This fact sheet includes summary information and lists of sources of further help.

What is ADHD?

ADHD, attention deficit hyperactivity disorder, and ADD, attention deficit disorder, refer to a range or problems associated with poor attention span. ADHD is the most common childhood-onset behavioural disorder, but it can be difficult to diagnose. It greatly reduces a child’s ability to maintain attention without being distracted, to control what he/she does or says or to judge the amount of physical activity appropriate to a situation. It prevents children from learning and socialising well.

The behavioural problems and learning difficulties associated with ADHD can range from mild to severe. Many children may be very active or easily distracted or have difficulty concentrating. Where these behaviours are relatively mild, they are not usually considered a disorder. In more severe cases there are a number or treatments which can bring significant improvements.

Most parents worry about the behaviour of their child at some time, and untamed behaviour is a normal part of development. The difference between ‘normal’ behaviour and ADHD is one of extremes. An ADHD child will show the same challenging behaviour in all settings, wherever he/she is and whoever he/she is with. ADHD children need special help as without it the condition can be damaging to them, their families and their futures.

What are the symptoms of ADHD?

The symptoms are grouped under three problem areas: attention, hyperactivity and impulsivity. A child with ADHD will usually have characteristics of each of these and will show them in more than one setting, for example at home and at school.

Children can be very young when these problems start. Parents often describe ADHD children as ‘motor driven’; they are frequently restless and always on the go. They can be very clumsy, always asking for attention and very disruptive amongst other children. They can exceptionally untidy, disorganised and forgetful.

ADHD children are always highly impulsive. They act and speak without thinking, and say and do things they shouldn’t. This can lead to a reputation for acting stupidly. Indeed learning is very difficult for them because they are so easily distracted. Their work is careless and full of mistakes, writing is especially difficult. Teachers will note that such children never sit still, flit from task to task, never finish anything and seem not to pay attention to what they are told.

Making friends can be extremely hard for these children. They are bossy and talkative, often butting in and not listening to others. They can also be moody and other children may find them disturbing. As they grow older their physical restlessness can become a sort of inner jitteriness. Their frustration and dismay at what they can’t control only makes their problems worse.

It must be remembered that all children misbehave occasionally. Extreme or inappropriate behaviour doesn’t necessarily mean there is anything wrong. But if the behaviour has been going on for a long time it may mean there is a problem of some kind, though not necessarily ADHD.  The indicators below may help you assess your child’s problems. You should discuss these with your GP and your child’s teachers in order to find out more and get appropriate help for your child.

Problems with attention

A child is thought to have significant attention problems if he or she has shown at least six of the following listed symptoms for at least six months. These characteristics would be otherwise unusual for the child’s age and level of intelligence.

  • Paying attention - does not pay close attention to detail or makes careless errors during work or play.
  • Finishing things - does not finish tasks or maintain attention in play activities.
  • Listening - seems not to listen to what he or she is told.
  • Following instructions - does not follow through instructions or finish homework or chores (not because of confrontational behaviour or failure to understand).
  • Disorganisation - about tasks and activities.
  • Putting things off – avoiding tasks like homework that require sustained mental effort.
  • Losing things - such as pencils, books or toys.
  • Distraction – is easily sidetracked.
  • Absent mindedness– is forgetful in the course of daily activities.


In a similar way, hyperactivity is detected by looking for certain symptoms. These are not the same as normal boisterous or enthusiastic childish behaviour. At least three of the following may be noticeable over a six month period if a child is hyperactive. Again, these would be unusual for the child’s age and intelligence:

  • Restless - runs around or climbs over things excessively.
  • Noisy - unduly loud in play, or finds it hard to take part in quiet activities.
  • Cannot sit still - leaves his/her seat in class or in other situations where remaining seated is expected.
  • Fidgets – plays with hands or feet or squirms on his/her seat.


At least one of the following symptoms of impulsiveness may have occurred at least for six months to an extent that is unusual for  the child’s age and level of intelligence.

  • Blurting out - gives answers before questions are completed.
  • Difficulty waiting – does not stand in line or await turns in games or group situations.
  • Interrupting - intrudes on others, for example by butting into conversations or games.
  • Talking excessively - without responding to normal social cues and manners.

