adhd essay abstract

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Hyperactivity Disorder (ADHD), Research Paper Example

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Attention-Deficit / Hyperactivity Disorder (ADHD) is a mental illness that is characterized by the lack of the ability of an individual to concentrate or stay still. This is a problematic disorder for all individuals that have been diagnosed with it, but it is particularly difficult for students with the disease to participate in school activities. The symptoms of ADHD are commonly mistaken for learning disabilities, as the individuals who exhibit them often demonstrate difficulty with learning. However, these symptoms are not related to learning impairment and result in an impaired ability to learn because these individuals are not able to concentrate in the same way as their peers.

Many individuals believe that ADHD is not a real disorder and is simply a term that is assigned to children who are not able to follow rules or behave properly (Schonwald 189). While many children would be classified as having some type of behavior problem according to current behavioral standards, ADHD is present in only those that demonstrate that their lack of focus and attention in addition to their large amounts of energy is impacting with their ability to learn normally (Ramsay 25). Many energetic children can be directed to focus on their studies, and after several tries, a teacher or a parent will be successful. However, children with ADHD often cannot gain this focus at any point in time, indicating that there is a clinical problem.

ADHD is typically diagnosed when a parent, friend, or teacher observes that the behavior patterns exhibited by an individual is not characteristic for his or her age. In order to confirm this diagnosis, the individual will typically travel to a psychologist to be evaluated. A series of tests will be conducted that attempt to assess whether the child is simply energetic and cannot always retain focus or whether there is a chronic problem. The psychologists will use a combination of these tests in addition to self-assessment from the patient and observations from friends and family to make the diagnosis. Many medical professionals believe that ADHD could be treated in part through therapy sessions that aim to adjust reactions to certain stimuli, while others believe that because the illness has a biological basis, medication is the only effective treatment method. Yet, other parties believe that a combination of therapy and medicine is the only proper way to treat ADHD.

The individuals that claim that ADHD is not a real disease do not understand the biological aspects of this illness. Studies have shown that the brains of children with ADHD are typically physically smaller than individuals without the disease (Cohen 5). In particular, the prefrontal cortex, basal ganglia and cerebellum are reduced in size and are therefore not able to achieve the expected connectivity with the other areas of the brain. Ultimately, this leads to chemical imbalances with regards to the neurotransmitters that are responsible for sending messages to the different parents of the brain. Individuals without ADHD use some of these signals to know when they should stop their behaviors, but children and adults with this disorder do not experience the same signaling process (Curatolo 79). Therefore they are unable to stop their behaviors in the same manner as normal children and adults, which is in part because they are simply unable to comprehend that the behaviors they are exhibiting are wrong.

Ultimately, psychological treatment and medical treatment would not be effective to treat individuals with ADHD if this were not a real disease. When people diagnose with this illness have gone under treatment, they have demonstrated clear progress in behavior. Therapy is meant to allow these individuals to recognize which behaviors they are exhibiting and how they differ from their peers. They are then given ways to recognize when they are acting inappropriately and educated about how these situations could be prevented or rectified. In many situations, therapy alone is only ideal for cases of ADHD in which patients exhibit only slight symptoms. The purpose of the medication is to in part, rectify the problems that are occurring with the brain’s chemistry in these patients. In patients that exhibit severe symptoms, it is often difficult for them to be able to benefit from therapy because they may continue to exhibit these behaviors during the learning process, which impairs these therapy goals. Therefore, they may be provided medication to lesson these symptoms to make therapy more effective. The particular treatment that is assigned to an individual suffering from ADHD depends on the professional opinions of psychologists and psychiatrists, who collaborate to determine the severity of the symptoms and the best way to allow the child or adult to function in a normal school or work environment (Sim 615).

Professionals attempt to diagnose individuals with ADHD using criteria from a book called the DSM-IV. Some professionals prefer to use this book for mental disorders, while others opt to use the newer addition of this publication called the DSM-V. As a whole, this document describes ADHD as “persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (CDC, n.d.). For ADHD to be diagnosed by a professional, they must observe that these symptoms have been occurring over a long period of time. Therefore, one of the primary criterion for this diagnosis is that individuals must exhibit six or more of the following symptoms: they must not be able to give complete attention to details or make unanticipated mistakes at their jobs, in school, or in other functions; they must often not appear to listen to verbal directions despite repeated attempts; they must not frequently follow directions which leads to them not completing projects that they have started and are expected to finish; they frequently have trouble organizing tasks and activities; they often ignore and do not enjoy work that requires a lot of thought; they frequently misplace objects that are necessary to complete their responsibilities; they are frequently and easily distracted; they are frequently generally forgetful with regards to daily activities (CDC, n.d.). While many of these situations are exhibited by children or adults at some point, individuals with ADHD repeat many of these behaviors over a long period of time, which interferes with their ability to function in school or at work. Therefore, children with ADHD are typically diagnosed by teachers or other members of school staff because they are most likely to pick up on these behaviors before the parents. It is often an educator or a school psychologists who arranges the appointment for the formal diagnosis with the parent.

An additional symptom of ADHD is hyperactivity and impulsivity. According to the psychologist’s diagnostic manual, the following symptoms must be met, demonstrating inappropriate behavior for the child’s age level: they are frequently not able to stay still and must play with objects or move in their seat; they frequently travel away from their seats when remaining seated is appropriate; they are not able to play quietly; they must frequently talk or move; they respond to questions in class before they have fully completed the question; they have difficulty taking turns; they frequently invade the space of others (CDC, n.d.). Again, many individuals believe that these symptoms do not signify ADHD because they understand that some children exhibit these behaviors normally. While this is true in some cases, children with ADHD exhibit a majority of these symptoms, which have been repeated over a long period of time. These individuals are generally those who are unable to remain seated and quiet in school, which may interfere with the learning process of both themselves and of their peers. Individuals with ADHD exhibit some symptoms that overlap with other disorders, so it is necessary for the health care professional to rule out these other options before confirming a diagnosis of the disease (Greathead).

Despite the attempts of many individuals to deny the existence of ADHD, it is clear that this cannot be done. There are many environmental and biological factors that contribute to the development of the illness, and these factors are evident upon medical and psychological examination. It is therefore necessary to avoid demonizing both individuals with this disorder in addition to their families for psychological impacts that are beyond their control. It is instead important to work towards building an understanding of how individuals with ADHD can be helped and to understand the challenges that they face on a daily basis.

One of the most beneficial solutions to addressing the ADHD problem is modifying educational practices to cater to individuals that need to exert their energy, rather than sitting quietly in the classroom and listening. Many activities can be made for the whole class that will enable this type of engagement and promote learning. For example, activities that require standing and sitting to say “yes” or “no” to a question would be beneficial because it allows students with ADHD to move around. Since they are likely to do so without permission, it is necessary to take control of the situation by allowing this behavior, but assigning rules to it first. In addition, children with ADHD occasionally wish to stand as they write, which should be considered acceptable, provided that they are not disturbing their classmates. These solutions can only be reached once we understand that ADHD is not simply a behavior problem that children choose to enact, rather it is a consequence of complex environmental and biological factors that are beyond our control.

In conclusion, ADHD is a real disorder that must be taken very seriously. It is detrimental to the individuals with this illness to pretend that it does not exist. While many children do exhibit behavior problems from time to time and do not have ADHD, we must be aware that those with repetitive behavior problems have the disease and should be provided with help to alleviate some of these symptoms. These individuals can be helped by spreading an understanding that they are not misbehaving on purpose and that we should assist their learning by finding the methods that work best for them.

Works Cited

CDC. Symptoms and Diagnosis. N.D. Web. 24 April 2015.           <http://www.cdc.gov/ncbddd/adhd/diagnosis.html>

Cohen DJ. Cicchetti D, ed. Developmental Psychopathology, Developmental Neuroscience (2nd,illustrated ed.). John Wiley & Sons, 2006.

Curatolo P, D’Agati E, Moavero R. The neurobiological basis of ADHD. Ital J Pediatr 36(2010): 79.

Greathead, Philippa. Language Disorders and Attention Deficit Hyperactivity Disorder. 6 November 2013. Web. 24 April 2015. <http://www.addiss.co.uk/languagedisorders.htm>.

Ramsay JR. Cognitive behavioral therapy for adult ADHD. Routledge, 2007.

Schonwald A, Lechner E. Attention deficit/hyperactivity disorder: complexities and controversies. Curr. Opin. Pediatr . 18.2(2006):189–195.

Sim MG, Hulse G, Khong E. When the child with ADHD grows up. Aust Fam Physician  33.8 (2014): 615–618.

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GENERAL COMMENTARY article

Commentary: perspectives on adhd in children and adolescents as a social construct amidst rising prevalence of diagnosis and medication use.

• 1 Accare Child Study Center, Groningen, Netherlands
• 2 Department of Psychiatry, University Medical Center Groningen (UMCG), Groningen, Netherlands
• 3 Specialists in Youth and Family Care, Levvel, Amsterdam, Netherlands
• 4 Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
• 5 Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centers (AUMC), Amsterdam, Netherlands

A Commentary on Perspectives on ADHD in children and adolescents as a social construct amidst rising prevalence of diagnosis and medication use

By Banaschewski T, Häge A, Hohmann S and Mechler K (2024) Front. Psychiatry. 14:1289157. doi:  10.3389/fpsyt.2023.1289157

1 Introduction

The recent perspective article by Banaschewski et al. ( 1 ) in Frontiers in Psychiatry speculates about a potential “transformative paradigm shift” in the field of ADHD. This proposed paradigm shift centralizes around the notion that ADHD would not reflect a natural entity, but instead is best described as a social or cultural construct. I wholeheartedly agree with this statement, and in this commentary, I advocate for the necessity of this paradigm shift. It will yield significant benefits for individuals with ADHD in at least two crucial aspects: (1) by mitigating many of the negative consequences of receiving an ADHD classification, among which is an overreliance on medication, and (2) by improving the quality of our support.

2 Negative consequences of the current ADHD paradigm

The ADHD paradigm of the last decades, in which ADHD is mostly regarded as a natural entity, may have led to several unintended but potentially harmful consequences. Although everyone agrees that ADHD is the result of a complex interplay of biological and contextual factors ( 2 ), the current scientific and societal narrative predominantly focuses on biological factors such as genetics and brain functioning ( 3 – 7 ). Contextual factors like poverty ( 8 ), parental psychopathology ( 9 ), trauma ( 10 ), screentime ( 11 ), early deprivation ( 12 ), and being youngest in class ( 13 ) receive substantially less attention. The risk of this predominant emphasis on biological factors is that it may create a deterministic, individualized, and decontextualized view on ADHD. Decontextualization refers to the belief by children, their parents, teachers and clinicians that children themselves, or their brains, are primarily responsible for their symptoms. Decontextualization can have many negative consequences. Here, I will briefly discuss three: prognostic pessimism, stigma, and overreliance on medication.

2.1 Prognostic pessimism

First, decontextualization could lead to prognostic pessimism (i.e., having less hope for and lower expectations about the future). This is plausible as biological, decontextualized explanations of problem behaviors may imply that these problems are persistent and incurable ( 14 – 17 ). This phenomenon is firmly established for internalizing disorders: The more people attribute their problems to biology, the longer they expect them to last ( 18 , 19 ), the poorer they perceive their own coping skills ( 20 ), and the more negative they rate their prognosis ( 21 ). A single study on ADHD mirrored this trend: experimentally induced individualized, decontextualized beliefs about ADHD led to pessimistic expectations about the child’s potential ( 22 ). This resembles with other work demonstrating that academic expectations of children with ADHD are disproportionately low ( 23 ), as also mentioned by Banaschewski and colleagues. This is crucial because expectations often become self-fulfilling prophecies (i.e., Pygmalion vs Golem effects; 24 ).

Second, decontextualization could lead to stigmatization. Although not directly studied for ADHD, people are more reluctant to interact with people with mental health problems and perceive them as more dangerous, when they assume these mental health problems are caused by biological factors ( 17 , 25 , 26 ). Strikingly, this applies to clinicians as well: Clinicians linking their clients’ problems to biology display less empathy than clinicians attributing problems to non-biological factors ( 27 ).

2.3 Overreliance on medication

Third, decontextualization could lead to an overreliance on medication. When the starting point is that ADHD is a (neuro)biological disorder, clinical decision making may guide towards brain-focused solutions like medication ( 28 , 29 ). Indeed, the more clinicians explain problems by biological factors, the higher they estimate the effectiveness of medication ( 30 – 33 ). Similarly, greater emphasis on biological problem explanations also correlates with reduced confidence in the effectiveness of non-pharmacological, often context-focused, treatments ( 19 , 27 , 29 ).

3 A paradigm shift to inform better support for children with ADHD

A shift towards a paradigm that more explicitly acknowledges the influence of contextual factors on ADHD will inform better support for children with ADHD. Clinical guidelines recommend both behavioral parent training and medication as first-choice interventions but in practice, many more children with ADHD receive medication than behavioral parent training ( 34 ). An important reason for this discrepancy is that a decontextualized view on ADHD guides children, parents, teachers and also clinicians towards medication before initiating other treatments. Instead, the notion of a socially constructed concept of ADHD, as proposed by Banaschewski and colleagues, automatically puts more emphasis on contextual factors. The logical consequence of this paradigm shift will hopefully be an increase in the implementation of context-focused behavioral interventions for children in ADHD.

Of these interventions, the evidence-base for behavioral parent training is most compelling (for meta-analyses, see 35 – 37 ). Treatment sequencing studies demonstrate that initiating treatment with such behavioral interventions yields superior outcomes compared to initiating treatment with medication, both in terms of effectiveness and costs ( 38 , 39 ). Crucially, initiating treatment with behavioral interventions substantially reduces the need for medication later ( 40 ). By implementing such a stepped-care approach, overtreatment with medication is prevented while maintaining pharmacological treatment for those children who really need it.

4 Discussion

The upcoming paradigm shift in the field of ADHD will indeed be transformative, as anticipated by Banaschewski and colleagues. While it will undoubtedly come with many challenges, I see at least two clear gains: it will mitigate several unintended but harmful consequences of the current paradigm and it will pave the way to more balanced stepped-care recommendations, ultimately benefiting many children with ADHD and their families.

Author contributions

TD: Writing – review & editing, Writing – original draft, Conceptualization.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

I would like to thank Anouk van Dijk, Barbara van den Hoofdakker, Branko van Hulst, Sanne te Meerman and Yehuda Pollak for many inspiring conversations that have fueled my thoughts as outlined in this commentary. Parts of this commentary are adapted from a grant proposal I submitted to the Netherlands Organization for Health Research and Development in January, 2024.

Conflict of interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: ADHD, decontextualization, stigma, medication, prognostic pessimism, paradigm

Citation: Dekkers TJ (2024) Commentary: Perspectives on ADHD in children and adolescents as a social construct amidst rising prevalence of diagnosis and medication use. Front. Psychiatry 15:1383492. doi: 10.3389/fpsyt.2024.1383492

Received: 07 February 2024; Accepted: 14 March 2024; Published: 25 March 2024.

Reviewed by:

Copyright © 2024 Dekkers. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Tycho J. Dekkers, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward

Affiliations.

• 1 Academic Unit of Psychology, Center for Innovation in Mental Health, University of Southampton, Southampton, UK.
• 2 Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
• 3 Solent NHS Trust, Southampton, UK.
• 4 New York University Child Study Center, New York City, New York, USA.
• 5 Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
• 6 Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
• 7 Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
• 8 Royal Children's Hospital, Melbourne, Victoria, Australia.
• PMID: 30301823
• PMCID: PMC10270437
• DOI: 10.1136/ebmental-2018-300050

In this clinical review we summarise what in our view have been some the most important advances in the past two decades, in terms of diagnostic definition, epidemiology, genetics and environmental causes, neuroimaging/cognition and treatment of attention-deficit/hyperactivity disorder (ADHD), including: (1) the most recent changes to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases; (2) meta-analytic evidence showing that, after accounting for diagnostic methods, the rates of ADHD are fairly consistent across Western countries; (3) the recent finding of the first genome-wide significant risk loci for ADHD; (4) the paradigm shift in the pathophysiological conceptualisation of ADHD from alterations in individual brain regions to a complex dysfunction in brain networks; (5) evidence supporting the short-term efficacy of ADHD pharmacological treatments, with a different profile of efficacy and tolerability in children/adolescents versus adults; (6) a series of meta-analyses showing that, while non-pharmacological treatment may not be effective to target ADHD core symptoms, some of them effectively address ADHD-related impairments (such as oppositional behaviours for parent training and working memory deficits for cognitive training). We also discuss key priorities for future research in each of these areas of investigation. Overall, while many research questions have been answered, many others need to be addressed. Strengthening multidisciplinary collaborations, relying on large data sets in the spirit of Open Science and supporting research in less advantaged countries will be key to face the challenges ahead.

© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

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• Attention Deficit Disorder with Hyperactivity* / diagnosis
• Attention Deficit Disorder with Hyperactivity* / etiology
• Attention Deficit Disorder with Hyperactivity* / genetics
• Attention Deficit Disorder with Hyperactivity* / therapy

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Search strategy, data extraction, risk of bias and applicability, data synthesis and analysis, parent ratings, teacher ratings, youth self-reports, combined rating scales, additional clinician tools, neuropsychological tests, biospecimen, neuroimaging, variation in diagnostic accuracy with clinical setting or patient subgroup, measures for diagnostic performance, available tools, importance of the comparator sample, clinical implications, future research, conclusions, acknowledgments, tools for the diagnosis of adhd in children and adolescents: a systematic review.

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Bradley S. Peterson , Joey Trampush , Morah Brown , Margaret Maglione , Maria Bolshakova , Mary Rozelle , Jeremy Miles , Sheila Pakdaman , Sachi Yagyu , Aneesa Motala , Susanne Hempel; Tools for the Diagnosis of ADHD in Children and Adolescents: A Systematic Review. Pediatrics April 2024; 153 (4): e2024065854. 10.1542/peds.2024-065854

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Correct diagnosis is essential for the appropriate clinical management of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.

This systematic review provides an overview of the available diagnostic tools.

We identified diagnostic accuracy studies in 12 databases published from 1980 through June 2023.

Any ADHD tool evaluation for the diagnosis of ADHD, requiring a reference standard of a clinical diagnosis by a mental health specialist.

Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards.

In total, 231 studies met eligibility criteria. Studies evaluated parental ratings, teacher ratings, youth self-reports, clinician tools, neuropsychological tests, biospecimen, EEG, and neuroimaging. Multiple tools showed promising diagnostic performance, but estimates varied considerably across studies, with a generally low strength of evidence. Performance depended on whether ADHD youth were being differentiated from neurotypically developing children or from clinically referred children.

Studies used different components of available tools and did not report sufficient data for meta-analytic models.

A valid and reliable diagnosis of ADHD requires the judgment of a clinician who is experienced in the evaluation of youth with and without ADHD, along with the aid of standardized rating scales and input from multiple informants across multiple settings, including parents, teachers, and youth themselves.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental conditions in youth. Its prevalence has remained constant at ∼5.3% worldwide over the years, and diagnostic criteria have remained constant when based on rigorous diagnostic procedures. 1   Clinical diagnoses, however, have increased steadily over time, 2   and currently, ∼10% of US children receive an ADHD diagnosis. 3   Higher rates of clinical compared with research-based diagnoses are because of an increasing clinician recognition of youth who have ADHD symptoms that are functionally impairing but do not fully meet formal diagnostic criteria. 4   The higher diagnostic rates over time in clinical samples also results from youth receiving a diagnosis incorrectly. Some youth, for example, are misdiagnosed as having ADHD when they have symptoms of other disorders that overlap with ADHD symptoms, such as difficulty concentrating, which occurs in many other conditions. 5   Moreover, ADHD is more than twice as likely to be diagnosed in boys than in girls, 3   in lower-income families, 6   and in white compared with nonwhite youth 7   ; differences that derive at least in part from diagnostic and cultural biases. 8   – 11  

Improving clinical diagnostic accuracy is essential to ensure that youth who truly have ADHD benefit from receiving treatment without delay. Similarly, youth who do not have ADHD should not be diagnosed since an incorrect diagnosis risks exposing them to unbeneficial treatments. 12 , 13   Clinician judgement alone, however, especially by nonspecialist clinicians, is poor in diagnosing ADHD 14   compared with expert, research-grade diagnoses made by mental health clinicians. 15   Accurately diagnosing ADHD is difficult because diagnoses are often made using subjective clinical impressions, and putative diagnostic tools have a confusing, diverse, and poorly described evidence base that is not widely accessible. The availability of valid diagnostic tools would especially help to reduce misdiagnoses from cultural biases and symptom overlap with ADHD. 12 , 16   – 19  

This review summarizes evidence for the performance of tools for children and adolescents with ADHD. We did not restrict to a set of known diagnostic tools but instead explored the range of available diagnostic tools, including machine-learning assisted and virtual reality-based tools. The review aimed to assess how diagnostic performance varies by clinical setting and patient characteristics.

The review aims were developed in consultation with the Agency for Healthcare Research and Quality (AHRQ), the Patient-Centered Outcomes Research Institute, the topic nominator American Academy of Pediatrics, key informants, a technical expert panel (TEP), and public input. The TEP reviewed the protocol and advised on key outcomes. Subgroup analyses and key outcomes were prespecified. The review is registered in PROSPERO (CRD42022312656) and the protocol is available on the AHRQ Web site as part of a larger evidence report on ADHD. The systematic review followed Methods of the (AHRQ) Evidence-based Practice Center Program. 20  

Population: age <18 years.

Interventions: any ADHD tool for the diagnosis of ADHD.

Comparators: diagnosis by a mental health specialist, such as a psychologist, psychiatrist, or other provider, who often used published scales or semistructured diagnostic interviews to ensure a reliable DSM-based diagnosis of ADHD.

Key outcomes: diagnostic accuracy (eg, sensitivity, specificity, area under the curve).

Setting: any.

Study design: diagnostic accuracy studies.

Other: English language, published from 1980 to June 2023.

We searched PubMed, Embase, PsycINFO, ERIC, and ClinicalTrials.gov. We identified reviews for reference-mining through PubMed, Cochrane Database of Systematic Reviews, Campbell Collaboration, What Works in Education, PROSPERO, ECRI Guidelines Trust, G-I-N, and ClinicalKey. The peer reviewed strategy is in the Supplemental Appendix . All citations were screened by trained literature reviewers supported by machine learning ( Fig 1 ). Two independent reviewers assessed full text studies for eligibility. The TEP reviewed studies to ensure all were captured. Publications reporting on the same participants were consolidated into 1 record.

Literature flow diagram.

The data abstraction form included extensive guidance to aid reproducibility and standardization in recording study details, results, risk of bias, and applicability. One reviewer abstracted data and a methodologist checked accuracy and completeness. Data are publicly available in the Systematic Review Data Repository.

We assessed characteristics pertaining to patient selection, index test, reference standard, flow and timing that may have introduced bias, and evaluated applicability of study results, such as whether the test, its conduct, or interpretation differed from how the test is used in clinical practice. 21 , 22  

We differentiated parent, teacher, and youth self-report ratings; tools for clinicians; neuropsychological tests; biospecimens; EEG; and neuroimaging. We organized analyses according to prespecified outcome measures. A narrative overview summarized the range of diagnostic performance for key outcomes. Because lack of reported detail in many individual studies hindered use of meta-analytic models, we created summary figures to document the diagnostic performance reported in each study. We used meta-regressions across studies to assess the effects of age, comorbidities, racial and ethnic composition, and diagnostic setting (differentiating primary care, specialty care, school settings, mixed settings, and not reported) on diagnostic performance. One researcher with experience in use of specified standardized criteria 23   initially assessed the overall strength of evidence (SoE) (see Supplemental Appendix ) for each study, then discussed it with the study team to communicate our confidence in each finding.

We screened 23 139 citations and 7534 publications retrieved as full text against the eligibility criteria. In total, 231 studies reported in 290 publications met the eligibility criteria (see Fig 1 ).

Methodological quality of the studies varied. Selection bias was likely in two-thirds of studies; several were determined to be problematic in terms of reported study flow and timing of assessments (eg, not stating whether diagnosis was known before the results of the index test); and several lacked details on diagnosticians or diagnostic procedures ( Supplemental Fig 1 ). Applicability concerns limited the generalizability of findings ( Supplemental Fig 2 ), usually because youth with comorbidities were excluded. Many different tools were assessed within the broader categories (eg, within neuropsychological tests), and even when reporting on the same diagnostic tool, studies often used different components of the tool (eg, different subscales of rating scales), or they combined components in a variety of ways (eg, across different neuropsychological test parameters).

The evidence table ( Supplemental Table 10 , Supplemental Appendix ) shows each study’s finding. The following highlights key findings across studies.

Fifty-nine studies used parent ratings to diagnose ADHD ( Fig 2 ). The most frequently evaluated tool was the CBCL (Child Behavior Checklist), alone or in combination with other tools, often using different score cutoffs for diagnosis, and evaluating different subscales (most frequently the attention deficit/hyperactivity problems subscale). Sensitivities ranged from 38% (corresponding specificity = 96%) to 100% (specificity = 4% to 92%). 24 , 25  

Diagnostic performance parent and teacher ratings. For a complete list of scales see Supplemental Appendix .

Area under the curve (AUC) for receiver operator characteristic curves ranged widely from 0.55 to 0.95 but 3 CBCL studies reported AUCs of 0.83 to 0.84. 26   – 28   Few studies reported measurement of reliability. SoE was downgraded for study limitation (lack of detailed reporting), imprecision (large performance variability), and inconsistent findings ( Supplemental Table 1 ).

Twenty-three studies used teacher ratings to diagnose ADHD ( Fig 2 ). No 2 studies reported on rater agreement, internal consistency, or test-retest reliability for the same teacher rating scale. The highest sensitivity was 97% (specificity = 26%). 25   The Teacher Report Form, alone or in combination with Conners teacher rating scales, yielded sensitivities of 72% to 79% 29   and specificities of 64% to 76%. 30 , 32   reported AUCs ranged from 0.65 to 0.84. 32   SoE was downgraded to low for imprecision (large performance variability) and inconsistency (results for specific tools not replicated), see Supplemental Table 2 .

Six studies used youth self-reports to diagnose ADHD. No 2 studies used the same instrument. Sensitivities ranged from 53% (specificity = 98%) to 86% (specificity = 70%). 35   AUCs ranged from 0.56 to 0.85. 36   We downgraded SoE for domain inconsistency (only 1 study reported on a given tool and outcome), see Supplemental Table 3 .

Thirteen studies assessed diagnostic performance of ratings combined across informants, often using machine learning for variable selection. Only 1 study compared performance of combined data to performance from single informants, finding negligible improvement (AUC youth = 0.71; parent = 0.85; combined = 0.86). 37   Other studies reported on limited outcome measures and used ad hoc methods to combine information from multiple informants. The best AUC was reported by a machine learning supported study combining parent and teacher ratings (AUC = 0.98). 38  

Twenty-four studies assessed additional tools, such as interview guides, that can be used by clinicians to aid diagnosis of ADHD. Sensitivities varied, ranging from 67% (specificity = 65%) to 98% (specificity = 100%); specificities ranged from 36% (sensitivity = 89%) to 100% (sensitivity = 98%). 39   Some of the tools measured activity levels objectively using an actometer or commercially available activity tracker, either alone or as part of a diagnostic test battery. Reported performance was variable (sensitivity range 25% to 100%, 40   specificity range 66% to 100%, 40   AUCs range 0.75–0.9996 41   ). SoE was downgraded for imprecision (large performance variability) and inconsistency (outcomes and results not replicated), see Supplemental Table 4 .

Seventy-four studies used measures from various neuropsychological tests, including continuous performance tests (CPTs). Four of these included 3- and 4-year-old children. 42   – 44   A large majority used a CPT, which assessed omission errors (reflecting inattention), commission errors (impulsivity), and reaction time SD (response time variability). Studies varied in use of traditional visual CPTs, such as the Test of Variables of Attention, more novel, multifaceted “hybrid” CPT paradigms, and virtual reality CPTs built upon environments designed to emulate real-world classroom distractibility. Studies used idiosyncratic combinations of individual cognitive measures to achieve the best performance, though many reported on CPT attention and impulsivity measures.

Sensitivity for all neuropsychological tests ranged from 22% (specificity = 96%) to 100% (specificity = 100%) 45   ( Fig 3 ), though the latter study reported performance for unique composite measures without replication. Specificities ranged from 22% (sensitivity = 91%) 46   to 100% (sensitivity = 100% to 75%). 45 , 47   AUCs ranged from 0.59 to 0.93. 48   Sensitivity for all CPT studies ranged from 22% ( specificity = 96) to 100% (specificity = 75%). 49   Specificities for CPTs ranged from 22% (sensitivity = 91%) to 100% (sensitivity = 89%) 47   ( Fig 3 ). AUCs ranged from 0.59 to 0.93. 50 , 51   SoE was deemed low for imprecise studies (large performance variability), see Supplemental Table 5.

Diagnostic performance neuropsychological tests, CPTs, activity monitors, biospecimen, EEG.

Seven studies assessed blood or urine biomarkers to diagnose ADHD. These measured erythropoietin or erythropoietin receptor, membrane potential ratio, micro RNA levels, or urine metabolites. Sensitivities ranged from 56% (specificity = 95%) to 100% (specificity = 100% for erythropoietin and erythropoietin receptors levels). 52   Specificities ranged from 25% (sensitivity = 79%) to 100% (sensitivity = 100%). 52   AUCs ranged from 0.68 to 1.00. 52   Little information was provided on reliability of markers or their combinations. SoE was downgraded for inconsistent and imprecise studies ( Supplemental Table 6 ).

Forty-five studies used EEG markers to diagnose ADHD. EEG signals were obtained in a variety of patient states, even during neuropsychological test performance. Two-thirds used machine learning algorithms to select classification parameters. Several combined EEG with demographic variables or rating scales. Sensitivity ranged widely from 46% to 100% (corresponding specificities 74 and 71%). 53 , 54   One study that combined EEG with demographics data supported by machine learning reported perfect sensitivity and specificity. 54   Specificity was also variable and ranged from 38% (sensitivity = 95%) to 100% (specificities = 71% or 100%). 53   – 56   Reported AUCs ranged from 0.63 to 1.0. 57 , 58   SoE was downgraded for study imprecision (large performance variability) and limitations (diagnostic approaches poorly described), see Supplemental Table 7 .

Nineteen studies used neuroimaging for diagnosis. One public data set (ADHD-200) produced several analyses. All but 2 used MRI: some functional MRI (fMRI), some structural, and some in combination, with or without magnetic resonance spectroscopy (2 used near-infrared spectroscopy). Most employed machine learning to detect markers that optimized diagnostic classifications. Some combined imaging measures with demographic or other clinical data in the prediction model. Sensitivities ranged from 42% (specificity = 95%) to 99% (specificity = 100%) using resting state fMRI and a complex machine learning algorithm 56   to differentiate ADHD from neurotypical youth. Specificities ranged from 55% (sensitivity = 95%) to 100% 56   using resting state fMRI data. AUCs ranged from 0.58 to over 0.99, 57   SoE was downgraded for imprecision (large performance variability) and study limitations (diagnostic models are often not well described, and the number and type of predictor variables entering the model were unclear). Studies generally did not validate diagnostic algorithms or assess performance measures in an independent sample ( Supplemental Table 8 ).

Regression analyses indicated that setting was associated with both sensitivity ( P = .03) and accuracy ( P = .006) but not specificity ( P = .68) or AUC ( P = .28), with sensitivities lowest in primary care ( Fig 4 ). Sensitivity, specificity, and accuracy were also lower when differentiating youth with ADHD from a clinical sample than from typically developing youth (sensitivity P = .04, specificity P < .001, AUC P < .001) ( Fig 4 ), suggesting that clinical population is a source of heterogeneity in diagnostic performance. Findings should be interpreted with caution, however, as they were not obtained in meta-analytic models and, consequently, do not take into account study size or quality.

Diagnostic performance by setting and population.

Supplemental Figs 3–5 in the Supplemental Appendix document effects by age and gender. We did not detect statistically significant associations of age with sensitivity ( P = .54) or specificity ( P = .37), or associations of the proportion of girls with sensitivity ( P = .63), specificity ( P = .80), accuracy ( P = .34), or AUC ( P = .90).

We identified a large number of publications reporting on ADHD diagnostic tools. To our knowledge, no prior review of ADHD diagnostic tools has been as comprehensive in the range of tools, outcomes, participant ages, and publication years. Despite the large number of studies, we deemed the strength of evidence for the reported performance measures across all categories of diagnostic tools to be low because of large performance variability across studies and various limitations within and across studies.

We required that studies report diagnoses when using the tool compared with diagnoses made by expert mental health clinicians. Studies most commonly reported sensitivity (true-positive rate) and specificity (true-negative rate) when a study-specific diagnostic threshold was applied to measures from the tool being assessed. Sensitivity and specificity depend critically on that study-specific threshold, and their values are inherently a trade-off, such that varying the threshold to increase either sensitivity or specificity reduces the other. Interpreting diagnostic performance in terms of sensitivity and specificity, and comparing those performance measures across studies, is therefore challenging. Consequently, researchers more recently often report performance for sensitivity and specificity in terms of receiver operating characteristics (ROC) curves, a plot of sensitivity versus specificity across the entire range of possible diagnostic thresholds. The area under this ROC curve (AUC) provides an overall, single index of performance that ranges from 0.5 (indicating that the tool provides no information above chance for classification) to 1.0 (indicating a perfect test that can correctly classify all participants as having ADHD and all non-ADHD participants as not having it). AUC values of 90 to 100 are commonly classified as excellent performance; 80 to 90 as good; 70 to 80 as fair; 60 to 70 as poor; and 50 to 60 failed performance.

