How do our brains determine what to focus on, and for how long? We each process and react to stimuli with varying levels of speed, focus, and responsiveness. But some may have more difficulty maintaining attention or controlling impulses, which can impact expected behavior.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood conditions. *From 2016-2019, approximately 10% of children in the U.S. between the ages of 3 and 17 had received an ADHD diagnosis at some point in their lives. The disorder continues into adulthood for at least around 30% of those diagnosed with ADHD, although this estimate may vary.
ADHD is usually characterized by inattentiveness, as well as hyperactivity or impulsive behaviors. Although all young children can be hyperactive, impulsive, and inattentive from time to time, these symptoms are more extreme and last longer in children with ADHD. They often struggle to form strong friendships, and their grades in school can reflect their behavior instead of their academic ability. Executive functions, such as finishing what they start, remembering to bring homework back to school, and following multistep directions, can be especially challenging for those with ADHD. Youths with ADHD also have lower rates of high school graduation and a higher risk of suicide.
No objective diagnostic test currently exists for ADHD, so a diagnosis requires a comprehensive evaluation, including a clinical interview and parent and teacher ratings. Because problems with attention and hyperactivity can be caused by other conditions such as depression, sleep issues, and learning disorders, careful evaluation is always needed to determine whether ADHD is truly the cause of the child’s symptoms. To warrant an ADHD diagnosis, attention and behavioral problems must be severe enough that they interfere with day-to-day functions. In addition, the behavioral issues must be present in more than one context — not only at home or at school, but in both settings.
Although ADHD tends to run in families, no well-defined set of genes is known to be responsible for the condition. Environmental risk factors, such as extreme early adversity, exposure to lead, and low birthweight, can also be involved. People with ADHD do not demonstrate any obvious brain alterations, but research has found that people with ADHD might have differences in brain structure and in the brain’s ability to remodel itself. Some people with ADHD also show unusual activity in brain cells that release dopamine, a chemical messenger involved in rewarding behavior.
ADHD has no cure, but treatments include drugs, behavioral interventions, or both. ADHD medications include stimulants such as methylphenidate, as well as newer, non-stimulant drugs. Some drugs are available in long-acting formulations so children do not have to interrupt the school day to take their medication. Determining the right drug and the right dose might require a period of experimentation and support from a specialist, since dosage is adjusted to how fast a child metabolizes the drug, and to minimize the side effects. Effective behavioral treatments include organizational support, exercise, and meditation.
Adapted from the 8th edition of Brain Facts by Karen Weintraub.
*This statistic was updated March 27, 2023, to reflect the most recent CDC data on ADHD prevalence.
If you or someone you know in the U.S. is struggling with self-harm or thoughts of suicide, visit or call the National Suicide Prevention Lifeline at 988 or 1-800-273-8255.
About the Author
Karen Weintraub is a long-time health/science journalist on staff at USA TODAY, where she covers infectious diseases, public health, and other medical conditions. She co-wrote books with Harvard-affiliated doctors — The Autism Revolution with Dr. Martha Herbert (Ballantine Books, 2012) and Fast Minds: How to Thrive If You Have ADHD (Or Think You Might) with Drs. Craig Surman and Tim Bilkey (Berkley, 2014) — as well as one on a history of innovation in her adopted hometown of Cambridge, Massachusetts, Born in Cambridge (MIT Press, 2022).
