What are the symptoms of ADHD?

Symptoms of ADHD are divided into two groups: inattentive behaviors, and hyperactive and impulsive behaviors.

Symptoms of Inattention

Symptoms of Hyperactivity/Impulsivity

  • Not giving close attention, missing details, or making careless mistakes
  • Difficulties sustaining attention during tasks or play activities
  • Not listening when spoken to
  • Not following through on instructions
  • Difficulty organizing tasks and activities
  • Avoiding, disliking, or reluctantly doing sustained tasks
  • Losing things
  • Easily distracted
  • Forgetfulness
  • Fidgeting, tapping hands or feet, or squirming in seat
  • Leaving seat in situations when remaining seated is expected
  • Running about or climbing when expected to be seated
  • Inability to play or engage in activities quietly
  • Being “on the go” or acting as if “driven by a motor”
  • Talking excessively
  • Blurting out answers
  • Difficulty waiting in lines or for a turn
  • Interrupting or intruding on others

Associated Symptoms of ADHD may include issues with:

  • Planning
  • Making decisions
  • Shifting from one situation to another
  • Controlling emotions
  • Learning from past mistakes
  • Socializing
  • Participating during games or team sports
  • Poor school performance

How is ADHD diagnosed?

A child-adolescent psychiatrist may diagnose a child or teen with ADHD after determining whether the symptoms he or she is experiencing meet the diagnostic criteria; have been present since before the individual’s 12th birthday; several symptoms must be present across two or more settings (e.g., home, school, other activities); and the symptoms have persisted for at least six months and interfere with or reduce the quality of and individual’s performance in daily activities (e.g., social, academic, occupational).

The child-adolescent psychiatrist may conduct caregiver, teacher, and child interviews, although many practitioners also use standardized assessments, as well as behavior and emotion rating form results to support the diagnosis. Because the symptoms of ADHD can also be the result of other issues, such as anxiety, depression, or trauma, the professional responsible for diagnosing a child will carefully rule out other possible reasons for his or her behavior.

ADHD Facts

Worldwide frequency of the condition

ADHD is estimated to be present in about 5.9% of the world’s child and adolescent population, although estimates range widely from 0.1% up to 10.2%. While there is no recent, specific epidemiological data for Greece, a recent review of European countries reported a 2.9% frequency of the disorder.

Burden of the condition in Greece

ADHD accounts for 0.8% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents. It is the 6th most prominent mental health condition adding to the health burden of the Greek child and adolescent population.

Gender ratio

Gender comparative data for ADHD suggests that males are more likely to be diagnosed than females at a rate of 2:1.

Peak age of onset

The peak age of onset for ADHD is 9.5 years, which is later than for neurodevelopmental disorders, in general, which is 5.5 years of age.

Proportion of the condition that emerges before age 18

According to recent data, the proportion of ADHD that emerges before age 18 years is 73.0%. This means that 73.0% of individuals with ADHD will have been diagnosed by the time they are 18 years old. This is lower than for neurodevelopmental disorders, in general, where the proportion is 83.2%.

What are the associated factors for ADHD?

Some common factors associated with ADHD are:

  • Genetic and familial factors. Most likely a combination of multiple genes that interact in a complex way with multiple environmental factors. Having a first-degree relative who has been diagnosed with ADHD results in increased risk.
  • Preterm birth.
  • Very low birth weight.
  • Complications during pregnancy. These include maternal hypertensive disorders, preeclampsia, and hyperthyroidism; smoking or drinking alcohol by a pregnant mother; and there is also some evidence that exposure to some medications (e.g., acetaminophen, valproate) may increase risk for ADHD.
  • Complications after the child is born and early in childhood. These encephalitis and other early infections.
  • Environmental factors. These include lead exposure, exposure to second-hand cigarette smoke, certain food dyes, and air pollution.

What other disorders co-occur with ADHD?

Even though each child and adolescent is different, ADHD might be commonly comorbid with specific learning disorders, anxiety disorders, ODD, Conduct Disorder, and DMDD.