Most research is available on parental ratings. Overall, AUCs for parent rating scales ranged widely from “poor” 58   to “excellent.” 59   Analyses restricted to the CBCL, the most commonly evaluated scale, yielded more consistent “good” AUCs for differentiating youth with ADHD from others in clinical samples, but the number of studies contributing data were small. Internal consistency for rating scale items was generally high across most rating scales. Test-retest reliability was good, though only 2 studies reported it. One study reported moderate rater agreement between mothers and fathers for inattention, hyperactivity, and impulsivity symptoms. Few studies included youth under 7 years of age.

AUCs for teacher rating scales ranged from “failed” 33   to “good.” 34   Internal consistency for scale items was generally high. Teacher ratings demonstrated very low rater agreement with corresponding parent scales, suggesting either a problem with the instruments or a large variability in symptom presentation with environmental context (home or school).

Though data were limited, self-reports from youth seemed to perform less well than corresponding parent and teacher reports, with AUCs ranging from “failed” for CBCL or ASEBA when distinguishing ADHD from other patients 33   to “good” for the SWAN in distinguishing ADHD from neurotypical controls. 36 , 37  

Studies evaluating neuropsychological tests yielded AUCs ranging from “poor” 60 , 61   to “excellent.” 50   Many used idiosyncratic combinations of cognitive measures, which complicates interpretation of the results across studies. Nevertheless, extracting specific, comparable measures of inattention and impulsivity from CPTs yielded diagnostic performance ranging from “poor” to “excellent” in differentiating ADHD youth from neurotypical controls and “fair” in differentiating ADHD youth from other patients. 42 , 60 , 62   No studies provided an independent replication of diagnosis using the same measure.

Blood biomarkers yielded AUCs ranging from “poor” (serum miRNAs) 63   to “excellent” (erythropoietin and erythropoietin receptors levels) 52   in differentiating ADHD from neurotypical youth. None have been independently replicated, and test-retest reliability was not reported. Most EEG studies used machine learning for diagnostic classification. AUCs ranged from “poor” 64   to “excellent” when differentiating ADHD youth from neurotypical controls. 65   Diagnostic performance was not prospectively replicated in any independent samples.

Most neuroimaging studies relied on machine learning to develop diagnostic algorithms. AUCs ranged from “poor” 66   to “excellent” for distinguishing ADHD youth from neurotypically developing controls. 57   Most studies used pre-existing data sets or repositories to retrospectively discriminate youths with ADHD from neurotypical controls, not from other clinical populations and not prospectively, and none assessed test-retest reliability or the independent reproducibility of findings. Reporting of final mathematical models or algorithms for diagnosis was limited. Activity monitors have the advantage of providing inexpensive, objective, easily obtained, and quantified measures that can potentially be widely disseminated and scaled.

Studies of combined approaches, such as integrating diagnostic tools with clinician impressions, were limited. One study reported increased sensitivity and specificity when an initial clinician diagnosis combined EEG indicators (the reference standard was a consensus diagnosis from a panel of ADHD experts). 67   These findings were not independently replicated, however, and no test-retest reliability was reported.

Many studies aimed to distinguish ADHD youth from neurotypical controls, which is a distinction of limited clinical relevance. In clinically referred youth, most parents, teachers, and clinicians are reasonably confident that something is wrong, even if they are unsure whether the cause of their concern is ADHD. To be informed by a tool that the child is not typically developing is not particularly helpful. Moreover, we cannot know whether diagnostic performance for tools that discriminate ADHD youth only from neurotypical controls is determined by the presence of ADHD or by the presence of any other characteristics that accompany clinical “caseness,” such as the presence of comorbid illnesses or symptoms shared or easily confused with those of other conditions, or the effects of chronic stress or current or past treatment. The clinically more relevant and difficult question is, therefore, how well the tool distinguishes youth with ADHD from those who have other emotional and behavioral problems. Consistent with these conceptual considerations that argue for assessing diagnostic performance in differentiating youth with ADHD from those with other clinical conditions, we found significant evidence that, across all studies, sensitivity, specificity, and AUC were all lower when differentiating youth with ADHD from a clinical sample than when differentiating them from neurotypical youth. These findings also suggest that the comparison population was a significant source of heterogeneity in diagnostic performance.

Despite the large number of studies on diagnostic tools, a valid and reliable diagnosis of ADHD ultimately still requires the judgement of a clinician who is experienced in the evaluation of youth with and without ADHD, along with the aid of standardized rating scales and input from multiple informants across multiple settings, including parents, teachers, and youth themselves. Diagnostic tools perform best when the clinical question is whether a youth has ADHD or is healthy and typically developing, rather than when the clinical question is whether a youth has ADHD or another mental health or behavioral problem. Diagnostic tools yield more false-positive and false-negative diagnoses of ADHD when differentiating youth with ADHD from youth with another mental health problem than when differentiating them from neurotypically developing youth.

Scores for rating scales tended to correlate poorly across raters, and ADHD symptoms in the same child varied across settings, indicating that no single informant in a single setting is a gold-standard for diagnosis. Therefore, diagnosis using rating scales will likely benefit from a more complete representation of symptom expression across multiple informants (parents, school personnel, clinicians, and youth) across more than 1 setting (home, school, and clinic) to inform clinical judgement when making a diagnosis, thus, consistent with current guidelines. 68   – 70   Unfortunately, methods for combining scores across raters and settings that improve diagnosis compared with scores from single raters have not been developed or prospectively replicated.

Despite the widespread use of neuropsychological testing to “diagnose” youth with ADHD, often at considerable expense, indirect comparisons of AUCs suggest that performance of neuropsychological test measures in diagnosing ADHD is comparable to the diagnostic performance of ADHD rating scales from a single informant. Moreover, the diagnostic accuracy of parent rating scales is typically better than neuropsychological test measures in head-to-head comparisons. 44 , 71   Furthermore, the overall SoE for estimates of diagnostic performance with neuropsychological testing is low. Use of neuropsychological test measures of executive functioning, such as the CPT, may help inform a clinical diagnosis, but they are not definitive either in ruling in or ruling out a diagnosis of ADHD. The sole use of CPTs and other neuropsychological tests to diagnose ADHD, therefore, cannot be recommended. We note that this conclusion regarding diagnostic value is not relevant to any other clinical utility that testing may have.

No independent replication studies have been conducted to validate EEG, neuroimaging, or biospecimen to diagnose ADHD, and no clinical effectiveness studies have been conducted using these tools to diagnose ADHD in the real world. Thus, these tools do not seem remotely close to being ready for clinical application to aid diagnosis, despite US Food and Drug Administration approval of 1 EEG measure as a purported diagnostic aid. 67 , 72  

All studies of diagnostic tools should report data in more detail (ie, clearly report false-positive and -negative rates, the diagnostic thresholds used, and any data manipulation undertaken to achieve the result) to support meta-analytic methods. Studies should include ROC analyses to support comparisons of test performance across studies that are independent of the diagnostic threshold applied to measures from the tool. They should also include assessment of test-retest reliability to help discern whether variability in measures and test performance is a function of setting or of measurement variability over time. Future studies should address the influence of co-occurring disorders on diagnostic performance and how well the tools distinguish youth with ADHD from youth with other emotional and behavioral problems, not simply from healthy controls. More studies should compare the diagnostic accuracy of different test modalities, head-to-head. Independent, prospective replication of performance measures of diagnostic tools in real-world settings is essential before US Food and Drug Administration approval and before recommendations for widespread clinical use.

Research is needed to identify consensus algorithms that combine rating scale data from multiple informants to improve the clinical diagnosis of ADHD, which at present is often unguided, ad hoc, and suboptimal. Diagnostic studies using EEG, neuroimaging, and neuropsychological tests should report precise operational definitions and measurements of the variable(s) used for diagnosis, any diagnostic algorithm employed, the selected statistical cut-offs, and the number of false-positives and false-negatives the diagnostic tool yields to support future efforts at synthetic analyses.

Objective, quantitative neuropsychological test measures of executive functioning correlate only weakly with the clinical symptoms that define ADHD. 73   Thus, many youth with ADHD have normal executive functioning profiles on neuropsychological testing, and many who have impaired executive functioning on testing do not have ADHD. 74   Future research is needed to understand how test measures of executive functioning and the real-world functional problems that define ADHD map on to one another and how that mapping can be improved.

One of the most important potential uses of systematic reviews and meta-analyses in improving the clinical diagnosis of ADHD and treatment planning would be identification of effect modifiers for the performance of diagnostic tools: determining, for example, whether tools perform better in patients who are younger or older, in ethnic minorities, or those experiencing material hardship, or who have a comorbid illness or specific ADHD presentation. Future studies of ADHD should more systematically address the modifier effects of these patient characteristics. They should make available in public repositories the raw, individual-level data and the algorithms or computer code that will aid future efforts at replication, synthesis, and new discovery for diagnostic tools across data sets and studies.

Finally, no studies meeting our inclusion criteria assessed the consequences of being misdiagnosed or labeled as either having or not having ADHD, the diagnosis of ADHD specifically in preschool-aged children, or the potential adverse consequences of youth being incorrectly diagnosed with or without ADHD. This work is urgently needed.

We thank Cynthia Ramirez, Erin Tokutomi, Jennifer Rivera, Coleman Schaefer, Jerusalem Belay, Anne Onyekwuluje, and Mario Gastelum for help with data acquisition. We thank Kymika Okechukwu, Lauren Pilcher, Joanna King, and Robyn Wheatley from the American Academy of Pediatrics (AAP), Jennie Dalton and Paula Eguino Medina from PCORI, Christine Chang and Kim Wittenberg from AHRQ, and Mary Butler from the Minnesota Evidence-based Practice Center. We thank Glendy Burnett, Eugenia Chan, MD, MPH, Matthew J. Gormley, PhD, Laurence Greenhill, MD, Joseph Hagan, Jr, MD, Cecil Reynolds, PhD, Le'Ann Solmonson, PhD, LPC-S, CSC, and Peter Ziemkowski, MD, FAAFP who served as key informants. We thank Angelika Claussen, PhD, Alysa Doyle, PhD, Tiffany Farchione, MD, Matthew J. Gormley, PhD, Laurence Greenhill, MD, Jeffrey M. Halperin, PhD, Marisa Perez-Martin, MS, LMFT, Russell Schachar, MD, Le'Ann Solmonson, PhD, LPC-S, CSC, and James Swanson, PhD who served as a technical expert panel. Finally, we thank Joel Nigg, PhD, and Peter S. Jensen, MD for their peer review of the data.

Drs Peterson and Hempel conceptualized and designed the study, collected data, conducted the analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript; Dr Trampush conducted the critical appraisal; Ms Brown, Ms Maglione, Drs Bolshakova and Padkaman, and Ms Rozelle screened citations and abstracted the data; Dr Miles conducted the analyses; Ms Yagyu designed and executed the search strategy; Ms Motala served as data manager; and all authors provided critical input for the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

This trial has been registered at PROSPERO (identifier CRD42022312656).

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2024-065787 .

Data Sharing: Data are available in SRDRPlus.

FUNDING: The work is based on research conducted by the Southern California Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract 75Q80120D00009). The Patient-Centered Outcomes Research Institute (PCORI) funded the research (PCORI Publication No. 2023-SR-03). The findings and conclusions in this manuscript are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ or PCORI, its Board of Governors, or Methodology Committee. Therefore, no statement in this report should be construed as an official position of PCORI, AHRQ or of the US Department of Health and Human Services.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest to disclose.

attention-deficit/hyperactivity disorder

area under the curve

Child Behavior Checklist

continuous performance test

functional magnetic resonance imaging

receiver operating characteristics

strength of evidence

technical expert panel

Supplementary data

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Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers

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Children with Attention Deficit Hyperactivity Disorder (ADHD) are more at risk for academic underachievement compared to their typically developing peers. Understanding their greatest strengths and challenges at school, and how these can be supported, is vital in order to develop focused classroom interventions. Ten primary school pupils with ADHD (aged 6–11 years) and their teachers (N = 6) took part in semi-structured interviews that focused on (1) ADHD knowledge, (2) the child’s strengths and challenges at school, and (3) strategies in place to support challenges. Thematic analysis was used to analyse the interview transcripts and three key themes were identified; classroom-general versus individual-specific strategies, heterogeneity of strategies, and the role of peers. Implications relating to educational practice and future research are discussed.

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Characterised by persistent inattention, hyperactivity and impulsivity (APA, 2013), ADHD is a neurodevelopmental disorder thought to affect around 5% of children (Russell et al., 2014 ) although prevalence estimates vary (Sayal et al., 2018 ). Although these core symptoms are central to the ADHD diagnosis, those with ADHD also tend to differ from typically developing children with regards to cognition and social functioning (Coghill et al., 2014 ; Rhodes et al., 2012 ), which can negatively impact a range of life outcomes such as educational attainment and employment (Classi et al., 2012 ; Kuriyan et al., 2013 ). Indeed, academic outcomes for children with ADHD are often poor, particularly when compared with their typically developing peers (Arnold et al., 2020 ) but also compared to children with other neurodevelopmental disorders, such as autism (Mayes et al., 2020 ). Furthermore, children with ADHD can be viewed negatively by their peers. For example, Law et al. ( 2007 ) asked 11–12-year-olds to read vignettes describing the behaviour of a child with ADHD symptoms, and then use an adjective checklist to endorse those adjectives that they felt best described the target child. The four most frequently ascribed adjectives were all negative (i.e. ‘careless’, ‘lonely’, ‘crazy’, and ‘stupid’). These negative perceptions can have a significant impact on the wellbeing of individuals with ADHD, including self-stigmatisation (Mueller et al., 2012 ). There is evidence that teachers with increased knowledge of ADHD report more positive attitudes towards children with ADHD compared to those with poor knowledge (Ohan et al., 2008 ) and thus research that identifies the characteristics of gaps in knowledge is likely to be important in addressing stigma.

Previous research of teachers' ADHD knowledge is mixed, with the findings of some studies indicating that teachers have good knowledge of ADHD (Mohr-Jensen et al., 2019 ; Ohan et al., 2008 ) and others suggesting that their knowledge is limited (Latouche & Gascoigne, 2019 ; Perold et al., 2010 ). Ohan et al. ( 2008 ) surveyed 140 primary school teachers in Australia who reported having experience of teaching at least one child with ADHD. Teachers completed the ADHD Knowledge Scale which consisted of 20 statements requiring a response of either true or false (e.g. “A girl/boy can be appropriately labelled as ADHD and not necessarily be over-active ”). They found that, on average, teachers answered 76.34% of items correctly, although depth of knowledge varied across the sample. Almost a third of the sample (29%) had low knowledge of ADHD (scoring less than 69%), with just under half of teachers (47%) scoring in the average range (scores of 70–80%). Only a quarter (23%) had “high knowledge” (scores above 80%) suggesting that knowledge varied considerably. Furthermore, Perold et al. ( 2010 ) asked 552 teachers in South Africa to complete the Knowledge of Attention Deficit Disorders Scale (KADDS) and found that on average, teachers answered only 42.6% questions about ADHD correctly. Responses of “don’t know” (35.4%) and incorrect responses (22%) were also recorded, indicating gaps in knowledge as well as a high proportion of misconceptions. Similar ADHD knowledge scores were reported in Latouche and Gascoigne’s ( 2019 ) study, who found that teachers enrolled into their ADHD training workshop in Australia had baseline KADDS scores of below 50% accuracy (increased to above 80% accuracy after training).

The differences in ADHD knowledge reported between Ohan et al. ( 2008 ) and the more recent studies could be due to the measures used. Importantly, when completing the KADDS, respondents can select a “don’t know” option (which receives a score of 0), whereas the ADHD Knowledge Scale requires participants to choose either true or false for each statement. The KADDS is longer, with a total of 39 items, compared to the 20-item ADHD Knowledge Scale, offering a more in-depth knowledge assessment. The heterogeneity of measures used within the described body of research is also highlighted within Mohr-Jensen et al. ( 2019 ) systematic review; the most frequently used measure (the KADDS) was only used by 4 out of the 33 reviewed studies, showing little consensus on the best way to measure ADHD knowledge. Despite these differences in measurement, the findings from most studies indicate that teacher ADHD knowledge is lacking.