CONTENT PROVIDED BY
BrainFacts/SfN
References
Allen, E. G., Freeman, S. B., Druschel, C., Hobbs, C. A., O'Leary, L. A., Romitti, P. A., Royle, M. H., Torfs, C. P., & Sherman, S. L. (2009). Maternal age and risk for trisomy 21 assessed by the origin of chromosome nondisjunction: a report from the Atlanta and National Down Syndrome Projects. Human genetics, 125(1), 41–52. https://doi.org/10.1007/s00439-008-0603-8
Barbaresi, W. J., Colligan, R. C., Weaver, A. L., Voigt, R. G., Killian, J. M., & Katusic, S. K. (2013). Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics, 131(4), 637–644. https://doi.org/10.1542/peds.2012-2354
Bishop D. V. (2015). The interface between genetics and psychology: lessons from developmental dyslexia. Proceedings. Biological sciences, 282(1806), 20143139. https://doi.org/10.1098/rspb.2014.3139
Casanova, J. R., Nishimura, M., & Swann, J. W. (2014). The effects of early-life seizures on hippocampal dendrite development and later-life learning and memory. Brain research bulletin, 103, 39–48. https://doi.org/10.1016/j.brainresbull.2013.10.004
Casanova, M. (2015). The Neuropathology of Autism. In: Fatemi, S. (eds) The Molecular Basis of Autism. Contemporary Clinical Neuroscience. Springer, New York, NY. 153-171. https://doi.org/10.1007/978-1-4939-2190-4_8
Christensen, D. L., Baio, J., Braun, K. V., Bilder, D., Charles, J., Constantino, J. N., Daniels, J., Maureen, S. Durkin, M. S., Robert, T., Fitzgerald, R. T., Kurzius-Spencer, M., Lee, L., Pettygrove, S., Robinson, C., Schulz, E., Wells, C., Wingate, M. S., Zahorodny, W., Yeargin-Allsopp, M. (2016). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ 2016;65(No. SS-3)(No. SS-3):1–23. DOI: http://dx.doi.org/10.15585/mmwr.ss6503a1external icon.
Chronis-Tuscano, A., Molina, B. S., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of general psychiatry, 67(10), 1044–1051. https://doi.org/10.1001/archgenpsychiatry.2010.127
Durkin, M. S., Maenner, M. J., Newschaffer, C. J., Lee, L. C., Cunniff, C. M., Daniels, J. L., Kirby, R. S., Leavitt, L., Miller, L., Zahorodny, W., & Schieve, L. A. (2008). Advanced parental age and the risk of autism spectrum disorder. American journal of epidemiology, 168(11), 1268–1276. https://doi.org/10.1093/aje/kwn250
Emerson, R. W., Adams, C., Nishino, T., Hazlett, H. C., Wolff, J. J., Zwaigenbaum, L., Constantino, J. N., Shen, M. D., Swanson, M. R., Elison, J. T., Kandala, S., Estes, A. M., Botteron, K. N., Collins, L., Dager, S. R., Evans, A. C., Gerig, G., Gu, H., McKinstry, R. C., Paterson, S., … Piven, J. (2017). Functional neuroimaging of high-risk 6-month-old infants predicts a diagnosis of autism at 24 months of age. Science translational medicine, 9(393), eaag2882. https://doi.org/10.1126/scitranslmed.aag2882
Finn, E. S., Shen, X., Holahan, J. M., Scheinost, D., Lacadie, C., Papademetris, X., Shaywitz, S. E., Shaywitz, B. A., & Constable, R. T. (2014). Disruption of functional networks in dyslexia: a whole-brain, data-driven analysis of connectivity. Biological psychiatry, 76(5), 397–404. https://doi.org/10.1016/j.biopsych.2013.08.031
Fisch, H., Hyun, G., Golden, R., Hensle, T. W., Olsson, C. A., & Liberson, G. L. (2003). The influence of paternal age on down syndrome. The Journal of urology, 169(6), 2275–2278. https://doi.org/10.1097/01.ju.0000067958.36077.d8
Frazier, T. W., Klingemier, E. W., Beukemann, M., Speer, L., Markowitz, L., Parikh, S., Wexberg, S., Giuliano, K., Schulte, E., Delahunty, C., Ahuja, V., Eng, C., Manos, M. J., Hardan, A. Y., Youngstrom, E. A., & Strauss, M. S. (2016). Development of an Objective Autism Risk Index Using Remote Eye Tracking. Journal of the American Academy of Child and Adolescent Psychiatry, 55(4), 301–309. https://doi.org/10.1016/j.jaac.2016.01.011