How is ADHD treated?

ADHD is usually treated with medication. Psychotherapy or a combination of psychotherapy and medication can be helpful specially when there are associated headstrong and rule breaking behaviors.

Kids with ADHD are sometimes prescribed stimulant medication, which will help them be calm, focus, and control their impulses. The two most common medications are methylphenidate (e.g., methylphenidate, dexmethylphenidate) and amphetamines (e.g., amphetamine/ dextroamphetamine, lisdexamfetamine), although amphetamines are not presently available in Greece. For children who are unable to tolerate methylphenidate or have not responded after a six-week trial, atomoxetine (i.e., atomoxetine), a serotonin and norepinephrine reuptake inhibitor (SNRI) may be prescribed. While these medications may have side effects, they are safe for kids to use with proper monitoring by their doctor and close supervision from their caregivers. A child or adolescent who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

For children that have comorbid oppositional symptoms (e.g., headstrong behaviors and rule breaking behavior), there are multiple therapies that have been shown to effectively treat associated symptoms and behaviors of ADHD. Younger children and their caregivers are commonly referred for parent-child interaction therapy (PCIT), which is a therapy for the parent and the child together, where the parent learns how to encourage good behavior. Caregivers of older children may also be referred for a behavioral parent training (BPT), such as parent management training (PMT), where they learn skills to address their child’s symptoms.

There is also some evidence that cognitive-behavioral therapy (CBT) may help older children or adolescents with ADHD. CBT involves a therapist teaching a kid to control their behaviors, discussing how their thoughts and feelings are connected to their behavior, and practicing ways to improve self-control. Other treatments, including meditation, computer cognitive training, cognitive training for executive functioning, and neurofeedback have less supporting evidence.

The combination between therapy and medication should also be considered.

Where to find more information

If you need more information on inattention, hyperactivity, and impulsivity and reasons for concerns, you can also go to "Inattention, hyperactivity and impulsivity" on our website.

To learn more about the technical work conducted to develop this guide, please consult our reference list:

References

Clinical description, symptoms, and diagnostic information

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Child Mind Institute. (2022, May 2). Complete guide to ADHD. https://childmind.org/guide/parents-guide-to-adhd/
  • Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
  • World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6A05 Attention Deficit Hyperactivity Disorder. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f821852937

Facts

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
  • Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J. S., Tannock, R., & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1(1), 15020. https://doi.org/10.1038/nrdp.2015.20
  • Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)
  • Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis. International Journal of Epidemiology, 43(2), 434–442. https://doi.org/10.1093/ije/dyt261
  • Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. Am J Psychiatry.
  • Rocco, I., Corso, B., Bonati, M., & Minicuci, N. (2021). Time of onset and/or diagnosis of ADHD in European children: A systematic review. BMC Psychiatry, 21(1), 575. https://doi.org/10.1186/s12888-021-03547-x
  • Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02131-2
  • Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7
  • Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. Pediatrics, 135(4), e994–e1001. https://doi.org/10.1542/peds.2014-3482

Associated factors

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Arango, C., Dragioti, E., Solmi, M., Cortese, S., Domschke, K., Murray, R. M., Jones, P. B., Uher, R., Carvalho, A. F., Reichenberg, A., Shin, J. I., Andreassen, O. A., Correll, C. U., & Fusar‐Poli, P. (2021). Risk and protective factors for mental disorders beyond genetics: An evidence‐based atlas. World Psychiatry, 20(3), 417–436. https://doi.org/10.1002/wps.20894
  • Bitsko, R. H., Holbrook, J. R., O’Masta, B., Maher, B., Cerles, A., Saadeh, K., Mahmooth, Z., MacMillan, L. M., Rush, M., & Kaminski, J. W. (2023). A systematic review and meta-analysis of prenatal, birth, and postnatal factors associated with Attention-Deficit/Hyperactivity Disorder in children.
  • Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
  • Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50