Qualitative methods can provide rich data, facilitating a deeper understanding of phenomena that quantitative methods alone cannot reveal. Despite this, there are very few examples in the literature of qualitative methods being used to understand teacher knowledge of ADHD. In one example, Lawrence et al. ( 2017 ) interviewed fourteen teachers in the United States about their experiences of working with pupils with ADHD, beginning with their knowledge of ADHD. They found that teachers tended to focus on the external symptoms of ADHD, expressing knowledge of both inattentive and hyperactive symptoms. Although this provided key initial insights into the nature of teachers’ ADHD knowledge, only a small section of the interview schedule (one out of eight questions/topics) directly focused on ADHD knowledge. Furthermore, none of the questions asked directly about strengths, with answers focusing on difficulties. It is therefore difficult to determine from this study whether teachers are aware of strengths and difficulties outside of the triad of symptoms. A deeper investigation is necessary to fully understand what teachers know, and to identify areas for targeted psychoeducation.

Importantly, improved ADHD knowledge may impact positively on the implementation of appropriate support for children with ADHD in school. For example, Ohan et al. ( 2008 ) found that teachers with high or average ADHD knowledge were more likely to perceive a benefit of educational support services than those with low knowledge, and teachers with high ADHD knowledge were also more likely to endorse a need for, and seek out, those services compared to those with low knowledge. Furthermore, improving knowledge through psychoeducation may be important for improving fidelity to interventions in ADHD (Dahl et al., 2020 ; Nussey et al., 2013 ). Indeed, clinical guidelines recommend inclusion of psychoeducation in the treatment plan for children with ADHD and their families (NICE, 2018 ). Furthermore, Jones and Chronis-Tuscano ( 2008 ) found that educational ADHD training increased special education teachers’ use of behaviour management strategies in the classroom. Together, these findings suggest that understanding of ADHD may improve teachers’ selection and utilisation of appropriate strategies.

Child and teacher insight into strategy use in the classroom on a practical, day-to-day level may provide an opportunity to better understand how different strategies might benefit children, as well as the potential barriers or facilitators to implementing these in the classroom. Previous research with teachers has shown that aspects of the physical classroom can facilitate the implementation of effective strategies for autistic children, for example to support planning with the use of visual timetables (McDougal et al., 2020 ). Despite this, little research has considered the strategies that children with ADHD and their teachers are using in the classroom to support their difficulties and improve learning outcomes. Moore et al. ( 2017 ) conducted focus groups with UK-based educators (N = 39) at both primary and secondary education levels, to explore their experiences of responding to ADHD in the classroom, as well as the barriers and facilitators to supporting children. They found that educators mostly reflected on general inclusive strategies in the classroom that rarely targeted ADHD symptoms or difficulties specifically, despite the large number of strategies designed to support ADHD that are reported elsewhere in the literature (DuPaul et al., 2012 ; Richardson et al., 2015 ). Further to this, when interviewing teachers about their experiences of teaching pupils with ADHD, Lawrence et al. ( 2017 ) specifically asked about interventions or strategies used in the classroom with children with ADHD. The reported strategies were almost exclusively behaviourally based, for example, allowing children to fidget or move around the classroom, utilising rewards, using redirection techniques, or reducing distraction. This lack of focus on cognitive strategies is surprising, given the breadth of literature focusing on the cognitive difficulties in ADHD (e.g. Coghill, et al., 2014 ; Gathercole et al., 2018 ; Rhodes et al., 2012 ). Furthermore, to our knowledge research examining strategy use from the perspective of children with ADHD themselves, or strengths associated with ADHD, is yet to be conducted.

Knowledge and understanding of ADHD in children with ADHD has attracted less investigation than that of teachers. In a Canadian sample of 8- to 12-year-olds with ADHD (N = 29), Climie and Henley ( 2018 ) found that ADHD knowledge was highly varied between children; scores on the Children ADHD Knowledge and Opinions Scale ranged from 5 to 92% correct (M = 66.53%, SD = 18.96). The authors highlighted some possible knowledge gaps, such as hyperactivity not being a symptom for all people with ADHD, or the potential impact upon social relationships, however the authors did not measure participant’s ADHD symptoms, which could influence how children perceive ADHD. Indeed, Wiener et al ( 2012 ) has shown that children with ADHD may underestimate their symptoms. If this is the case, it would also be beneficial to investigate their understanding of their own strengths and difficulties, as well as of ADHD more broadly. Furthermore, if children do have a poor understanding of ADHD, they may benefit from psychoeducational interventions. Indeed, in their systematic review Dahl et al. ( 2020 ) found two studies in which the impact of psychoeducation upon children’s ADHD knowledge was examined, both of which reported an increase in knowledge as a consequence of the intervention. Understanding the strengths and difficulties of the child, from the perspective of the child and their teacher, will also allow the design of interventions that are individualised, an important feature for school-based programmes (Richardson et al., 2015 ). Given the above, understanding whether children have knowledge of their ADHD and are aware of strategies to support them would be invaluable.

Teacher and child knowledge of ADHD and strategies to support these children is important for positive developmental outcomes, however there is limited research evidence beyond quantitative data. Insights from children and teachers themselves is particularly lacking and the insights which are available do not always extend to understanding strengths which is an important consideration, particularly with regards to implications for pupil self-esteem and motivation. The current study therefore provides a vital examination of the perspectives of both strengths and weaknesses from a heterogeneous group of children with ADHD and their teachers. Our sample reflects the diversity encountered in typical mainstream classrooms in the UK and the matched pupil-teacher perspectives enriches current understandings in the literature. Specifically, we aimed to explore (1) child and teacher knowledge of ADHD, and (2) strategy use within the primary school classroom to support children with ADHD. This novel approach, from the dual perspective of children and teachers, will enable us to identify potential knowledge gaps, areas of strength, and insights on the use of strategies to support their difficulties.

Participants

Ten primary school children (3 female) aged 7 to 11 years (M = 8.7, SD = 1.34) referred to Child and Adolescent Mental Health Services (CAMHS) within the NHS for an ADHD diagnosis were recruited to the study. All participant characteristics are presented in Table 1 . All children were part of the Edinburgh Attainment and Cognition Cohort and had consented to be contacted for future research. Children who were under assessment for ADHD or who had received an ADHD diagnosis were eligible to take part. Contact was established with the parent of 13 potential participants. Two had undergone the ADHD assessment process with an outcome of no ADHD diagnosis and were therefore not eligible to take part, and one could not take part within the timeframe of the study. The study was approved by an NHS Research Ethics Committee and parents provided informed consent prior to their child taking part. Co-occurrences data for all participants was collected as part of a previous study and are reported here for added context. All of the children scored above the cut-off (T-score > 70) for ADHD on the Conners 3 rd Edition Parent diagnostic questionnaire (Conners, 2008 ). The maximum possible score for this measure is 90. At the point of interview, seven children had received a diagnosis of ADHD, two children were still under assessment, and one child had been referred for an ASD diagnosis (Table 1 ). The ADHD subtype of each participant was not recorded, however all children scored above the cut-off for both inattention (M = 87.3, SD = 5.03) and hyperactivity (M = 78.6, SD = 5.8) which is indicative of ADHD combined type. Use of stimulant medication was not recorded at the time of interview.

Following the child interview and receipt of parental consent, each child’s school was contacted to request their teacher’s participation in the study. Three teachers could not take part within the timeframe of the study, and one refused to take part. Six teachers (all female) were successfully contacted and gave informed consent to participate.

Due to the increased likelihood of co-occurring diagnoses in the target population, we also report Autism Spectrum Disorder (ASD) symptoms and Developmental Co-ordination Disorder (DCD) symptoms using the Autism Quotient 10-item questionnaire (AQ-10; Allison et al., 2012 ) and Movement ABC-2 Checklist (M-ABC2; Henderson et al., 2007 ) respectively, both completed by the child’s parent.

Scores of 6 and above on the AQ-10 indicates referral for diagnostic assessment for autism is advisable. All but one of the participants scored below the cut-off on this measure (M = 3.6, SD = 1.84).

The M-ABC2 checklist categorises children as scoring green, amber or red based on their scores. A green rating (up to the 85th percentile) indicates no movement difficulty, amber ratings (between 85 and 95th percentile) indicate risk of movement difficulty, and red ratings (95th percentile and above) indicate high likelihood of movement difficulty. Seven of the participants received a red rating, one an amber rating, and two green ratings.

Socioeconomic status (SES) is also known to impact educational outcomes, therefore the SES of each child was calculated using the Scottish Index of Multiple Deprivation (SIMD), which is an area-based measure of relative deprivation. The child’s home postcode was entered into the tool which provided a score of deprivation on a scale of 1 to 5. A score of 1 is given to the 20% most deprived data zones in Scotland, and a score of 5 indicates the area was within the 20% least deprived areas.

Semi-Structured Interview

The first author, who is a psychologist, conducted interviews with each participant individually, and then a separate interview with their teacher. This was guided by a semi-structured interview schedule (see Appendix A, Appendix B) developed in line with our research questions, existing literature, and using authors (T.S. and J.B.) expertise in educational practice. The questions were adapted to be relevant for the participant group. For example, children were asked “If a friend asked you to tell them what ADHD is, what would you tell them?” and teachers were asked, “What is your understanding of ADHD or can you describe a typical child with ADHD?”. The schedule comprised two key sections for both teachers and children. The first section focused on probing the participant’s understanding and knowledge of ADHD broadly. The second section focused on the participating child’s academic and cognitive strengths and weaknesses, and the strategies used to support them. Interviews with children took place in the child’s home and lasted between 19 and 51 min (M = 26.3, SD = 10.9). Interviews with teachers took place at their school and were between 28 and 50 min long (M = 36.5, SD = 7.61). Variation in interview length was mostly due to availability of the participant and/or age of the child (i.e. interviews with younger children tended to be shorter). All interviews were recorded on an encrypted voice recorder and transcribed by the first author prior to data analysis. Pseudonyms were randomly generated for each child to protect anonymity.

Reflexive thematic analysis was used to analyse the data (Braun & Clarke, 2019 ). This flexible approach allows the data to drive the analysis, putting the participant at the centre of the research and placing high value on the experiences and perspectives of individual participants (Braun & Clarke, 2006 ). The six phases of reflexive thematic analysis as outlined by Braun and Clarke were followed: (1) familiarisation, (2) generating codes, (3) constructing themes, (4) revising themes, (5) defining themes, (6) producing the report. Due to the exploratory nature of this study, bottom-up inductive coding was used. Two of the authors (E.M. and C.T.) worked collaboratively to construct and subsequently define the themes using the process described above. More specifically, one author (E.M.) generated codes, with support from another author (C.T.). Collated codes and data were then abstracted into potential themes, which were reviewed and refined using relevant literature, as well as within the wider context of the data. This process continued until all themes were agreed upon.

In the first part of the analysis, focus was placed on summarising the participants’ understanding of ADHD, as well as what they thought their biggest strengths and challenges were at school. Following this, an in-depth analysis of the strategies used in the classroom was conducted, taking into account the perspective of both teachers and children, aiming to generate themes from the data.

Knowledge of ADHD

Children and teachers were asked about their knowledge of ADHD. When asked if they had ever heard of ADHD, the majority of children said yes. Some of the children could not explain to the interviewer what ADHD was or responded in a way that suggested a lack of understanding ( “it helps you with skills” – Niall, 7 years; “ Well it’s when you can’t handle yourself and you’re always crazy and you can just like do things very fast”— Nathan, 8 years). Very few of the children were able to elaborate accurately on their understanding of ADHD, which exclusively focused on inattention. For example, Paige (8 years) said “ its’ kinda like this thing that makes it hard to concentrate ” and Finn (10 years) said “ they get distracted more just in different ways that other people would ”. This suggests that children with ADHD may lack or have a limited awareness or understanding of their diagnosis.

When asked about their knowledge of ADHD, teachers tended to focus on the core symptoms of ADHD. All teachers directly mentioned difficulties with attention, focus or concentration, and most directly or indirectly referred to hyperactivity (e.g. moving around, being in “ overdrive ”). Most teachers also referred to social difficulties as a feature of ADHD, including not following social rules, reacting inappropriately to other children and appearing to lack empathy, which they suggested could be linked to impulsivity. For example, “ reacting in social situations where perhaps other children might not react in a similar way” (Paige’s teacher) and “ They can react really really quickly to things and sometimes aggressively” (Eric’s teacher). Although no teachers directly mentioned cognitive difficulties, some referred to behaviours indicative of cognitive difficulties, for example, “ they can’t store a lot of information at one time” (Eric’s teacher) and, “ it’s not just the concentration it’s the amount they can take in at a time as well” (Nathan’s teacher), which may reflect processing or memory differences. Heterogeneity was mentioned, in that ADHD can mean different things for different children (e.g., “ I think ADHD differs from child to child and I think that’s really important” —Nathan’s teacher). Finally, academic difficulties as a feature of ADHD were also mentioned (e.g., “ a child… who finds some aspects of school life, some aspects of the curriculum challenging ”—Jay’s teacher).

After being asked to give a general description of ADHD, each child was asked about their own strengths at school and teachers were also asked to reflect on this topic for the child taking part.

When asked what they like most about school, children often mentioned art or P.E. as their preferred subjects. A small number of children said they enjoyed maths or reading, but this was not common and the majority described these subjects as a challenge or something they disliked. There was also clear link between the aspects of school children enjoyed, and what they perceived to be a strength for them. For example, when asked what he liked about school, Eric (10 years) said, “ Math, I’m pretty good at that”, or when later asked what they were good at, most children responded with the same answers they gave when asked what they liked about school. It is interesting to note that subjects such as art or P.E. generally have a different format to more traditionally academic subjects such as maths or literacy. Indeed, Felicity (11 years) said, “ I quite like art and drama because there’s not much reading…and not really too much writing in any of those” . Children also tended to mention the non-academic aspects of school, such as seeing their friends, or lunch and break times.

Teachers’ descriptions of the children’s strengths were much more variable compared to strengths mentioned by children. Like the children, teachers tended to consider P.E and artistic activities to be a strength for the child with ADHD. Multiple teachers referred to the child having a good imagination and creative skills. For example, “ she’s a very imaginative little girl, she has a great ability to tell stories and certainly with support write imaginative stories” (Paige’s teacher) . Teachers referred to other qualities or characteristics of the child as strengths, although these varied across teachers. These included openness, both socially but also in the context of willingness to learn or being open to new challenges, being a hard worker, or an enjoyable person to be around (e.g., “ he is the loveliest little boy, I’ve got a lot of time for [Nathan]. He makes me smile every day, you know, he just comes out with stuff he’s hilarious”— Nathan’s teacher). The most noticeable theme that emerged from this data was that when some teachers began describing one of the child’s strengths, it was suffixed with a negative. For example, Henry’s teacher said, “ He’s got a very good imagination, his writing- well not so much the writing of the stories, he finds writing quite a challenge, but his verbalising of ideas he’s very imaginative”. This may reflect that while these children have their own strengths, these can be limited by difficulties. Indeed, Paige’s teacher said, “ I think she’s a very able little girl without a doubt, but there is a definite barrier to her learning in terms of her organisation, in terms of her focus” , which reinforces this notion.

Children were asked directly about what they disliked about school, and what they found difficult. Children tended to focus more on specific subjects, with maths and aspects of literacy being the most frequently mentioned of these. Children referred to difficulties with or a dislike for reading, writing and/or spelling activities, for example, Rory (9 years) said “ Well I suppose spelling because … sometimes we have to do some boring tasks like we have to write it out three times then come up with the sentence for each one which takes forever and it’s hard for me to think of the sentences if I’m not ready” . Linking this with known cognitive difficulties in ADHD, it is interesting to note that both memory and planning are implicated in this quote from Rory about finding spelling challenging. In terms of writing, children referred to both the physical act of writing (e.g., “ probably writing cause sometimes I forget my finger spaces ”—Paige, 8 years; “ [writing the alphabet is] too hard… like the letters joined together … [and] I make mistakes” —Jay, 7 years) as well as the planning associated with writing a longer piece of work (e.g. “ when I run out of ideas for it, it’s really hard to think of some more so I don’t usually get that much writing done ”—Rory (9 years) .

Aside from academic subjects, several children referred to difficulties with focus or attention (e.g. “ when I find it hard to do something I normally kind of just zone out ”—Felicity, 11 years, “ probably concentrating sometimes ”—Rory, 9 years), but boredom was also a common and potentially related theme (e.g. “ Reading is a bit hard though … it just sometimes gets a bit boring” —Finn, 10 years, “ I absolutely hate maths … ‘cause it’s boring ”—Paige, 8 years). It could be that children with ADHD find it more difficult to concentrate during activities they find boring. Indeed, when Jay (7 years) was asked how it made him feel when he found something boring, he said “ it made me not do my work ”. Some children also alluded to the social difficulties faced at school, which included bullying and difficulties making friends (e.g. “ just making all kind of friends [is difficult] ‘cause the only friend that I’ve got is [name redacted] ”—Nathan, 8 years; “ sometimes finding a friend to play with at break time [is difficult] ” – Paige, 8 years; “ there’s a lot of people in my school that they bully me” —Eric, 10 years).