Who does ADHD affect?

Quantifying ADHD is not straightforward as different experts use different terms and definitions. This can become very confusing for parents and everyone else involved. Figures from the USA suggest that between three and seven schoolchildren in very hundred could be affected, but others in the UK think the figure may be more like one to three percent.

It seems more boys than girls receive this diagnosis, but the reasons are far from clear. As the condition relates to behaviour, assessment of children may be affected by what society expects the behaviour of children of different genders or backgrounds to be like.  
Clearly it is difficult to achieve a ‘true’ picture of ADHD. For this reason it has been suggested that ADHD should be regarded as a way of defining a set of behaviours which is open to change, not as a specific ‘illness’.

Could it be something else?

The symptoms and characteristics associated with ADHD could also be signs other medical disorders or learning problems.

Conditions which may produce similar symptoms

Epilepsy - grand mal or petit mal epileptic seizures can make a child drowsy and impair his/her attention. Epilepsy can also cause unusual behaviour and lead to abnormal perceptions.

Hearing problems - such as deafness or glue ear can make it hard for a child to follow instructions and make them seem inattentive.

Reading problems - make it hard for a child to complete tasks or follow instructions.

Obsessive compulsive disorder (OCD) - leads children to follow rituals that preoccupy their thoughts and distract their attention.

Tourette's syndrome – which involves repetitive, involuntary jerking movements of the body and sudden outbursts of noise or swearing.

Autism and Asperger's syndrome - these often lead to difficulties in understanding and using language.

Lack of sleep - prolonged periods of insufficient sleep can cause poor concentration.

What other difficulties are associated with ADHD?

ADHD often occurs alongside other difficulties and is not the sole cause of problem behaviour. For example, children may have temper tantrums and sleep problems or may be clumsy.

Other behavioural problems that can occur with ADHD:

Confrontational defiant behaviour – the child loses his/her temper, argues and refuses to comply with adults and deliberately annoys others.

Conduct disorders - the child may be destructive or show deceitful behaviour such as lying, breaking rules and stealing.

Learning difficulties - including dyslexia.

Severe clinical depression


What causes ADHD?

It is not clear why children develop ADHD and there may be a number of factors which contribute to the disorder.

Genetic and biological factors

Families – a child with ADHD is four times as likely to have a relative who has ADHD or who had the same difficulties in childhood. Studies of twins suggest a genetic link to ADHD. In 80-90 per cent of identical twins where one has ADHD so does the other. Recent research also suggests there is a greater chance of inheriting the condition from male relatives such as grandfathers and uncles.

Brain injuries - due to birth trauma or pre-birth problems. The brain structures believed to be linked to the development of ADHD are vulnerable to damage caused by lack of oxygen during birth.

Chemical deficiency – many doctors, particularly in the USA, think a shortage of brain chemicals may affect how a child concentrates, plans and acts.

Stress and Environmental factors

Family stress – it has been suggested that stress may trigger ADHD. Stress can clearly affect parents’ relationships with their children and make them more disruptive. Families with an ADHD diagnosed child often show signs of stress; but if home feels very disrupted and confidence is low then stress is very likely. So it is unclear whether stress or ADHD comes first.

Foods and additives – there is also a theory that some foods and food additives, or exposure to lead, could be responsible for symptoms of ADHD, although some experts are doubtful. If you think some foods are making your child over excited or irritable it may be very helpful to try changes to diet such as cutting out drinks or foods containing caffeine or many additives. It is always important to talk to a doctor or dietician before doing so.

Do children outgrow ADHD?.

Many children do grow out of their problems. It seems that the more help a child gets, and the earlier it starts, the more likely it is that he/she will grow up to lead a positive, successful life. The longer hyperactivity or behavioural problems persist untreated then the greater the chance of deeper problems both at home and at school. School and family have an enormous influence on any child’s development; persistent challenging behaviour can cause negative reactions from family and teachers which may have life-long effects.

Sometimes hyperactive children do go on to develop problems in adult life which can include drug or alcohol abuse or anti-social or criminal behaviour. But many experts think such patterns may be due to factors other than a diagnosis of ADHD.

How is ADHD diagnosed?

