Resource Center
American Council on Education
1 Dupont Circle, Suite 800
Washington, DC 20036
A national clearinghouse on post-high school education for people
Learning Disabilities Association of America
4156 Library Road
Pittsburgh, PA 15234
Provides information and referral to state chapters, parent
resources, and local support groups. Publishes news briefs and a
National Association of Private Schools for Exceptional Children
1522 K Street, NW, Suite 1032
Washington, DC 20005
Provides referrals to private special education programs.
National Center for Learning Disabilities
99 Park Avenue, 6th Floor
New York, NY 10016
Provides referrals and resources. Publishes Their World magazine
describing true stories on ways children and adults cope with LD.
National Clearinghouse for Alcohol and Drug Information
P.O. Box 2345
Rockville, MD 20847
Provides information on the risks of alcohol during pregnancy, and
fetal alcohol syndrome.
National Information Center for Children and Youth with Disabilities
P.O. Box 1492
Washington, DC 20013
Publishes free, Fact-filled newsletters. Arranges workshops.
Advises parents on the laws entitling children with disabilities
to special education and other services.
Sibling Information Network
A.J. Pappanikou Center
1776 Ellington Road
South Windsor, CT 06074
Publishes a newsletter for and about siblings of children with
Tourette Syndrome Association
42-40 Bell Boulevard
Bayside, NY 11361
State and local chapters provide national information, advocacy,
research, and support.
Message From The National Institute of Mental Health
Research conducted and supported by the National Institute of Mental Health brings hope to millions of people who suffer from
mental illness and to their families and friends. In many years of work with animal as well as human subjects, researchers have
advanced our understanding of the brain and vastly expanded the capability of mental health professionals to diagnose, treat, and
prevent mental and brain disorders.
Now, in the 1990s, which the President and Congress have declared the "Decade of the Brain," we stand at the threshold of a new
era in brain and behavioral sciences. Through research, we will learn even more about mental and brain disorders such as
depression, bipolar disorder, schizophrenia, panic disorder, obsessive-compulsive disorder, and attention deficit hyperactivity
disorder. And we will be able to use this knowledge to develop new therapies that can help more people overcome mental illness.
The National Institute of Mental Health is part of the National Institutes of Health (NIH), the Federal Government's primary agency
for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services.
All material in this publication is free of copyright restrictions and may be copied, reproduced, or duplicated without permission
from NIMH; citation of the source is appreciated.
This booklet was written by Sharyn Neuwirth, M.Ed., an education writer and instructional designer in Silver Spring, MD. Scientific
information and review was provided by NIMH staff members L. Eugene Arnold, M.D.; F. Xavier Castellanos, M.D.; and Alan J.
Zametkin, M.D. Also providing review and assistance were Russell A. Barkley, Ph.D., University of Massachusetts Medical
School; Eileen Weiner-Dwyer, Ph.D., and Kevin Dwyer, M.A., N.C.S.P., of the Montgomery County (Maryland) Schools; JoAnne
Evans, R.N., Children and Adults with Attention Deficit Disorders; Jane Hauser, U.S. Department of Education; Reid Lyon, Ph.D.,
National Institute of Child Health and Human Development; Harvey C. Parker, Ph.D., A.D.D. Warehouse; Larry B. Silver, M.D.,
Georgetown University. Editorial direction was provided by Lynn J. Cave, NIMH.
U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute of Mental Health
NIH Publication No. 96-3572
Printed 1994, Reprinted 1996
This publication is available for purchase from the U.S. Government Printing Office S/N 017-024-01543-1
Updated: June 28, 2002