Geschwind, D. H., & State, M. W. (2015). Gene hunting in autism spectrum disorder: on the path to precision medicine. The Lancet. Neurology, 14(11), 1109–1120. https://doi.org/10.1016/S1474-4422(15)00044-7
Guastella, A. J., & Hickie, I. B. (2016). Oxytocin Treatment, Circuitry, and Autism: A Critical Review of the Literature Placing Oxytocin Into the Autism Context. Biological psychiatry, 79(3), 234–242. https://doi.org/10.1016/j.biopsych.2015.06.028
Hallmayer, J., Cleveland, S., Torres, A., et al. Genetic Heritability and Shared Environmental Factors Among Twin Pairs With Autism. Arch Gen Psychiatry. 2011;68(11):1095–1102. doi:10.1001/archgenpsychiatry.2011.76
Helguera, P., Seiglie, J., Rodriguez, J., Hanna, M., Helguera, G., & Busciglio, J. (2013). Adaptive downregulation of mitochondrial function in down syndrome. Cell metabolism, 17(1), 132–140. https://doi.org/10.1016/j.cmet.2012.12.005
Hornig, M., Bresnahan, M. A., Che, X., Schultz, A. F., Ukaigwe, J. E., Eddy, M. L., Hirtz, D., Gunnes, N., Lie, K. K., Magnus, P., Mjaaland, S., Reichborn-Kjennerud, T., Schjølberg, S., Øyen, A. S., Levin, B., Susser, E. S., Stoltenberg, C., & Lipkin, W. I. (2018). Prenatal fever and autism risk. Molecular psychiatry, 23(3), 759–766. https://doi.org/10.1038/mp.2017.119
Jiang, J., Jing, Y., Cost, G. J., Chiang, J. C., Kolpa, H. J., Cotton, A. M., Carone, D. M., Carone, B. R., Shivak, D. A., Guschin, D. Y., Pearl, J. R., Rebar, E. J., Byron, M., Gregory, P. D., Brown, C. J., Urnov, F. D., Hall, L. L., & Lawrence, J. B. (2013). Translating dosage compensation to trisomy 21. Nature, 500(7462), 296–300. https://doi.org/10.1038/nature12394
Kasparek, T., Theiner, P., & Filova, A. (2015). Neurobiology of ADHD From Childhood to Adulthood: Findings of Imaging Methods. Journal of attention disorders, 19(11), 931–943. https://doi.org/10.1177/1087054713505322
Katsnelson, A., Buzsáki, G., & Swann, J. W. (2014). Catastrophic childhood epilepsy: a recent convergence of basic and clinical neuroscience. Science translational medicine, 6(262), 262ps13.
Kozlowski, A. M., Matson, J. L., Horovitz, M., Worley, J. A., & Neal, D. (2011). Parents' first concerns of their child's development in toddlers with autism spectrum disorders. Developmental neurorehabilitation, 14(2), 72–78. https://doi.org/10.3109/17518423.2010.539193
Lainhart J. E. (2015). Brain imaging research in autism spectrum disorders: in search of neuropathology and health across the lifespan. Current opinion in psychiatry, 28(2), 76–82. https://doi.org/10.1097/YCO.0000000000000130
Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of general psychiatry, 63(6), 694–701. https://doi.org/10.1001/archpsyc.63.6.694
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (2016). Autism Spectrum Disorder (ASD): Data & Statistics. Centers for Disease Control. https://www.cdc.gov/ncbddd/autism/data.html
Nei, M., Ngo, L., Sirven, J. I., & Sperling, M. R. (2014). Ketogenic diet in adolescents and adults with epilepsy. Seizure, 23(6), 439–442. https://doi.org/10.1016/j.seizure.2014.02.015
Norton, E. S., & Wolf, M. (2012). Rapid automatized naming (RAN) and reading fluency: implications for understanding and treatment of reading disabilities. Annual review of psychology, 63, 427–452. https://doi.org/10.1146/annurev-psych-120710-100431
Ozernov-Palchik, O., & Gaab, N. (2016). Tackling the 'dyslexia paradox': reading brain and behavior for early markers of developmental dyslexia. Wiley interdisciplinary reviews. Cognitive science, 7(2), 156–176. https://doi.org/10.1002/wcs.1383