There is no single diagnostic test for ADHD, nor are there DNA tests, blood tests or other laboratory tests to confirm a diagnosis. Parents often begin the process of getting a diagnosis by talking to their GP or their child’s teacher. A GP will refer the child on to further specialists if ADHD is suspected; GPs often rely heavily on parents to identify ADHD in the first instance. A child mental health expert, such as child psychiatrist, educational psychologist or paediatrician will usually then make the diagnosis based on tests and a range of supplementary information from people who know the child.

The tests that may be involved are based on DSM-IV (the American Psychiatric Association’s diagnostic method) or ICD-10 (its European counterpart). One of the expert’s aims will be to rule out other possible causes for the child’s behaviour such as language or hearing problems, dyslexia, autism, epilepsy or depression.

Different sorts of information will need to be gathered. It will often be appropriate for professionals such as psychologists, speech therapists, teachers and health visitors to contribute their observations to the assessment of a child with possible ADHD. The information needed includes:

History of symptoms

The precise nature of the child’s behavioural difficulties, when they were first noticed, in what situations they occur, and what things or factors make them worse or better.

Medical history

Risk factors -  that it is thought could contribute to ADHD. These include difficulties and risks in pregnancy and during birth. For example it could be significant that the mother was in poor health, very young, drank alcohol, smoked or had an extended or complicated labour .

Certain medical conditions – several are known to be associated with ADHD. These include fragile-X syndrome, foetal alcohol syndrome, G6PD deficiency, phenylketonuria and generalised resistance to thyroid hormone.

Accidents, operations and chronic medical conditions -  such as epilepsy, asthma and heart, liver and kidney disorders all need to be taken in to account. Also of possible relevance is any medication the child is taking, as well as any adverse reactions they have had to medication in the past.

Psychiatric history

Looking into any mental health problems the child has had can help rule out depression or anxiety being behind the symptoms.

Educational history

The child’s levels of attainment, his/her abilities and any specific difficulties, how he/she functions within the class peer group and gets on with teachers will probably be looked at. Any behaviour difficulties which have led to suspensions or exclusions will be recorded. A more detailed evaluation of the child's learning by a psychologist may be necessary.

Temperament and personality

The child's temperament and personality, those of other family members and the nature of relationships within the family may need to be assessed. This will include discussion of the methods used by the parents to manage the child's behaviour and how successful they have been.

Family history

The mental and physical health of the child's parents and other family members can be relevant, particularly if other family members have been diagnosed with ADHD or depression.

Social assessment

The family's social circumstances, such as housing, income, and social support may all have an impact on the child's behaviour.

What treatment is available for ADHD?

Treatment will depend on the child's exact diagnosis. Treatment should take into account specific difficulties and the individual child’s strengths that may aid improvement. Not all children are offered the same treatment for ADHD.

Ideally, treatment will include a package of measures involving behaviour management, counselling or psychotherapy, special help at school, and, perhaps, medication. Unfortunately, getting all of these may be difficult as funding can be limited.

It is also important that parents get help and support to learn skills to help their children. It is not easy to live or cope with a child with ADHD. Parents need to feel confident with the techniques suggested and this in turn will help reduce stress and conflict.

Positive behaviour reinforcement

Children naturally want their parents' attention, it is a powerful reward. Because ADHD children can be very difficult to manage they will get a lot of negative attention. Scolding, shouting and arguing are forms of negative attention. When the child’s behaviour produces these reactions it actually encourages him/her to repeat the behaviour. This cycle of negative behaviour reinforcement needs to be broken and replaced with positive reinforcement. This requires time and patience but often has remarkable results.

Positive reinforcement encourages parents to notice good behaviour and reward it with praise. Children benefit from frequent, enthusiastic praise and from clear statements that have done well. At the same time parents should ignore bad behaviour such as arguing, swearing and tantrums. This is not easy as it is very natural to tell the child to stop. But by avoiding eye contact, not responding and moving away the reinforcement of the unwanted behaviour is removed. 
An important part of this technique is the avoidance of  'stop' instructions. So rather than 'stop shouting' you would say 'please talk more quietly'. Time-out techniques can also be used if the child keeps refusing a request.