When asked what they thought were the child’s biggest challenges at school, teachers' responses were relatively variable, although some common themes were identified. As was the case for children, teachers reflected on difficulties with attention, which also included being able to sit at the table for long periods of time (e.g. “ I would say he struggles the most with sitting at his table and focusing on one piece of work ”—Henry’s teacher). Teachers did also mention difficulties with subjects such as maths and literacy, although this varied from child to child, and often they discussed these in the context of their ADHD symptom-related difficulties. For example, Eric’s teacher said, “ we’ve struggled to get a long piece of writing out of him because he just can’t really sit for very long ”. This quote also alludes to difficulties with evaluating the child’s academic abilities, due to their ADHD-related difficulties, which was supported by other teachers (e.g. “ He doesn’t particularly enjoy writing and he’s slow, very slow. And I don’t know if that’s down to attention or if that’s something he actually does find difficult to do ” —Henry’s teacher). Furthermore, some teachers reflected on the child’s confidence as opposed to a direct academic difficulty. For example, Luna’s teacher said, “ I think it’s she lacks the confidence in maths and reading like the most ” and later, elaborated with “ she’ll be like “I can’t do it” but she actually can. Sometimes she’s … even just anxious at doing a task where she thinks … she might not get it. But she does, she’s just not got that confidence”.

Teachers also commonly mentioned social difficulties, and referred to these difficulties as a barrier to collaborative learning activities (e.g. “ he doesn’t always work well with other people and other people can get frustrated” —Henry’s teacher; “ [during] collaborative group work [Paige] perhaps goes off task and does things she shouldn’t necessarily be doing and that can cause friction within the group” —Paige’s teacher). Teachers also mentioned emotion regulation, mostly in relation to the child’s social difficulties. For example, Eric’s teacher said “ I think as well he does still struggle with his emotions like getting angry very very quickly, and being very defensive when actually he’s taken the situation the wrong way” , which suggests that the child’s difficulty with regulating emotions may impact on their social relationships.

Strategy Use in the Classroom

Strategies to support learning fell into one of four categories: concrete or visual resources, information processing, seating and movement, and support from or influence of others. Examples of codes included in each of these strategy categories are presented in Table 2 .

Concrete or visual resources were the most commonly mentioned type of strategy by teachers and children, referring to the importance of having physical representations to support learning. Teachers spoke about the benefit of using visual aids (e.g. “ I think [Henry] is quite visual so making sure that there is visual prompts and clues and things like that to help him ”—Henry’s teacher), and teachers and children alluded to these resources supporting difficulties with holding information in mind. For example, when talking about the times table squares he uses, Rory said “ sometimes I forget which one I’m on…and it’s easier for me to have my finger next to it than just doing it in my head because sometimes I would need to start doing it all over again ”.

Seating and movement were also commonly mentioned, which seemed to be specific to children with ADHD in that it was linked to inattention and hyperactivity symptoms. For example, teachers referred to supporting attention or avoiding distraction by the positioning of a child’s location in the classroom (e.g. “ he’s so easily distracted, so he has an individual desk in the room and he’s away from everyone else because he wasn’t coping at a table [and] he’s been so much more settled since we got him an individual desk” —Eric’s teacher). Some teachers also mentioned the importance of allowing children to move around the room where feasible, as well as giving them errands to perform as a movement break (e.g. “ if I need something from the printer, [Nathan] is gonna go for it for me…because that’s down the stairs and then back up the stairs so if I think he’s getting a bit chatty or he’s not focused I’ll ask him to go and just give him that break as well” —Nathan’s teacher). Children also spoke about these strategies but didn’t necessarily describe why or how these strategies help them.

Information processing and cognitive strategies included methods that supported children to process learning content or instructions. For example, teachers frequently mentioned breaking down tasks or instructions into more manageable chunks (e.g. “ with my instructions to [Eric] I break them down … I’ll be like “we’re doing this and then we’re doing this” whereas the whole class wouldn’t need that ”—Eric’s teacher). Teachers and children also mentioned using memory strategies such as songs, rhymes or prompts. For example, Jay’s teacher said, “ if I was one of the other children I could see why it would be very distracting but he’s like he’s singing to himself little times table songs that we’ve been learning in class” , and Paige (8 years) referred to using mnemonics to help with words she struggles to spell, “ I keep forgetting [the word] because. But luckily we got the story big elephants can always understand little elephants [which helps because] the first letter of every word spells because” .

Both groups of participants mentioned support from and influence of others, and referred to working with peers, the teacher–child relationship, and one-to-one teaching. Peer support was a common theme across the data and is discussed in more detail in the thematic analysis findings, where teachers and children referred to the importance of the role of peers during learning activities. Understanding the child well and adapting to them was also seen as important, for example, Luna’s teacher said, “ with everything curricular [I] try and have an art element for her, just so I know it’ll engage her [because] if it’s like a boring old written worksheet she’s not gonna do it unless you’re sitting beside her and you’re basically telling her the answers” . As indicated in this quote, teachers also referred to the effectiveness of one-to-one or small group work with the child (e.g. “ when somebody sits beside her and explains it, and goes “come on [Paige] you know how to do this, let’s just work through a couple of examples”… her focus is generally better ” – Paige’s teacher), however this resource is not always available (e.g. “ I’d love for someone to be one-to-one with [Luna] but it’s just not available, she doesn’t meet that criteria apparently ” – Luna’s teacher). Children also referred to seeking direct support from their teacher (e.g. “if I can’t get an idea of what I’m doing then I ask the teacher for help” – Paige, 8 years), but were more likely to mention seeking support from their peers than the teacher.

Thematic Analysis

In addition to summarising the types of strategies that teachers and children reported using in the classroom, the data were also analysed using thematic analysis to generate themes. These are now presented. The theme names, definitions, and example quotes for each theme are presented in Table 3 .

Theme 1: Classroom-General Versus Individual-Specific Strategies

During the interviews, teachers spoke about strategies that they use as part of their teaching practice for the whole class but that are particularly helpful for the child/children with ADHD. These tended to be concrete or visual resources that are available in the classroom for anyone, for example, a visual timetable or routine checklist (e.g. “ there’s also a morning routine and listing down what’s to be done and where it’s to go … it’s very general for the class but again it’s located near her” —Paige’s teacher).

Teachers also mentioned using strategies that have been implemented specifically for that child, and these strategies tended to focus on supporting attention. For example, Nathan’s teacher spoke about the importance of using his name to attract his attention, “ maybe explaining to the class but then making sure that I’m saying “[Nathan], you’re doing this”, you know using his name quite a lot so that he knows it’s his task not just the everybody task ”, and this was a strategy that multiple teachers referred to using with the individual child and not necessarily for other children. Other strategies to support attention with a specific child also tended to be seating and movement related, such as having an individual desk or allowing them to fidget. For example, Luna’s teacher said, “ she’s a fidgeter so she’ll have stuff to fidget with … [and] even if she’s wandering around the classroom or she’s sitting on a table, I don’t let other kids do that, but as long as she’s listening, it’s fine [with me]” .

Similar to teachers, children spoke about strategies or resources that were in place for them specifically as well as about general things in the classroom that they find helpful. That said, it was less common for children to talk about why particular strategies were in place for them and how they helped them directly.

In addition to recognising strategies that teachers had put in place for them, children also referred to using their own strategies in the classroom. The most frequently mentioned strategy was fidgeting, and although some of the younger children spoke about having resources available in the classroom for fidgeting, some of the older children referred to using their own toy or an object that was readily available to them but not intended for fidgeting. For example, Finn (10 years) and Rory (9 years) both spoke about using items from their pencil case to fiddle with, and explained that this would help them to focus. (“ Sometimes I fidget with something I normally just have like a pencil holder under the table moving about … [and] it just keeps my mind clear and not from something else ”—Rory; “ Sometimes I fiddle with my fingers and that sometimes helps, but if not I get one of my coloured pencils and have a little gnaw on it because that actually takes my mind off some things and it’s easier for me to concentrate when I have something to do ”—Finn). Henry (9 years) spoke about being secretive with his fidgeting as it was not permitted in class, “ if you just bring [a fidget toy] in without permission [the teacher will] just take it off of you, so it has to be something that’s not too big. I bring in a little Lego ray which is just small enough that she won’t notice ”. Although some teachers did mention having fidget toys available, not all teachers seemed to recognise the importance of this for the child, and some children viewed fidgeting as a behaviour they should hide from the teacher.

Another strategy mentioned uniquely by children was seeing their peers as a resource for ideas or information. This is discussed in more detail in Theme 3—The role of peers , but reinforces the notion that children also develop their own strategies, independently from their teacher, rather than relying only on what is made available to them.

Theme 2: Heterogeneity of Strategies

Teachers spoke about the need for a variety of strategies in the classroom, for two reasons: (1) that different strategies work for different children (e.g. “ some [strategies] will work for the majority of the children and some just don’t seem to work for any of them ”—Jay’s teacher), and (2) what works for a child on one occasion may not work consistently for the same child (e.g. “ I think it’s a bit of a journey with him, and some things have worked and then stopped working, so I think we’re constantly adapting and changing what we’re doing ”—Eric’s teacher). One example of both of these challenges of strategy use came from Luna’s teacher, who spoke about using a reward chart with Luna and another child with ADHD, “ [Luna] and another boy in my class [with ADHD] both had [a reward chart]… but I think whereas the boy loved his and still loves his, she was getting a bit “oh I’m too cool for this” or that sort of age… so I stopped doing that for her and she’s not missing that at all” . These quotes demonstrate that strategies can work differently for different children, highlighting the need for a variety of strategies for teachers to access and trial with children.

Some children also referred to the variability of whether a strategy was helpful or not; for example, Henry (9 years) said that he finds it helpful to fidget with a toy but that sometimes it can distract him and prevent him from listening to the teacher. He said, “ Well, [the fidget toy] helps but it also gets me into trouble when the teacher spots me building it when I’m listening…but then sometimes I might not listen in maths and [use the fidget toy] which might make it worse”. This highlights that both children and teachers might benefit from support in understanding the contexts in which to use particular strategies, as well as why they are helpful from a psychological perspective.

For teachers, building a relationship with and understanding the child was also highly important in identifying strategies that would work. Luna’s teacher reflected upon the difference in Luna’s behaviour at the start of the academic year, compared to the second academic term, “ at the start of the year, we would just clash the whole time. I didn’t know her, she didn’t know me … and then when we got that bond she was absolutely fine so her behaviour has got way better ”. Eric’s teacher also reflected on how her relationship with Eric had changed, particularly after he received his diagnosis of ADHD, “ I think my approach to him has completely changed. I don’t raise my voice, I speak very calmly, I give him time to calm down before I even broach things with him. I think our relationship’s just got so much better ‘cause I kind of understand … where he’s coming from ”. She also said, “ it just takes a long time to get to know the child and get to know what works for them and trialling different things out ”, which demonstrates that building a relationship with and understanding the child can help to identify the successful strategies that work with different children.

Theme 3: The Role of Peers

Teachers and children spoke about the role of the child’s peers in their learning. Teachers talked about the benefit of partnering the child with good role models (e.g. “ I will put him with a couple of good role models and a couple of children who are patient and who will actually maybe get on with the task, and if [Jay] is not on task or not on board with what they’re doing at least he’s hearing and seeing good behaviour ”—Jay’s teacher), whereas children spoke more about their peers as a source of information, idea generation, or guidance on what to do next. For example, when asked what he does to help him with his writing, Henry (9 years) said, “ [I] listen to what my partner’s saying… my half of the table discuss what they’re going to do so I can literally hear everything they’re doing and steal some of their ideas ”. Henry wasn’t the only child to use their peers as a source of information, for example, Niall (7 years) said, “ I prefer working with the children because some things I might not know and the children might help me give ideas ”, and with a more specific example, Rory (9 years) said, “ somebody chose a very good character for their bit of writing, and I was like “I think I might choose that character”, and somebody else said “my setting was going to be the sea”, and I chose that and put that in a tiny bit of my story ”.

Some children also spoke about getting help from their peers in other ways, particularly when completing a difficult task. Paige (8 years) said, “ if the question isn’t clear I try and figure it out, and if I can’t figure it out then… don’t tell my teacher this but I sometimes get help from my classmates ”, which suggests some guilt associated with asking for help from her peers. This could be related to confidence and self-esteem, which teachers mentioned as a difficulty for some children with ADHD. In some instances, children felt it necessary to directly copy their peers’ work; for example, Nathan (8 years) spoke about needing a physical resource (i.e. “ fuzzies ”) to complete maths problems, but that when none were available he would “ just end up copying other people ”. This could also be related to a lack of confidence, as he may feel as though he may not be able to complete the task on his own. Indeed, Nathan’s teacher mentioned that when he is given the option to choose a task from different difficulty levels, Nathan would typically choose something easier, and that it was important to encourage him to choose something more difficult to build his confidence, “ I quite often say to him “come on I think you can challenge yourself” and [will] use that language”.

Peers clearly play an important role for the children with ADHD, and this is recognised both by the children themselves, and by their teachers. Teachers also mentioned that children with ADHD respond well to one-to-one learning with staff, indicating that it is important for these children to have opportunities to learn in different contexts: whole classroom learning, small group work and one-to-one.

In this study, a number of important topics surrounding ADHD in the primary school setting were explored, including ADHD knowledge, strengths and challenges, and strategy use in the classroom, each of which will now be discussed in turn before drawing together the findings and outlining the implications.

ADHD Knowledge

Knowledge of ADHD varied between children and their teachers. Whilst most of the children claimed to have heard of ADHD, very few could accurately describe the core symptoms. Previous research into this area is limited, however this finding supports Climie and Henley’s ( 2018 ) finding that children’s knowledge of ADHD can be limited. By comparison, all of the interviewed teachers had good knowledge about the core ADHD phenotype (i.e. in relation to diagnostic criteria) and some elaborated further by mentioning social difficulties or description of behaviours that could reflect cognitive difficulties. This supports and builds further upon existing research into teachers’ ADHD knowledge, demonstrating that although teachers understanding may be grounded in a focus upon inattention and hyperactivity, this is not necessarily representative of the range of their knowledge. By interviewing participants about their ADHD knowledge, as opposed to asking them to complete a questionnaire as previous studies have done (Climie & Henley, 2018 ; Latouche & Gascoigne, 2019 ; Ohan et al., 2008 ; Perold et al., 2010 ), the present study has demonstrated the specific areas of knowledge that should be targeted when designing psychoeducation interventions for children and teachers, such as broader aspects of cognitive difficulties in executive functions and memory. Improving knowledge of ADHD in this way could lead to increased positive attitudes and reduction of stigma towards individuals with ADHD (Mueller et al., 2012 ; Ohan et al., 2008 ), and in turn improving adherence to more specified interventions (Bai et al., 2015 ).

Strengths and Challenges

A range of strengths and challenges were discussed, some of which were mentioned by both children and teachers, whilst others were unique to a particular group. The main consensus in the current study was that art and P.E. tended to be the lessons in which children with ADHD thrive the most. Teachers elaborated on this notion, speaking about creative skills, such as a good imagination, and that these skills were sometimes applied in other subjects such as creative writing in literacy. Little to no research has so far focused on the strengths of children with ADHD, therefore these findings identify important areas for future investigation. For example, it is possible that these strengths could be harnessed in educational practice or intervention.

Although a strength for some, literacy was commonly mentioned as a challenge by both groups, specifically in relation to planning, spelling or the physical act of writing. Previous research has repeatedly demonstrated that literacy outcomes are poorer for children with ADHD compared to their typically developing peers (DuPaul et al., 2016; Mayes et al., 2020 ), however in these studies literacy tended to be measured using a composite achievement score, where the nuance of these difficulties can be lost. Furthermore, in line with a recent systematic review and meta-analysis (McDougal et al., 2022 ) the present study’s findings suggest that cognitive difficulties may contribute to poor literacy performance in ADHD. This issue was not unique to literacy, however, as teachers also spoke about academic challenges in the context of ADHD symptoms being a barrier to learning, such as finding it difficult to remain seated long enough to complete a piece of work. Children also raised this issue of engagement, who referred to the most challenging subjects being ‘boring’ for them. This link between attention difficulties and boredom in ADHD has been well documented (Golubchik et al., 2020 ). The findings here demonstrate the need for further research into the underlying cognitive difficulties leading to academic underachievement.

Both children and teachers also mentioned social and emotional difficulties. Research has shown that many different factors may contribute to social difficulties in ADHD (for a review see Gardner & Gerdes, 2015 ), making it a complex issue to disentangle. That said, in the current study teachers tended to attribute the children’s relationship difficulties to behaviour, such as reacting impulsively in social situations, or going off task during group work, both of which could be linked to ADHD symptoms. Despite these difficulties, peers were also considered a positive support. This finding adds to the complexity of understanding social difficulties for children with ADHD, demonstrating the necessity and value of further research into this key area.