Ozonoff, S., Young, G. S., Carter, A., Messinger, D., Yirmiya, N., Zwaigenbaum, L., Bryson, S., Carver, L. J., Constantino, J. N., Dobkins, K., Hutman, T., Iverson, J. M., Landa, R., Rogers, S. J., Sigman, M., & Stone, W. L. (2011). Recurrence risk for autism spectrum disorders: a Baby Siblings Research Consortium study. Pediatrics, 128(3), e488–e495. https://doi.org/10.1542/peds.2010-2825
Papavassiliou, P., Charalsawadi, C., Rafferty, K., & Jackson-Cook, C. (2015). Mosaicism for trisomy 21: a review. American journal of medical genetics. Part A, 167A(1), 26–39. https://doi.org/10.1002/ajmg.a.36861
Paulesu, E., Danelli, L., & Berlingeri, M. (2014). Reading the dyslexic brain: multiple dysfunctional routes revealed by a new meta-analysis of PET and fMRI activation studies. Frontiers in human neuroscience, 8, 830. https://doi.org/10.3389/fnhum.2014.00830
Presson, A. P., Partyka, G., Jensen, K. M., Devine, O. J., Rasmussen, S. A., McCabe, L. L., & McCabe, E. R. (2013). Current estimate of Down Syndrome population prevalence in the United States. The Journal of pediatrics, 163(4), 1163–1168. https://doi.org/10.1016/j.jpeds.2013.06.013
Schendel, D., & Bhasin, T. K. (2008). Birth weight and gestational age characteristics of children with autism, including a comparison with other developmental disabilities. Pediatrics, 121(6), 1155–1164. https://doi.org/10.1542/peds.2007-1049
Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). What have we learnt about the causes of ADHD?. Journal of child psychology and psychiatry, and allied disciplines, 54(1), 3–16. https://doi.org/10.1111/j.1469-7610.2012.02611.x
Tolaymat, A., Nayak, A., Geyer, J. D., Geyer, S. K., & Carney, P. R. (2015). Diagnosis and management of childhood epilepsy. Current problems in pediatric and adolescent health care, 45(1), 3–17. https://doi.org/10.1016/j.cppeds.2014.12.002
Tomasi, D., & Volkow, N. D. (2014). Functional connectivity of substantia nigra and ventral tegmental area: maturation during adolescence and effects of ADHD. Cerebral cortex (New York, N.Y. : 1991), 24(4), 935–944. https://doi.org/10.1093/cercor/bhs382
Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., Perou, R., & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. Journal of the American Academy of Child and Adolescent Psychiatry, 53(1), 34–46.e2. https://doi.org/10.1016/j.jaac.2013.09.001
Willsey, A. J., & State, M. W. (2015). Autism spectrum disorders: from genes to neurobiology. Current opinion in neurobiology, 30, 92–99. https://doi.org/10.1016/j.conb.2014.10.015
Wiseman, F. K., Al-Janabi, T., Hardy, J., Karmiloff-Smith, A., Nizetic, D., Tybulewicz, V. L., Fisher, E. M., & Strydom, A. (2015). A genetic cause of Alzheimer disease: mechanistic insights from Down syndrome. Nature reviews. Neuroscience, 16(9), 564–574. https://doi.org/10.1038/nrn3983
Witton, J., Padmashri, R., Zinyuk, L. E., Popov, V. I., Kraev, I., Line, S. J., Jensen, T. P., Tedoldi, A., Cummings, D. M., Tybulewicz, V. L. J., Fisher, E. M. C., Bannerman, D. M., Randall, A. D., Brown, J. T., Edwards, F. A., Rusakov, D. A., Stewart, M. G., & Jones, M. W. (2015). Hippocampal circuit dysfunction in the Tc1 mouse model of Down syndrome. Nature neuroscience, 18(9), 1291–1298. https://doi.org/10.1038/nn.4072
Young, L. J., & Barrett, C. E. (2015). Neuroscience. Can oxytocin treat autism? Science (New York, N.Y.), 347(6224), 825–826. https://doi.org/10.1126/science.aaa8120
Zuberi, S. M., & Symonds, J. D. (2015). Update on diagnosis and management of childhood epilepsies. Jornal de pediatria, 91(6 Suppl 1), S67–S77. https://doi.org/10.1016/j.jped.2015.07.003
