ADHD, attention deficit hyperactivity disorder, is a neurodevelopmental condition that affects attention, activity levels and impulse control. In adults it appears as trouble holding attention, disorganisation, restlessness and acting without thinking. ADHD does not begin in adulthood: symptoms must have started in childhood and continued since.
Key points
- ADHD affects attention, activity levels and impulse control. It begins in childhood and continues into adult life.
- Three presentations are recognised: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
- Under NICE guidance, only a specialist psychiatrist, paediatrician or other appropriately qualified trained professional can diagnose ADHD; a GP refers instead.
- Girls and women are less likely to be referred, more likely to have undiagnosed ADHD, and more likely to be given an incorrect diagnosis.
- NICE recommends medication for adults whose symptoms still impair daily life after changes to their environment, with non-drug support instead or alongside.
Symptoms
- Inattention: losing focus on tasks that are not urgent, losing track of belongings or deadlines, difficulty starting or finishing tasks.
- Hyperactivity and impulsivity: restlessness, difficulty sitting still, talking a lot or interrupting, deciding quickly without weighing consequences.
- Visible overactivity often settles with age into internal restlessness; inattention persists and shows more with adult self-organisation demands.
Causes and risk factors
- Heritability of childhood ADHD is estimated at around 70 to 80% in family and twin studies; no single gene causes it.
- Higher rates among people born preterm, with epilepsy or acquired brain injury, or with autism or a learning disability.
- Not caused by parenting, sugar or screen use, despite popular belief.
Treatment
- Information, support and changes to environment come before medication; non-drug support is a structured psychological intervention plus regular follow-up.
- First-line medication for adults: lisdexamfetamine or methylphenidate. If neither is tolerated, atomoxetine.
- Prescribing usually moves to primary care under a shared care protocol once dose is settled, which some GP practices decline.
When to speak to a professional
- Difficulty with attention, restlessness or impulsive decisions is causing lasting problems at work, in study or in relationships, and the pattern goes back to childhood.
- You are using alcohol or drugs to manage symptoms, or low mood or anxiety is building.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.