Positive behaviour reinforcement techniques take time to learn and can be very trying for parents initially. But they can be taught and parenting skills classes may be available to support parents.

Other behaviour techniques for parents and teachers

It is just as important to help your child gain more self-control, at home and at school. Adding more structure to daily life and help with personal organisation are good first steps. For example, use an alarm clock to break homework into manageable chunks and create a list of daily tasks to be ticked off as completed. Establishing a good routine is essential for children with attention problems.

At school these children need to be encouraged to participate in learning. They need assistance to set their own pace and need lessons pitched at the appropriate level with variety and interest. Educational psychologists can greatly help parents and teachers with advice on effective learning programmes.

Both parents and teachers can also follow other simple techniques to set clear boundaries for the ADHD child which can help to manage his/her problematic behaviour. Support and advice from a specialist such as a psychologist may be useful in applying these methods.

  • Create daily routines - with homework schedules, fixed bedtime and mealtime routines.
  • Be specific in your instructions - and make clear and reasonable requests, for example instead of telling the child to 'behave' give a clear instruction such as 'play quietly with your Lego for 10 minutes'.
  • Set clear and easily understood boundaries - for example with how much TV he/she may watch, or that swearing is unacceptable.
  • Be consistent - in the handling and managing of the child always stick to the same rules.
  • Remove disturbing or disruptive elements from the daily routine - for example, remove siblings from the room or turn off the TV when homework needs to be done.
  • Plan structured programmes - with the aim gradually lengthening the child's concentration span and his/her ability to focus on tasks.
  • Communicate on a one-to-one basis - avoid addressing other children at the same time.
  • Use rewards consistently and frequently - for example, stickers can be used to reinforce appropriate behaviour such as listening to adults and concentrating.
  • Use sanctions when necessary - for loss of privileges, being sent to his/her room for unacceptable behaviour or overstepping of boundaries.
  • Work with school or nursery - discuss your child with teachers and see if you can work together.


For mild attention deficit problems behavioural management techniques (such as those above) are important and are usually the treatment of choice.

Ritalin: When medication is used, the most common and are amphetamine-like stimulants, mainly Ritalin and Dexedrine. 
Ritalin reduces hyperactivity and impulsiveness and helps to focus a child's attention. Often the child on such medication becomes less aggressive, seems to comply with requests, and becomes less forgetful. Many parents say their child's behaviour has vastly improved as a result of Ritalin.

However, there is growing concern about the use of Ritalin to treat ADHD. Ritalin is classified as a class A drug. Many parents and professionals are worried about possible side effects, including damage to the cardiovascular and nervous systems. Ritalin's manufacturers recommend that it is only used to treat children aged six years and over. If symptoms do not improve after a month's trial it should be discontinued. The manufacturers also recommend that even if Ritalin is effective it should discontinued periodically to assess the child's condition. Parents should discuss any concerns with their child's doctors, and they may suggest changing the dose of the drug.

Psychological treatments

In addition to techniques to manage behaviour, other forms of psychological treatment might be suggested including:

  • Anxiety management
  • Cognitive therapy
  • Individual psychotherapy
  • Social skills training

Educational management

This can include individual, or group, learning support for coexisting learning difficulties and educational underachievement.


Research has not shown conclusively that diet is a significant factor in ADHD for most children and experts differ in their opinions on the role of diet. Some complementary and alternative medicine is firmly based in diet theory. Children may also often have particular food allergies that need investigation. Some parents may feel their child’s behaviour changes when particular additives are removed from the diet and see improvement with the removal of strongly coloured or highly processed foods. (see Stress and Environmental factors, above).

All dietary changes should be supervised by a doctor and nutritionist. With medical supervision, all foods suspected of causing behavioural problems are removed from the diet then slowly reintroduced while the child's behaviour is monitored by the psychologist.

