What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a common condition that is caused by parts of the brain not functioning in the usual way. In most cases, ADHD first appears in early childhood. Often, the symptoms and associated problems continue into adulthood. A recent US study estimated that 4% of adults have ADHD. There are effective treatments available.
What causes ADHD?
In people with ADHD, there are problems with areas of the brain that control certain behaviours – such as starting tasks, being able to stop unwanted behaviour, understanding consequences, remembering information and being able to plan for the future.
We do not know the exact cause of ADHD. In most cases, the condition is inherited, but both genetic and environmental factors are thought to play a role. Environmental factors that increase the risk of developing ADHD include: brain injury or infection, lack of oxygen or exposure to nicotine or large amounts of alcohol before birth, premature birth, and difficult experiences in early childhood.
Difficulty concentrating, restlessness and impulsiveness are the key symptoms of ADHD. Although everyone can display some of these behaviours sometimes, in people with ADHD the behaviours are more severe and occur more often.
People who have difficulty concentrating may:
- be unable to focus on a task for a long period of time
- show a lack of attention to detail
- be disorganised and forget things quickly
- be easily distracted and delay attending to tasks
- have erratic working habits
- forget appointments and display poor time management.
People who have symptoms of restlessness may:
- appear agitated or nervous
- be unable to sit and concentrate
- talk in a way that is hard to understand
- talk continuously without being aware of their surroundings.
People who have symptoms of impulsiveness may:
- act without appropriate prompts
- be spontaneous and hasty with words and actions
- not consider the consequences of their actions
- interrupt other people frequently or inappropriately
- approach people and tasks in an unplanned way.
- be unable to control their emotions, for example they may be impatient, have a hot temper and be irritable.
Impulsive behaviour is strongly associated with money mismanagement, traffic infringements, poorly thought-out job changes, lower levels of education, and experimentation or abuse of drugs or alcohol.
Not everyone with ADHD has all of these symptoms, and the severity of the symptoms can vary. Despite the name of the condition, not all people with ADHD have symptoms of hyperactivity (also described as restlessness).
In addition to the main symptoms, people with ADHD often also have low confidence, poor self-esteem, and a sense of failure, depression and anxiety resulting from their lack of control and unwanted behaviour. Other mental health problems are also common, for example depression, anxiety, bipolar and substance abuse disorders.
How do I find out if I have ADHD?
There are no laboratory tests, such as blood tests or scans, to determine if you have ADHD. The only way to find out is by undergoing an assessment with a medical professional – usually a psychiatrist. Psychiatrists are medical doctors who are specialists in the treatment of mental illness.
If you think you may have ADHD, the first step is to see your family doctor (GP) to discuss your concerns. After speaking with you, he/she may refer you to a psychiatrist for further assessment.
The assessment takes the form of an interview to discuss your symptoms and problems. The medical professional you see may want to also talk to your partner or family. You will only be diagnosed with ADHD if the symptoms seriously affect your everyday life.
A full medical assessment is important because there are other possible causes of the problems that need to be ruled out. Psychological tests and rating scales alone cannot be used to make a diagnosis, but they can help find out if you have any learning or social problems. A neuropsychological assessment can be helpful for identifying whether you have any particular areas of cognitive weakness, which can help with occupational and educational planning.
If you are diagnosed with ADHD, and you agree with your psychiatrist that you wish to undergo treatment, he or she will develop an individual treatment plan that's right for you. Treatments are aimed at reducing the symptoms, but won't cure you of the condition.
If your ADHD is causing serious difficulties in your everyday life, your treatment plan will usually include medication – usually either methylphenidate (sold under the names Ritalin, Attenta and Concerta) or dexamphetamine. These medications, known as psychostimulants, are restricted medications in Australia and New Zealand. This means that they can only be prescribed by doctors with special authorisation, and they must follow strict regulations when prescribing them. Your doctor should explain to you the significance of these regulations.
The medication will most probably be combined with psychosocial treatments such as psycho-education, cognitive therapy, support groups, and counselling (including ADHD coaching and mentoring). Management of ADHD typically requires the involvement of multiple health-care providers.
Your treatment plan should be developed in collaboration with you, your partner and your family according to:
- your individual needs
- the seriousness of the problems
- the presence of other physical or mental disorders.
While you are undergoing treatment, it is important that a medical practitioner monitors your general physical health. They will check for any side-effects of medications and the presence of other physical or psychological disorders. These may include substance abuse, mood disorders and anxiety disorders.
The RANZCP recommends the following guides for members of the public interested in learning more about ADHD.
About these links Rather than develop its own guidelines on this topic, the RANZCP gathered a group of experts to review a range of local and international guidelines, and choose the ones best suited for use in Australia and New Zealand. Consumer and carer representatives also had extensive input.
Interested in information for clinicians? Visit our Adult ADHD practice guidelines page.