Co-occurring disorders

  • American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.
  • Bishop, C., Mulraney, M., Rinehart, N., & Sciberras, E. (2019). An examination of the association between anxiety and social functioning in youth with ADHD: A systematic review. Psychiatry Research, 273, 402–421. https://doi.org/10.1016/j.psychres.2019.01.039
  • Di Lorenzo, R., Balducci, J., Poppi, C., Arcolin, E., Cutino, A., Ferri, P., D’Amico, R., & Filippini, T. (2021). Children and adolescents with ADHD followed up to adulthood: A systematic review of long-term outcomes. Acta Neuropsychiatrica, 33(6), 283–298. https://doi.org/10.1017/neu.2021.23
  • Khodeir, M. S., El-Sady, S. R., & Mohammed, H. A. E.-R. (2020). The prevalence of psychiatric comorbid disorders among children with specific learning disorders: A systematic review. The Egyptian Journal of Otolaryngology, 36(1), 57. https://doi.org/10.1186/s43163-020-00054-w
  • Solberg, B. S., Halmøy, A., Engeland, A., Igland, J., Haavik, J., & Klungsøyr, K. (2018). Gender differences in psychiatric comorbidity: A population-based study of 40 000 adults with attention deficit hyperactivity disorder. Acta Psychiatrica Scandinavica, 137(3), 176–186. https://doi.org/10.1111/acps.12845
  • Tung, I., Li, J. J., Meza, J. I., Jezior, K. L., Kianmahd, J. S. V., Hentschel, P. G., O’Neil, P. M., & Lee, S. S. (2016). Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis. Pediatrics, 138(4), e20160430. https://doi.org/10.1542/peds.2016-0430

Interventions

  • Battagliese, G., Caccetta, M., Luppino, O. I., Baglioni, C., Cardi, V., Mancini, F., & Buonanno, C. (2015). Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness. Behaviour Research and Therapy, 75, 60–71. https://doi.org/10.1016/j.brat.2015.10.008
  • Correll, C. U., Cortese, S., Croatto, G., Monaco, F., Krinitski, D., Arrondo, G., Ostinelli, E. G., Zangani, C., Fornaro, M., Estradé, A., Fusar‐Poli, P., Carvalho, A. F., & Solmi, M. (2021). Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: An umbrella review. World Psychiatry, 20(2), 244–275. https://doi.org/10.1002/wps.20881
  • Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-Based Psychosocial Treatments for Children and Adolescents With Attention Deficit/Hyperactivity Disorder. Journal of Clinical Child & Adolescent Psychology, 47(2), 157–198. https://doi.org/10.1080/15374416.2017.1390757
  • Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022
  • Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J. S., Tannock, R., & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1(1), 15020. https://doi.org/10.1038/nrdp.2015.20
  • Khoodoruth, M. A. S., Ouanes, S., & Khan, Y. S. (2022). A systematic review of the use of atomoxetine for management of comorbid anxiety disorders in children and adolescents with attention-deficit hyperactivity disorder. Research in Developmental Disabilities, 128, 104275. https://doi.org/10.1016/j.ridd.2022.104275
  • Park, J., Lee, D. Y., Kim, C., Lee, Y. H., Yang, S.-J., Lee, S., Kim, S.-J., Lee, J., Park, R. W., & Shin, Y. (2022). Long-term methylphenidate use for children and adolescents with attention deficit hyperactivity disorder and risk for depression, conduct disorder, and psychotic disorder: A nationwide longitudinal cohort study in South Korea. Child and Adolescent Psychiatry and Mental Health, 16(1), 80. https://doi.org/10.1186/s13034-022-00515-5
  • Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A systematic review and meta-analysis. Part 1: Psychostimulants, alpha-2 agonists, and atomoxetine. The Canadian Journal of Psychiatry, 60(2), 42–51. https://doi.org/10.1177/070674371506000202
  • Riise, E. N., Wergeland, G. J. H., Njardvik, U., & Öst, L.-G. (2021). Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clinical Psychology Review, 83, 101954. https://doi.org/10.1016/j.cpr.2020.101954
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