Complementary and alternative therapies

A number of therapies and treatments claim to aid ADHD children. Click on the links below to read an HSF factsheet:

Auditory Integration Training (AIT)– a therapy based which aims to retrain hearing systems

Biofeedback – a technique to monitor and control body responses

Brushing Therapy – stimulation by brushing to promote development of the central nervous system

Cranial Osteopathy/Craniosacral Osteopathy – a gentle but powerful form of osteopathy centred on the skull, used to diagnose and treat bodily dysfunctions

Dolphin Therapy – interaction with dolphins to promote children’s sensory abilities and to focus on specific areas such as speech or motor skills

Evening Primrose Oil – an essential fatty acid believed to regulate several key biochemical functions of the body

Feingold Food Programme – a food programme based on fresh products and the elimination of additives to improve health and behaviour

G-therapy – part of Ayurvedic medicine, a rememdy based on plant extracts used in the manner of homeopathy which aims to effect neuro transmission and thus improve skills and behaviour

Hypnotherapy – the use of hypnosis to break patterns of thought or behaviour by means of positive suggestion or imagery

Magnesium – an essential mineral for physical function, cell renewal, vitamin absorbtion and hormone production

Neuro-Linguistic Programming (NLP) – a form of psycho-therapy focussing on unconscious thought patterns with the aim of reprogramming responses to certain situations

Neurotherapy – an advanced form of biofeedback using brain scanning techniques to aid self-control and improve alertness

Nutritional Therapy – using diet to address nutrient deficiencies which may cause illness and poor health

Pycnogenol – an anti-oxidant plant extract which claims to protect against free radicals and to promote good health and function in many areas; it claims to protect brain cells and to assist with attention disorders

Ritalin – a stimulant of the central nervous system, prescribed to aid concentration and focus

Sunflower Method – a holistic method based on the interdependent function of physical, mental and emotional functions using individually tailored therapy programmes

The Tomatis Method – a method devised by an ear, nose and throat specialist to improve the auditory system and thus listening capabilities and attention

Yoga – an ancient method of relaxation and meditation using physical postures an breathing techiniques; it is believed to promote naturalhealing processes and can be used therapeutically for many problems including special needs

What is the likely outcome?

In many cases, children simply seem to outgrow ADHD. About half of those affected appear to function normally by young adulthood, but a significant number will have problems that continue into adult life. These may take the form of depression, irritability, antisocial behaviour and attention problems.


ADHD is a very large subject and there are many theories about its possible causes and treatment. Research continues in many countries and new information emerges all the time. Below are details of some recent research endeavours; it is not a complete list of research in this field. The specialist organisations listed at the end of this factsheet may also be sources of information about current research.

A study exploring treatments to re reduce symptoms which looks at alternative interventions such as intense aerobic activity.

  • Atomoxetine and Stimulants in Combination for Treatment of Attention Deficit Hyperactivity Disorder: Four Case Reports
  • ADHD Least Understood In The UK - New Global Survey Reveals UK Parents Hardest Hit By Child's ADHD
  • Understanding and Recognizing ADHD by Dr Nikos Myttas
  • Assessing the molecular genetics of attention networks
  • Recent Advances in the Genetics of Attention Deficit Hyperactivity Disorder
  • Does routine child health surveillance contribute to the early detection of children with pervasive developmental disorders? - An epidemiological study in Kent, U.K.
  • Methylphenidate Improves Response Inhibition in Adults with Attention-Deficit/Hyperactivity Disorder
  • Long term medical conditions: career prospects
  • Understanding and recognizing ADHD - Article by Dr Nikos Myttas
  • Extracts from Institute of Psychiatry Research Report 2002
  • Developmental neuropsychopathology of attention deficit and impulsiveness.
  • IMAGE - Mapping susceptibility genes for attention deficity hyperactivity disorder
  • Sail (Study Of Activity And Impulsivity Levels In Children)
  • Treatment In Childhood Could Halve Rates Of Mental Disorders
  • Hyperactivity and Conduct Problems as Risk Factors for Adolescent Development
  • Neuropsychological analyses of impulsiveness in childhood hyperactivity
  • Ritalin "does not lead to drug abuse"
  • Nonstimulant Therapy Shows Effectiveness in ADHD
  • Brain Areas Critical To Human Time Sense Identified
  • ADHD in Girls
  • Study Finds Careful Medication Management Of ADHD Superior To Beharioural Treatment
  • Brain Scan Shows ADHD
  • Treating Children's Sleep Disorders Improves Attention Deficit Symptoms

Attention Research Update

Attention Research Update

A free e-mail newsletter for parents, health care professionals and educators compiled by a senior research scientist at Duke University, North Carolina, USA. Research studies reviewed include medical research and alternative treatments.