The three key themes of classroom-general versus individual-specific strategies , heterogeneity of strategies and the role of peers were identified from the interview transcripts with children and their teachers. Within the first theme, classroom-general versus individual-specific strategies, it was clear that teachers utilise strategies that are specific to the child with ADHD, as well as strategies that are general to the classroom but that are also beneficial to the child with ADHD. Previously, Moore et al. ( 2017 ) found that teachers mostly reflected on using general inclusive strategies, rather than those targeted for ADHD specifically, however the methods differ from the current study in two key ways. Firstly, Moore et al.’s sample included secondary and primary school teachers, for whom the learning environment is very different. Secondly, focus groups were used as opposed to interviews where the voices of some participants can be lost. The merit of the current study is that children were also interviewed using the same questions as teachers; we found that children also referred to these differing types of strategies, and reported finding them useful, suggesting that the reports of teachers were accurate. Interestingly, children also mentioned their own strategies that teachers did not discuss and may not have been aware of. This finding highlights the importance of communication between the child and the teacher, particularly when the child is using a strategy considered to be forbidden or discouraged, for example copying a peer’s work or fidgeting with a toy. This communication would provide an understanding of what the child might find helpful, but more importantly identify areas of difficulty that may need more attention. Further to this, most strategies specific to the child mentioned by teachers aimed to support attention, and few strategies targeted other difficulties, particularly other aspects of cognition such as memory or executive function, which supports previous findings (Lawrence et al., 2017 ). The use of a wide range of individualised strategies would be beneficial to support children with ADHD.

Similarly, the second theme, heterogeneity of strategies , highlighted that some strategies work with some children and not others, and some strategies may not work for the same child consistently. Given the benefit of a wide range of strategy use, for both children with ADHD and their teachers, the development of an accessible tool-kit of strategies would be useful. Importantly, and as recognised in this second theme, knowing the individual child is key to identifying appropriate strategies, highlighting the essential role of the child’s teacher in supporting ADHD. Teachers mostly spoke about this in relation to the child’s interests and building rapport, however this could also be applied to the child’s cognitive profile. A tool-kit of available strategies and knowledge of which difficulties they support, as well as how to identify these difficulties, would facilitate teachers to continue their invaluable support for children and young people with ADHD. This links to the importance of psychoeducation; as previously discussed, the teachers in our study had a good knowledge of the core ADHD phenotype, but few spoke about the cognitive strengths and difficulties of ADHD. Children and their teachers could benefit from psychoeducation, that is, understanding ADHD in more depth (i.e., broader cognitive and behavioural profiles beyond diagnostic criteria), what ADHD and any co-occurrences might mean for the individual child, and why certain strategies are helpful. Improving knowledge using psychoeducation is known to improve fidelity to interventions (Dahl et al., 2020 ; Nussey et al., 2013 ), suggesting that this would facilitate children and their teachers to identify effective strategies and maintain these in the long-term.

The third theme, the role of peers , called attention to the importance of classmates for children with ADHD, and this was recognised by both children and their teachers. As peers play a role in the learning experience for children with ADHD, it is important to ensure that children have opportunities to learn in small group contexts with their peers. This finding is supported by Vygotsky’s ( 1978 ) Zone of Proximal Development; it is well established in the literature that children can benefit from completing learning activities with a partner, especially a more able peer (Vygotsky, 1978 ).

Relevance of Co-Occurrences

Co-occurring conditions are common in ADHD (Jensen & Steinhausen, 2015 ), and there are many instances within the data presented here that may reflect these co-occurrences, in particular, the overlap with DCD and ASD. For ADHD and DCD, the overlap is considered to be approximately 50% (Goulardins et al., 2015 ), whilst ADHD and autism also frequently co-occur with rates ranging from 40 to 70% (Antshel & Russo, 2019 ). It was not an aim of the current study to directly examine co-occurrences, however it is important to recognise their relevance when interpreting the findings. Indeed, in the current sample, scores for seven children (70%) indicated a high likelihood of movement difficulty. One child scored above the cut-off for autism diagnosis referral on the AQ-10, indicating heightened autism symptoms. Further to this, some of the discussions with children and teachers seemed to be related to DCD or autism, for example, the way that they can react in social situations, or difficulties with the physical act of handwriting. This finding feeds into the ongoing narrative surrounding heterogeneity within ADHD and individualisation of strategies to support learning. Recognising the potential role of co-occurrences should therefore be a vital part of any psychoeducation programme for children with ADHD and their teachers.

Limitations

Whilst a strong sample size was achieved for the current study allowing for rich data to be generated, it is important to acknowledge the issue of representativeness. The heterogeneity of ADHD is recognised throughout the current study, however the current study represents only a small cohort of children and young people with ADHD and their teachers which should be considered when interpreting the findings, particularly in relation to generalisation. Future research should investigate the issues raised using quantitative methods. Also on this point of heterogeneity, although we report some co-occurring symptoms for participants, the number of co-occurrences considered here were limited to autism and DCD. Learning disabilities and other disorders may play a role, however due to the qualitative nature of this study it was not feasible to collect data on every potential co-occurrence. Future quantitative work should aim to understand the complex interplay of diagnosed and undiagnosed co-occurrences.

Furthermore, only some of the teachers of participating children took part in the study; we were not able to recruit all 10. It may be, for example, that the six teachers who did take part were motivated to do so based on their existing knowledge or commitment to understanding ADHD, and the fact that not all child-teacher dyads are represented in the current study should be recognised. Another possibility is the impact of time pressures upon participation for teachers, particularly given the increasing number of children with complex needs within classes. Outcomes leading from the current study could support teachers in this respect.

It is also important to recognise the potential role of stimulant medication. Although it was not an aim of the current study to investigate knowledge or the role of stimulant medication in the classroom setting, it would have been beneficial to record whether the interviewed children were taking medication for their ADHD at school, particularly given the evidence to suggest that stimulant medication can improve cognitive and behavioural symptoms of ADHD (Rhodes et al., 2004 ). Examining strategy use in isolation (i.e. with children who are drug naïve or pausing medication) will be a vital aim of future intervention work.

Implications/Future Research

Taking the findings of the whole study together, one clear implication is that children and their teachers could benefit from psychoeducation, that is, understanding ADHD in more depth (i.e., broader cognitive and behavioural profiles beyond diagnostic criteria), what ADHD might mean for the individual child, and why certain strategies are helpful. Improving knowledge using psychoeducation is known to improve fidelity to interventions (Dahl et al., 2020 ; Nussey et al., 2013 ), suggesting that this would facilitate children and their teachers to identify effective strategies and maintain these in the long-term.

To improve knowledge and understanding of both strengths and difficulties in ADHD, future research should aim to develop interventions grounded in psychoeducation, in order to support children and their teachers to better understand why and in what contexts certain strategies are helpful in relation to ADHD. Furthermore, future research should focus on the development of a tool-kit of strategies to account for the heterogeneity in ADHD populations; we know from the current study’s findings that it is not appropriate to offer a one-size-fits-all approach to supporting children with ADHD given that not all strategies work all of the time, nor do they always work consistently. In terms of implications for educational practice, it is clear that understanding the individual child in the context of their ADHD and any co-occurrences is important for any teacher working with them. This will facilitate teachers to identify and apply appropriate strategies to support learning which may well result in different strategies depending on the scenario, and different strategies for different children. Furthermore, by understanding that ADHD is just one aspect of the child, strategies can be used flexibly rather than assigning strategies based on a child’s diagnosis.

This study has provided invaluable novel insight into understanding and supporting children with ADHD in the classroom. Importantly, these insights have come directly from children with ADHD and their teachers, demonstrating the importance of conducting qualitative research with these groups. The findings provide clear scope for future research, as well as guidelines for successful intervention design and educational practice, at the heart of which we must acknowledge and embrace the heterogeneity and associated strengths and challenges within ADHD.

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The funding was provided by Waterloo Foundation Grant Nos. (707-3732, 707-4340, 707-4614).

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Emily McDougal, Claire Tai & Sinéad M. Rhodes

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E.M. Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing - original draft, C.T. Formal Analysis, Writing - review & editing, T.M.S., J.N.B. and S.M.R. Conceptualization, Methodology, Writing - review & editing.

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Interview Schedule—Teacher

Demographic/experience.

How many years have you been teaching?

Are you currently teaching pupils with ADHD and around how many?

If yes, do you feel competent/comfortable/equipped teaching pupils with ADHD?

If no, how competent/comfortable/equipped would you feel to teach pupils with ADHD?

Would you say your experience of teaching pupils with ADHD is small/moderate/significant?

Psychoeducation

What is your understanding of ADHD/Can you describe a typical child with ADHD?

Probe behaviour knowledge

Probe cognition knowledge

Probe impacts of behaviour/cognition difficulties

Probe knowledge that children with ADHD differ from each other

Probe knowledge that children with ADHD have co-occurring difficulties as the norm

(If they do have some knowledge) Where did you learn about ADHD?

e.g. specific training, professional experience, personal experience, personal interest/research

Cognitive skills and strategies

Can you tell me about the pupil’s strengths?

Can you tell me about the pupil’s biggest challenges/what they need most support with?

When you are supporting the pupil with their learning, are there any specific things you do to help them? (i.e. strategies)

Probe internal

Probe external

Probe whether they think those not mentioned might be useful/feasible/challenges

Probe if different for different subjects/times of the day

In your experience, which of these you have mentioned are the most useful for the pupil?

Probe for examples of how they apply it to their learning

Probe whether these strategies are pupil specific or broadly relevant

Probe if specific to particular subjects/times of the day

In your experience, which of these you have mentioned are the least useful for the pupil?

What would you like to be able to support the pupil with that you don’t already do?

Probe why they can’t access this currently e.g. lack of training, resources, knowledge, time

Is there anything you would like to understand better about ADHD?

Probe behaviour

Probe cognition

Interview Schedule—Child

Script: We’re going to have a chat about a few different things today, mostly about your time at school. This will include things like how you get on, how you think, things you’re good at and things you find more difficult. I’ve got some questions here to ask you but try to imagine that I’m just a friend that you’re talking to about these things. There are no right or wrong answers, I’m just interested in what you’ve got to say. Do you have any questions?

Script: First we’re going to talk about ADHD (Attention Deficit Hyperactivity Disorder).

Have you ever heard of/has anyone ever told you what ADHD is?

(If yes) If a friend asked you to tell them what ADHD is, what would you tell them?

Is there anything you would like to know more about ADHD?

Cognition/strategy use

Script: Now we’re going to talk about something a bit different. Everyone has things they are good at, and things they find more difficult. For example, I’m quite good at listening to what people have to say, but I’m not so good at remembering people’s names. I’d like you to think about when you’re in school, and things you’re good at and things you are not so good at. It doesn’t just have to be lessons, it can be anything.

Do you like school?

Probe why/why not?

Probe favourite lessons

What sort of things do you find you do well at in school?

Is there anything you think that you find more difficult in school?

Probe: If I asked your teacher/parent what you find difficult, what would they say?

Probe: Is there anything at school you need extra help with?

Probe: Is there anything you do to help yourself with that?

Script: Some people do things to try to help themselves do things well. For example, when someone tells me a number to remember, I repeat it in my head over and over again.

Can you try to describe to me what you do to help you do these things?

Solving a maths problem

Planning your writing

Doing spellings

Trying to remember something

Concentrating/ignoring distractions

Listening to the teacher

Remaining seated in class when doing work

Working with other children in the class

Probe: Do you use anything in lessons to help you with your work?

Probe: What kind of things do you think could help you with your work?

Probe: Is there anything you do at home, such as when you’re doing your homework, to help you finish what you are doing to do it well?

Probe: Does someone help you with your homework at home? If yes, what do they do that helps? If no, what do you think someone could do to help?

Script: In this last part we’re going to talk about your time at school.

How many teachers are in your class?

Is there anyone who helps you with your work?

Do you work mostly on your own or in groups?

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McDougal, E., Tai, C., Stewart, T.M. et al. Understanding and Supporting Attention Deficit Hyperactivity Disorder (ADHD) in the Primary School Classroom: Perspectives of Children with ADHD and their Teachers. J Autism Dev Disord 53 , 3406–3421 (2023). https://doi.org/10.1007/s10803-022-05639-3

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Published : 01 July 2022

Issue Date : September 2023

DOI : https://doi.org/10.1007/s10803-022-05639-3

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RESEARCH PAPER ON ADHD Abstract Attention Deficit Hyperactive Disorder (ADHD) is a neurobehavioral development disorder among children. In the United States there are at least 2 million grade school children that are diagnosed with the disorder (Dupper, 2003). ADHD is determined to be one of the most common development disorders in children (Barlow & Durand, 2009). This paper will discuss the different aspects of ADHD, its symptoms, common traits, and the known treatments being used by clinicians. Moreover, the paper will also touch on the important things to consider when dealing with ADHD, particularly in the area of social work. By doing so, it will determine why social work should be an integral part of the diagnosis and …show more content…

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Attention-Deficit/Hyperactivity Disorder (“ADHD”) is a common childhood disorder that represents developmentally inappropriate levels of inattention, impulsivity and overactivity. It occurs in 3% to 5% of the school age population as stated by (Craighead, Craighead, Kazdin & Mahoney, 1994). Another author (Barkley, 1981) stated that ADHD occurs in at least one child in every classroom. As a result of these statistics, ADHD has become one of the most commonly referred and heavily studied psychological disorders of childhood. Studies show that about 50-60% of children with ADHD in the age range of five to seven years are hostile and defiant. By the

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In your ADHD essay, you might want to focus on the causes or symptoms of this condition. Another idea is to concentrate on the treatments for ADHD in children and adults. Whether you are looking for an ADHD topic for an argumentative essay, a research paper, or a dissertation, our article will be helpful. We’ve collected top ADHD essay examples, research paper titles, and essay topics on ADHD.

• ADHD and its subtypes
• The most common symptoms of ADHD
• The causes of ADHD: genetics, environment, or both?
• ADHD and the changes in brain structures
• ADHD and motivation
• Treating ADHD: the new trends
• Behavioral therapy as ADHD treatment
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• Learning Disabilities: Differentiating ADHD and EBD As for the most appropriate setting, it is possible to seat the child near the teacher. It is possible to provide instructions with the help of visual aids.
• Everything You Need to Know About ADHD The frontal hemisphere of the brain is concerned with coordination and a delay in development in this part of the brain can lead to such kind of disorder.
• Attention Deficit Hyperactivity Disorder (ADD / ADHD) Some critics maintain that the condition is a work of fiction by the psychiatric and pharmacists who have taken advantage of distraught families’ attempts to comprehend the behaviour of their children to dramatise the condition.
• Is Attention Deficit Hyperactivity Disorder Real? In fact, the existence of the condition, its treatment and diagnosis, have been considered controversial topics since the condition was first suggested in the medical, psychology and education.
• ADHD and Its Effects on the Development of a Child In particular, this research study’s focus is the investigation of the impact of household chaos on the development and behavior of children with ADHD.
• The History of ADHD Treatment: Drug Addiction Disorders Therefore, the gathered data would be classified by year, treatment type, and gender to better comprehend the statistical distribution of the prevalence of drug addiction.
• Attention Deficit Hyperactivity Disorder and Recommended Therapy The condition affects the motivational functioning and abnormal cognitive and behavioural components of the brain. Dysfunction of the prefrontal cortex contributed to a lack of alertness and shortened attention in the brain’s short-term memory.
• Rhetorical Modes Anthology on Attention Deficit Disorder It clearly outlines the origin and early symptoms of the disorder and the scientist who discovered attention deficit hyperactivity disorder. Summary & Validity: This article describes the causes of hyperactivity disorder and the potential factors […]
• Attention-Deficit Hyperactivity Disorder in a Young Girl The particular objective was to assist Katie in becoming more focused and capable of finishing her chores. The patient received the same amount of IR Ritalin and was required to continue taking it for an […]
• Similarities and Differences: SPD, ADHD, and ASD The three disorders, Sensory Processing Disorder, Attention Deficit Hyperactivity Disorder, and Autism Spectrum Disorder, are often confused with each other due to the connections and similarities that exist.
• Attention Deficit Hyperactivity Disorder Awareness According to Sayal et al, ADHD is common in young boys as it is easier to identify the problem. The disorder is well-known, and there is no struggle to identify the problem.
• Assessing the Personality Profile With ADHD Characteristics On the contrary, the study was able to understand significant changes in the emotional states and mood of the children when the observations and the tests ended.
• Aspects of ADHD Patients Well-Being This goal can be achieved through the help of mental health and behavioral counselors to enhance behavioral modification and the ability to cope with challenges calmly and healthily.
• ADHD and Problems With Sleep This is because of the activity of a person in the middle of the day and the condition around them. The downside of the study is that the study group included 52 adults with ADHD […]
• The Attention Deficit Hyperactivity Disorder Treatment It has been estimated that when medicine and therapy are applied as treatment together, the outcomes for children with ADHD are excellent.
• Attention Deficit Hyperactivity Disorder Organization’s Mission Children and Adults with Attention-Deficit/Hyperactivity Disorder is an organization that is determined to handle individuals affected by ADHD. The organization was founded in 1987 following the rampant frustration and isolation that parents experienced due to […]
• Case Conceptualization: Abuse-Mediated ADHD Patient The case provides insight into the underlying causes of James’s educational problems and the drug abuse of his parents. The case makes it evident that the assumption from the first case conceptualization about James’s ADHD […]
• Change: Dealing With Patients With ADHD In the current workplace, the most appropriate change would be the increase in the awareness of nurses regarding the methods of dealing with patients with ADHD.
• Dealing With Attention Deficit Hyperactivity Disorder Although my experience is not dramatic, it clearly shows how untreated ADHD leads to isolation and almost depression. However, the question arises of what is the norm, how to define and measure it.
• Parents’ Perception of Attending an ADHD Clinic The main principles of the clinic’s specialists should be an objective diagnosis of the neurological status of the child and the characteristics of his/her behavior, the selection of drug treatment only on the basis of […]
• ADHD: Mental Disorder Based on Symptoms The DSM-5 raised the age limit from 6 to 12 for qualifying the disorder in children and now requires five instead of six inattentive or hyperactive-impulsive symptoms.
• Understanding Attention-Deficit/Hyperactivity Disorder Thus, the smaller sizes of the reviewed brain structures associated with ADHD result in problems with attention, memory, and controlling movement and emotional responses.
• Effective Therapies for Attention Deficit Hyperactivity Disorder The problem at hand is that there is a need to determine which of the therapies administered is effective in the management of ADHD.
• Participants of “ADHD Outside the Laboratory” Study The participants in the testing group and those in the control group were matched for age within 6 months, for IQ within 15 points and finally for performance on the tasks of the study.
• Variables in “ADHD Outside the Laboratory” Study The other variables are the videogames, matching exercise and the zoo navigation exercise used to test the performance of the boys.
• Different Types of Diets and Children’s ADHD Treatment The last factor is a trigger that can lead to the development of a child’s genes’ reaction. Thus, diet is one of the factors that can help prevent the development of ADHD.
• Attention Deficit Hyperactivity Disorder in Children The consistent utilization of effective praises and social rewards indeed results in the behavioral orientation of the child following the treatment goals.
• Reward and Error Processing in ADHD: Looking Into the Neurophysiological and the Behavioral Measures The study was mainly concerned with looking into the neurophysiological and to some extent the behavioral measures utilized in self regulation particularly in children suffering from attention – deficit hyperactivity disorder and those who are […]
• Vyvanse – ADD and ADHD Medicine Company Analysis It is produced by Shire and New River Pharmaceuticals in its inactive form which has to undergo digestion in the stomach and through the first-pass metabolic effect in the liver into L-lysine, an amino acid […]
• Dealing With the Disruptive Behaviors of ADHD and Asperger Syndrome Students While teaching in a class that has students with ADHD and Asperger syndrome, the teacher should ensure that they give instructions that are simple and easy to follow.
• Behavioral Parenting Training to Treat Children With ADHD These facts considered, it is possible to state that the seriousness of ADHD accounts for the necessity of the use of behavioral parental training as the treatment of the disorder.
• Current Issues in Psychopharmacology: Attention-Deficit Hyperactivity Disorder This is the area that is charged with the responsibility for vision control as well as a regulation of one’s brain’s ability to go to aresynchronize’ and go to rest.
• Cognitive Psychology and Attention Deficit Disorder On top of the difficulties in regulating alertness and attention, many individuals with ADD complain of inabilities to sustain effort for duties.
• ADHD Symptoms in Children However, there are some concerns in identifying the children with ADHD.described in a report that support should be initiated from the parents in, recognizing the problem and seeking the help of the educational professionals.2.
• Adult and Paediatric Psychology: Attention Deficit Hyperactivity Disorder To allow children to exercise their full life potential, and not have any depression-caused impairment in the social, academic, behavioral, and emotional field, it is vital to reveal this disorder as early in life, as […]
• Attention-Deficit Hyperactivity Disorder: Biological Testing The research, leading to the discovery of the Biological testing for ADHD was conducted in Thessaloniki, Greece with 65 children volunteering for the research. There is a large difference in the eye movement of a […]
• Issues in the Diagnosis of Attention-Deficit Hyperactivity Disorder in Children Concept theories concerning the nature of attention-deficit/hyperactivity disorder influence treatment, the approach to the education of children with ADHD, and the social perception of this disease.
• Attention Deficit Hyperactivity Disorder Care Controversy The objective of this study was to assess the efficacy, in terms of symptoms and function, and safety of “once-daily dose-optimized GXR compared with placebo in the treatment of children and adolescents aged 6 17 […]
• Attention Deficit Hyperactivity Interventions The authors examine a wide range of past studies that reported on the effects of peer inclusion interventions and present the overall results, showing why further research on peer inclusion interventions for children with ADHD […]
• Sociodemographic and Cultural Factors of Attention Deficit Hyperactivity Disorder Children at this age have particular difficulties in retaining and concentrating attention and in controlling behavior, and this stage is sensitive to the development of these abilities. The general problem is the increase in prevalence […]
• Attention Deficit Hyperactivity Disorder (ADHD) in a Child A child counselor works with children to help them become mentally and emotionally stable. The case that is examined in this essay is a child with attention deficit hyperactivity disorder.
• Attention Deficit Hyperactivity Disorder: Drug-Free Therapy The proposed study aims to create awareness of the importance of interventions with ADHD among parents refusing to use medication. The misperceptions about ADHD diagnosis and limited use of behavioral modification strategies may be due […]
• Attention Deficit Hyperactivity Disorder: Psychosocial Interventions The mentioned components and specifically the effects of the condition on a child and his family would be the biggest challenge in the case of Derrick.
• The Diagnosis and Treatment of ADHD Cortese et al.state that cognitive behavioral therapy is overall a practical approach to the treatment of the condition, which would be the primary intervention in this case.
• The Attention Deficit Hypersensitivity Disorder in Education Since ADHD is a topic of a condition that has the potential to cripple the abilities of a person, I have become attached to it much.
• Attention Deficit Hyperactivity Disorder: Comorbidities Due to the effects that ADHD has on patients’ relationships with their family members and friends, the development of comorbid health problems becomes highly possible.
• Medicating Kids to Treat ADHD The traditional view is that the drugs for the disorder are some of the safest in the psychiatric practice, while the dangers posed by untreated ADHD include failure in studies, inability to construct social connections, […]
• Attention Deficit Hyperactivity Disorder: Signs and Strategies Determining the presence of Attention Deficit Hyperactivity Disorder in a child and addressing the disorder is often a rather intricate process because of the vagueness that surrounds the issue.
• Cognitive Therapy for Attention Deficit Disorder The counselor is thus expected to assist the self-reflection and guide it in the direction that promises the most favorable outcome as well as raise the client’s awareness of the effect and, by extension, enhance […]
• “Stress” Video and “A Natural Fix for ADHD” Article There certainly are some deeper reasons for people to get stressed, and the video documentary “Stress: Portrait of a Killer” and the article “A Natural Fix for A.D.H.D”.by Dr.
• Attention Deficit Disorder: Diagnosis and Treatment The patient lives with her parents and 12-year-old brother in a middle-class neighborhood. Her father has a small business, and her mother works part-time in a daycare center.
• Bright Not Broken: Gifted Kids, ADHD, and Autism It is possible to state that the book provides rather a high-quality review of the issues about the identification, education, and upbringing of the 2e children.
• Attention Deficit Hyperactive Disorder: Case Review On the other hand, Mansour’s was observed to have difficulties in the simple tasks that he was requested to perform. Mansour’s appears to be in the 3rd phase of growth.
• Treatment of Children With ADHD Because of the lack of sufficient evidence concerning the effects of various treatment methods for ADHD, as well as the recent Ritalin scandal, the idea of treating children with ADHD with the help of stimulant […]
• Attention Deficit Hyperactivity Disorder Medicalization This paper discusses the phenomenon of medicalization of ADHD, along with the medicalization of other aspects perceived as deviant or atypical, it will also review the clash of scientific ideas and cultural assumptions where medicalization […]
• Medication and Its Role in the ADHD Treatment Similar inferences can be inferred from the findings of the research conducted by Reid, Trout and Schartz that revealed that medication is the most appropriate treatment of the symptoms associated with ADHD.
• Children With Attention-Deficit Hyperactivity Disorder The purpose of the present research is to understand the correlation between the self-esteem of children with ADHD and the use of medication and the disorder’s characteristics.
• Psychology: Attention Deficit and Hyperactivity Disorder It is important to pay attention to the development of proper self-esteem in children as it can negatively affect their development and performance in the future.
• Natural Remedies for ADHD The key peculiarity of ADHD is that a patient displays several of these symptoms, and they are observed quite regularly. Thus, one can say that proper diet can be effective for the treatment of attention […]
• Cognitive Behavior Therapy in Children With ADHD The study revealed that the skills acquired by the children in the sessions were relevant in the long term since the children’s behaviors were modeled entirely.
• Is Attention Deficit Disorder a Real Disorder? When Medicine Faces Controversial Issues In addition, it is necessary to mention that some of the symptoms which the children in the case study displayed could to be considered as the ones of ADHD.
• Foods That Effect Children With ADHD/ ADD Therefore, it is the duty of parents to identify specific foods and food additives that lead to hyperactivity in their children.
• Toby Diagnosed: Attention Deficit Hyperactivity Disorder The symptoms of the disorder are usually similar to those of other disorder and this increases the risks of misdiagnosing it or missing it all together.
• Identifying, Assessing and Treating Attention Deficit Hyperactivity Disorder For these criteria to be effective in diagnosing a child with ADHD, the following symptoms have to be present so that the child can be labelled as having ADHD; the child has to have had […]
• ADHD Should Be Viewed as a Cognitive Disorder The manifestation of the disorder and the difficulties that they cause, as posited by the American Psychiatric Association, are typically more pronounced when a person is involved in some piece of work such as studying […]
• Attention Deficit Hyperactivity Disorder Influence on the Adolescents’ Behavior That is why the investigation was developed to prove or disprove such hypotheses as the dependence of higher rates of anxiety of adolescents with ADHD on their diagnosis, the dependence of ODD and CD in […]
• Stroop Reaction Time on Adults With ADHD The model was used to investigate the effectiveness of processes used in testing interference control and task-set management in adults with ADHD disorder.
• Attention Deficit Hyperactivity Disorder Causes Family studies, relationship studies of adopted children, twin studies and molecular research have all confirmed that, ADHD is a genetic disorder.
• Diagnosis and Treatment of ADHD The diagnosis of ADHD has drawn a lot of attention from scientific and academic circles as some scholars argue that there are high levels of over diagnosis of the disorder.
• Attention-Deficit Hyperactivity Disorder As it would be observed, some of the symptoms associated with the disorder for children would differ from those of adults suffering from the same condition in a number of ways.
• Working Memory in Attention Deficit and Hyperactivity Disorder (ADHD) Whereas many studies have indicated the possibility of the beneficial effects of WM training on people with ADHD, critics have dismissed them on the basis of flawed research design and interpretation.
• Attention-Deficit Hyperactivity Disorder: The Basic Information in a Nutshell In the case with adults, however, the definition of the disorder will be quite different from the one which is provided for a child ADHD.
• How ADHD Develops Into Adult ADD The development of dominance is vital in processing sensations and information, storage and the subsequent use of the information. As they become teenagers, there is a change in the symptoms of ADHD.
• Medical Condition of Attention Deficit Hyperactivity Disorder A combination of impulsive and inattentive types is referred to as a full blown ADHD condition. To manage this condition, an array of medical, behavioral, counseling, and lifestyle modification is the best combination.
• Effects of Medication on Education as Related to ADHD In addition, as Rabiner argues, because of the hyperactivity and impulsivity reducing effect of ADHD drugs, most ADHD suffers are nowadays able to learn in an indistinguishable class setting, because of the reduced instances of […]
• Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment Generally the results indicate that children with ADHD had a difficult time in evaluating time concepts and they seemed to be impaired in orientation of time.
• The Ritalin Fact Book: Stimulants Use in the ADHD Treatment Facts presented by each side of the critical issue The yes side of the critical issue makes it clear that the drugs being used to control ADHD are harmful as they affect the normal growth […]
• Behavior Modification in Children With Attention Deficit Hyperactivity Disorder Introduction The objective of the article is to offer a description of the process of behavior modification for a child diagnosed with ADHD.
• What Is ADHD and How Does It Affect Kids
• The Benefits of Physical Activities in Combating the Symptoms of ADHD in Students
• The Effects of Exercise and Physical Activity as Intervention for Children with ADHD
• What Are the Effects of ADHD in the Classroom
• Are Children Being Diagnosed with ADHD too Hastily
• The Effectiveness of Cognitive Behavioral Therapy on ADHD
• Understanding ADHD, Its Effects, Symptoms, and Approach to Children with ADHD
• ADHD Stimulant Medication Abuse and Misuse Among U.S. Teens
• Severity of ADHD and Anxiety Rise if Both Develop
• The Best Approach to Dealing with Attention Deficit/Herpactivity Disorder or ADHD in Children
• An Analysis of the Potential Causes and Treatment Methods for Attention Deficit Hyperactivity Disorder (ADHD) in Young Children
• The Best Way to Deal with Your Child Who Struggles with ADHD
• Response Inhibition in Children with ADHD
• Behavioral and Pharmacological Treatment of Children with ADHD
• Symptoms And Symptoms Of ADHD, Depression, And Anxiety
• Bioethics in Intervention in the Deficit Attention Hyperkinetic Disorder (ADHD)
• The Effects of Children’s ADHD on Parents’ Relationship Dissolution and Labor Supply
• The Effects of Pharmacological Treatment of ADHD on Children’s Health
• The Educational Implications Of ADHD On School Aged Children
• Differences in Perception in Children with ADHD
• The Effects Of ADHD On Children And Education System Child
• Students With ADD/ADHD and Class Placement
• The Advantage and Disadvantage of Using Psychostimulants in the Treatment of ADHD
• How to Increase Medication Compliance in Children with ADHD
• Effective Teaching Strategies for Students with ADHD
• Scientists Probe ADHD Treatment for Long Term Management of the Disease
• Should Stimulants Be Prescribed for ADHD Children
• The Rise of ADHD and the an Analysis of the Drugs Prescribed for Treatment
• The Correlation Between Smoking During Pregnancy And ADHD
• Exploring Interventions Improving Workplace Behavior In Adults With ADHD
• The Promise of Music and Art in Treating ADHD
• The Struggle Of ADHD Medication And Over Diagnosis
• The Problems of Detecting ADHD in Children
• The Harmful Effects of ADHD Medication in Children
• The Symptoms and Treatment of ADHD in Children and Teenagers
• The Impact of Adult ADD/ADHD on Education
• The Experience of Having the ADHD Disorder
• The Young Children And Children With ADHD, And Thinking Skills
• The Use of Ritalin in Treating ADD and ADHD
• The Ethics Of Giving Children ADHD Medication
• The Importance of Correctly Diagnosing ADHD in Children
• The Rise in ADHD Diagnosis and Treatment within the United States of America
• The World of ADHD Children
• The Use of Drug Therapies for Children with ADHD
• What Are the Effects of ADHD in the Classroom?
• Does ADHD Affect Essay Writing?
• What Are the Three Main Symptoms of ADHD?
• How Does ADHD Medication Affect the Brain?
• What Can ADHD Lead To?
• Is ADHD Legitimate Medical Diagnosis or Socially Constructed Disorder?
• How Does Art Help Children With ADHD?
• What Are the Four Types of ADHD?
• Can Sports Affect Impulse Control in Children With ADHD?
• What Age Does ADHD Peak?
• How Can You Tell if an Adult Has ADHD?
• Should Antihypertensive Drugs Be Used for Curing ADHD?
• How Does ADHD Affect Cognitive Development?
• Is Adult ADHD a Risk Factor for Dementia or Phenotypic Mimic?
• How Are People With ADHD Seen in Society?
• Can Additional Training Help Close the ADHD Gender Gap?
• How Does School Systems Deal With ADHD?
• Are Children With Low Working Memory and Children With ADHD Same or Different?
• How Does ADHD Affect School Performance?
• Should Children With ADHD Be Medicated?
• How Does Society View Children With ADHD?
• What Do Researches Tell Us About Students With ADHD in the Chilean Context?
• Why Should Teachers Understand ADHD?
• Does DD/ADHD Exist?
• What Are Some Challenges of ADHD?
• Why Is ADHD an Important Topic to Discuss?
• Is ADHD Born or Developed?
• Can ADHD Cause Lack of Emotion?
• Does ADHD Affect Females?
• Is ADHD on the Autism Spectrum?
• Chicago (A-D)
• Chicago (N-B)

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IvyPanda . "162 ADHD Essay Topics & Examples." February 20, 2024. https://ivypanda.com/essays/topic/adhd-essay-topics/.