The Curriculum, Evaluation and Management Centre

The CEM centre at the University of Durham has provided information to schools and colleges since 1993. Its work includes the Performance Indicators in Primary Schools (PIPS) project and the dissemination of ADHD research.

Research includes:

  • An Economic and Social Research Council funded study by Peter Tymms and Christine Merrell looking at screening in schools for children aged 4-5 years.

An American medical research institute with wide research interests.

ADHD Research includes:

  • Serotonin may hold the key to hyperactivity disorder
  • Paying attention
  • Treating children’s sleep disorders improves attention deficit symptoms


Published 2006 - 'The Theorem: A Complete Answer to Human Behaviour' by Douglas M Arone, published by O Books, John Hunt Publishing Ltd. ISBN 19050471X

The book claims new insights into ADHD and is written for a general readeship.

ADHD organisations

There are local support and self-help groups in many areas. Your GP surgery or local authority should be able to give details. Below are some organisations which may also provide useful information, help and advice:

Premier House 
Tel: 020 8952 2800 
Fax: 020 8952 2909
Email: info@addiss.co.uk
Web: www.addiss.co.uk
The national attention deficit hyperactivity disorder information and support service

The Association of Child Psychotherapists
Suite 7, 19-23 Wedmore Street, London N19 4RU
Tel: 020 7281 8479 
Web: www.childpsychotherapy.org.uk
For information on child psychotherapists working in your area

British Association for Counselling and Psychotherapy (BACP)
BACP House, 15 St John's Business Park, Lutterworth, Leicestershire LE17 4HB
Tel: 01455 883300
Fax: 01455 550243
Email: bacp@bacp.co.uk
Web: www.bacp.co.uk
See website or send A5 SAE for details of local practitioners

The British Psychological Society
St Andrews House, 48 Princess Road East, Leicester LE1 7DR
Tel: 0116 254 9568
Fax: 0116 227 1314
Email: enquiries@bps.org.uk
Web: www.bps.org.uk
Publishes a directory of chartered psychologists

Hyperactive Children’s Support Group
71 Whyke Lane, Chichester, West Sussex PO19 2LD
Tel: 01243 539966
Email: hacsg@hacsg.org.uk 
Web: www.hacsg.org.uk
Britain's leading proponent of the dietary approach to ADHD. The HACSG offers access to local groups throughout the UK

United Kingdom Council for Psychotherapy (UKCP)
2nd Floor, Edward House, 2 Wakely Street, London EC1V 7LT
Tel: 020 7014 995
Email: info@ukcp.org.uk 
Web: www.psychotherapy.org.uk
Umbrella organisation for psychotherapy in UK. Regional lists of psychotherapists are available free

College of Mental Health Pharmacy
The Long Barn, The Old Brewery, Priory Lane, Burford, Oxon OX18 4SG 
Website: www.cmhp.org.uk 
Helpline run by pharmacists to answer queries on psychiatric drugs

Suite 11, Baden Place, Crosby Row, London SE1 1YW
Tel: 020 7089 5050
Fax: 020 7407 8887
Parent Helpline: 0808 802 5544 (for any adult with concerns about the mental health of a child or young person)
Email: parents@youngminds.org.uk and ymenquiries@youngminds.org.uk
Web: www.youngminds.org.uk
A national charity committed to improving the mental health of all babies, children and young people

Youth Access
1–2 Taylors Yard, 67 Alderbrook Road, London SW12 8AD
Tel: 020 8772 9900
Email: admin@youthaccess.org.uk
Web: www.youthaccess.org.uk 
Information on youth counselling
Milton Keynes Support Group
31 Ramsons Avenue, Conniburrow, Milton Keynes MK14 7BB
Tel: 01908 676779/675110
Fax: 01908 676779
Helpline: 07506 365997 4pm-10pm
Email: mkadhd@googlemail.com 


Aims to promote awareness of ADHD and to provide information and practical help

A major charity promoting better mental health. A large range of information booklets can vie viewed or purchased online. The ADHD booklet provides extensive listings for further reading.

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