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ADHD articles within Scientific Reports

Article 31 March 2024 | Open Access

Transcranial random noise stimulation (tRNS) improves hot and cold executive functions in children with attention deficit-hyperactivity disorder (ADHD)

• Vahid Nejati
• , Mahshid Dehghan
•  &  Michael A. Nitsche

Article 19 March 2024 | Open Access

5-HT_FAsTR: a versatile, label-free, high-throughput, fluorescence-based microplate assay to quantify serotonin transport and release

• Lina Bukowski
• , Markus Emanuel Strøm
•  &  Steffen Sinning

Article 20 January 2024 | Open Access

Development of a human-analogue, 3-symptom domain Dog ADHD and Functionality Rating Scale (DAFRS)

• Barbara Csibra
• , Nóra Bunford
•  &  Márta Gácsi

Article 03 January 2024 | Open Access

Early parental deprivation during primate infancy has a lifelong impact on gene expression in the male marmoset brain

• Haruka Shinohara
• , Makiko Meguro-Horike
•  &  Shin-ichi Horike

Article 12 December 2023 | Open Access

The Prevalence of Behavioural Symptoms and Psychiatric Disorders in Hadza Children

• Dennis Ougrin
• , Emma Woodhouse
•  &  Ioannis Bakolis

Article 13 November 2023 | Open Access

Differences between subclinical attention-deficit/hyperactivity and autistic traits in default mode, salience, and frontoparietal network connectivities in young adult Japanese

• Risa Hirata
• , Sayaka Yoshimura
•  &  Hironobu Fujiwara

Article 16 September 2023 | Open Access

Anxiety and depression from age 3 to 8 years in children with and without ADHD symptoms

• Christine Baalsrud Ingeborgrud
• , Beate Oerbeck
•  &  Kristin Romvig Overgaard

Article 02 September 2023 | Open Access

Use of eye tracking to improve the identification of attention-deficit/hyperactivity disorder in children

• Dong Yun Lee
• , Yunmi Shin
•  &  Seong-Ju Kim

Article 29 April 2023 | Open Access

Clinical implications of somatic allele expansion in female FMR1 premutation carriers

• Ramkumar Aishworiya
• , Ye Hyun Hwang
•  &  Flora Tassone

Article 28 April 2023 | Open Access

Assessment of a multisite standardized biospecimen collection protocol for immune phenotyping in neurodevelopmental disorders

• Shane Cleary
• , Grace Teskey
•  &  Jane A. Foster

Article 23 January 2023 | Open Access

Owner-rated hyperactivity/impulsivity is associated with sleep efficiency in family dogs: a non-invasive EEG study

• Cecília Carreiro
• , Vivien Reicher

Article 05 November 2022 | Open Access

A data driven machine learning approach to differentiate between autism spectrum disorder and attention-deficit/hyperactivity disorder based on the best-practice diagnostic instruments for autism

• Nicole Wolff
• , Gregor Kohls
•  &  Veit Roessner

Article 23 September 2022 | Open Access

ADGRL3 genomic variation implicated in neurogenesis and ADHD links functional effects to the incretin polypeptide GIP

• Oscar M. Vidal
• , Jorge I. Vélez
•  &  Mauricio Arcos-Burgos

Article 28 July 2022 | Open Access

Training a machine learning classifier to identify ADHD based on real-world clinical data from medical records

• Pavol Mikolas
• , Amirali Vahid
•  &  Annet Bluschke

Article 31 March 2022 | Open Access

The gap between perceived mental health needs and actual service utilization in Australian adolescents

• Md Irteja Islam
• , Fakir Md Yunus
•  &  Alexandra Martiniuk

Article 11 March 2022 | Open Access

The impact of psychopathology on academic performance in school-age children and adolescents

• Mireia Pagerols
• , Raquel Prat
•  &  Rosa Bosch

Article 08 February 2022 | Open Access

Development of coordination and muscular fitness in children and adolescents with parent-reported ADHD in the German longitudinal MoMo Study

• , Olga Kunina-Habenicht
•  &  Alexander Woll

Article 20 December 2021 | Open Access

Contribution of vascular risk factors to the relationship between ADHD symptoms and cognition in adults and seniors

• Brandy L. Callahan
• , André Plamondon
•  &  Zahinoor Ismail

Article 18 November 2021 | Open Access

Adults who microdose psychedelics report health related motivations and lower levels of anxiety and depression compared to non-microdosers

• Joseph M. Rootman
• , Pamela Kryskow
•  &  Zach Walsh

Article 12 November 2021 | Open Access

Correlation between brain function and ADHD symptom changes in children with ADHD following a few-foods diet: an open-label intervention trial

• Saartje Hontelez
• , Tim Stobernack
•  &  Esther Aarts

Article 10 November 2021 | Open Access

U.S. national, regional, and state-specific socioeconomic factors correlate with child and adolescent ADHD diagnoses pre-COVID-19 pandemic

• Kesten Bozinovic
• , Flannery McLamb
•  &  Goran Bozinovic

Article 19 August 2021 | Open Access

A randomized-controlled neurofeedback trial in adult attention-deficit/hyperactivity disorder

• Beatrix Barth
• , Kerstin Mayer-Carius
•  &  Ann-Christine Ehlis

Article 26 May 2021 | Open Access

Evaluating atypical language in autism using automated language measures

• Alexandra C. Salem
• , Heather MacFarlane
•  &  Eric Fombonne

Article 27 January 2021 | Open Access

Brain structural and functional substrates of ADGRL3 ( latrophilin 3 ) haplotype in attention-deficit/hyperactivity disorder

• Ana Moreno-Alcázar
• , Josep A. Ramos-Quiroga
•  &  Joaquim Radua

Article 18 January 2021 | Open Access

Risk factors for low adherence to methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder

• Asami Ishizuya
• , Minori Enomoto
•  &  Kazuo Mishima

Article 08 December 2020 | Open Access

Exploration of a novel virtual environment improves memory consolidation in ADHD

• Valentin Baumann
• , Thomas Birnbaum
•  &  Kerstin Krauel

Article 18 November 2020 | Open Access

Using quantitative trait in adults with ADHD to test predictions of dual-process theory

• Emil Persson
• , Markus Heilig
•  &  Andrea J. Capusan

Article 26 October 2020 | Open Access

The association between thyroid function biomarkers and attention deficit hyperactivity disorder

• Diana Albrecht
• , Till Ittermann
•  &  Henry Völzke

Article 19 October 2020 | Open Access

Health system utilization before age 1 among children later diagnosed with autism or ADHD

• Matthew M. Engelhard
• , Samuel I. Berchuck
•  &  Scott H. Kollins

Article 29 September 2020 | Open Access

Cortical gyrification and its relationships with molecular measures and cognition in children with the FMR1 premutation

• Jun Yi Wang
• , Merna Danial
•  &  Susan M. Rivera

Article 01 September 2020 | Open Access

Aggravation of symptom severity in adult attention-deficit/hyperactivity disorder by latent Toxoplasma gondii infection: a case–control study

• Alexandra P. Lam
• , Dominik de Sordi
•  &  Alexandra Philipsen

Article 25 May 2020 | Open Access

Genomic analysis of the natural history of attention-deficit/hyperactivity disorder using Neanderthal and ancient Homo sapiens samples

• Paula Esteller-Cucala
• , Iago Maceda
•  &  Oscar Lao

Article 14 April 2020 | Open Access

Temporal trends and geographical variability of the prevalence and incidence of attention deficit/hyperactivity disorder diagnoses among children in Catalonia, Spain

• Laura Pérez-Crespo
• , Josefa Canals-Sans
•  &  Mònica Guxens

Article 10 April 2020 | Open Access

The SLC6A3 gene polymorphism is related to the development of attentional functions but not to ADHD

• Katarzyna Kuc
• , Maksymilian Bielecki
•  &  Anita Cybulska-Klosowicz

Article 21 February 2020 | Open Access

Maturational delay and asymmetric information flow of brain connectivity in SHR model of ADHD revealed by topological analysis of metabolic networks

• Seunggyun Ha
• , Hyekyoung Lee
•  &  Dong Soo Lee

Article 27 December 2019 | Open Access

Multimodal alterations of directed connectivity profiles in patients with attention-deficit/hyperactivity disorders

• Muthuraman Muthuraman
• , Vera Moliadze
•  &  Michael Siniatchkin

Effects of Acute Aerobic Exercise on Response Inhibition in Adult Patients with ADHD

• , J. Özyurt
•  &  A. Philipsen

Article 04 November 2019 | Open Access

Therapeutic effects of methylphenidate for attention-deficit/hyperactivity disorder in children with borderline intellectual functioning or intellectual disability: A systematic review and meta-analysis

• Cheuk-Kwan Sun
• , Ping-Tao Tseng
•  &  Ming-Kung Wu

Article 23 October 2019 | Open Access

Cognitive and Behavioural Weaknesses in Children with Reading Disorder and AD(H)D

• Sabrina Turker
• , Annemarie Seither-Preisler
•  &  Peter Schneider

Article 04 April 2019 | Open Access

Emotional dysregulation subgroups in patients with adult Attention-Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach

• Oliver Hirsch
• , Mira Lynn Chavanon
•  &  Hanna Christiansen

Article 14 March 2019 | Open Access

Association of symptoms of attention deficit-hyperactivity disorder and impulsive-aggression with severity of suicidal behavior in adult attempters

• I. Conejero
• , I. Jaussent
•  &  J. Lopez-Castroman

Article 12 March 2019 | Open Access

Prenatal Tobacco Exposure Modulated the Association of Genetic variants with Diagnosed ADHD and its symptom domain in children: A Community Based Case–Control Study

•  &  Yukai Du

Article 28 February 2019 | Open Access

Evaluating a scale of excessive mind wandering among males and females with and without attention-deficit/hyperactivity disorder from a population sample

• Florence D. Mowlem
• , Jessica Agnew-Blais
•  &  Philip Asherson

Article 19 November 2018 | Open Access

Trends and regional variations in the administrative prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Germany

• M. K. Akmatov
• , A. Steffen
•  &  J. Bätzing

Article 18 October 2018 | Open Access

Neonatal 6-OHDA lesion model in mouse induces Attention-Deficit/ Hyperactivity Disorder (ADHD)-like behaviour

• Otmane Bouchatta
• , Houria Manouze
•  &  Mohamed Bennis

Article 17 August 2018 | Open Access

Acute Physical Activity Enhances Executive Functions in Children with ADHD

• Valentin Benzing
• , Yu-Kai Chang
•  &  Mirko Schmidt

Article 16 August 2018 | Open Access

The Prevalence of Attention Deficit/Hyperactivity Disorder among Chinese Children and Adolescents

• , Yunwen Xu
•  &  Lian Tong

Article 07 August 2018 | Open Access

Identifying individuals with attention deficit hyperactivity disorder based on temporal variability of dynamic functional connectivity

• Xun-Heng Wang
•  &  Lihua Li

Article 06 July 2018 | Open Access

Attention deficit–hyperactivity disorder is associated with allergic symptoms and low levels of hemoglobin and serotonin

• Liang-Jen Wang
• , Ya-Hui Yu
•  &  Wen-Harn Pan

Article 16 May 2018 | Open Access

Genetic variant for behavioral regulation factor of executive function and its possible brain mechanism in attention deficit hyperactivity disorder

• , Zhaomin Wu
•  &  Yufeng Wang

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How to Remove Hurdles to Writing for Students with ADHD

Half of all kids with adhd struggle with writing, which can make every assignment — from straightforward worksheets to full-length essays — feel like torture. boost your child’s skills with these 18 strategies for school and home..

Studies suggest that more than half of children with attention deficit disorder ( ADHD or ADD ) struggle with writing. These students may have an overflow of creative ideas , but often struggle when it comes to getting these ideas onto paper.

Children with ADHD have a hard time getting started — and following through — on writing assignments because they have difficulty picking essay topics, locating appropriate resources, holding and manipulating information in their memory, organizing and sequencing the material, and getting it down on paper — all before they forget what they wanted to say.

But these hurdles don’t have to stop them from writing. Discuss the following ADHD writing strategies with your child’s teacher so you can work together to ease the difficulties attention deficit children have with writing.

Solutions in the Classroom: Guide the Writing Process

—Set up a note system. Ask the student to write her notes about a topic on individual sticky notes. She can then group the notes together that feature similar ideas so she’ll be able to easily identify the major concepts of the subject from the groupings.

—Start small and build skills. Ask students with ADHD to write a paragraph consisting of only two or three sentences. As their skills improve, the students can start writing several paragraphs at a time.

[ Free Download: 18 Writing Tricks for Students with ADHD ]

—Demonstrate essay writing. With the use of an overhead projector, write a paragraph or an entire essay in front of the class, explaining what you are doing at each step. Students can assist you by contributing sentences as you go. Students with ADHD are often visual learners , and tend to do better when they see the teacher work on a task.

—Give writing prompts. Students with ADHD usually don’t generate as many essay ideas as their peers. Help the children with ADHD increase their options for essay assignments by collecting materials that stimulate choices. Read a poem, tell a story, show pictures in magazines, newspapers, or books.

If the student is still struggling to get started, help him by sitting down and talking about the assignment with him. Review his notes from the brainstorming session and ask, “What are some ways you could write the first sentence?” If he doesn’t have an answer, say, “Here’s an idea. How would you write that in your own words?”

—Encourage colorful description. Students with ADHD often have difficulty “dressing up” their written words. Help them add adjectives and use stronger, more active verbs in sentences.

[ How Teens with Learning Differences Can Defeat Writing Challenges ]

—Explain the editing process. Students with ADHD have a hard time writing to length and often produce essays that are too short and lacking in details. Explain how the use of adjectives and adverbs can enhance their composition. Show them how to use a thesaurus, too.

Solutions in the Classroom: Use Accommodations Where Necessary

—Allow enough time. Students with ADHD, especially those with the inattentive subtype, may take longer to process information and should receive extended time to complete assignments.

—Don’t grade early work. Sensitive students are discouraged by negative feedback as they are developing their writing skills. Wait until the paper is finished before assigning it a grade.

—Don’t deduct points for poor handwriting or bad grammar. Unless an assignment is specifically measuring handwriting and grammar skills, when a child is working hard to remember and communicate, let some things slide.

—Use a graphic organizer. A graphic organizer organizes material visually in order to help with memory recall. Distribute pre-printed blank essay forms that students with ADHD can fill in, so they’ll reserve their efforts for the most important task — writing the essay.

—Grade limited essay elements. To encourage writing mastery and avoid overwhelming students, grade only one or two elements at any given time. For example, “This week, I’m grading subject-verb agreement in sentences.” Tighter grading focus channels students’ attention to one or two writing concepts at a time.

Solutions at Home

—Encourage journals. Have your child write down his thoughts about outings to the movies, visits with relatives, or trips to museums. Add some fun to the activity by asking your child to e-mail you his thoughts or text-message you from his cell phone.

—Assist with essay topic selection. Children with ADHD have difficulty narrowing down choices and making decisions. Help your student by listening to all of his ideas and writing down three or four of his strongest topics on cards. Next, review the ideas with him and have him eliminate each topic, one by one – until only the winner is left.

—Brainstorm. Once the topic is identified, ask him for all the ideas he thinks might be related to it. Write the ideas on sticky notes, so he can cluster them together into groupings that will later become paragraphs. He can also cut and paste the ideas into a logical sequence on the computer.

—Stock up on books, movies, games. These materials will introduce new vocabulary words and stimulate thinking. Explore these with your child and ask him questions about them to solicit his views.

—Be your child’s “scribe.” Before your child loses his idea for the great American novel, or for his next English assignment, have him dictate his thoughts to you as you write them out by hand or type them into the computer. As his skills improve over time, he’ll need less of your involvement in this process.

—Go digital. Children with ADHD often write slower than their classmates. Encourage your child to start the writing process on a computer. This way, she’ll keep her work organized and won’t misplace her essay before it’s finished. Also, by working on the computer she can easily rearrange the order of sentences and paragraphs in a second draft.

—Remind your child to proofread. Let your child know that he’ll be able to catch errors if he proofreads his rough draft before handing it in.

High-Tech Writing Helpers for Kids with ADHD

Portable word processor

These battery-operated devices look like a computer keyboard with a small calculator screen. Light and durable, portable word processors can be used at school for note-taking and writing assignments. Back home, files can be transferred to a PC or Mac. Basic models cost about $20.

Speech-recognition software

Word-prediction software

Software such as Co:Writer Solo ($325) helps with spelling and builds vocabulary, providing a drop-down list of words from which a student can choose. It also fills in words to speed composition. Some programs read sentences aloud, so the writer can hear what he has written and catch mistakes as they occur.

Electronic spell-checkers and dictionaries

Enter a word phonetically, and these portable gadgets define the word and provide the correct spelling. Talking devices read the words aloud. Franklin Electronics offers models beginning at about $20.

[ The Common Problems that Lead to Writer’s Block ]

Chris Zeigler Dendy, M.S., is a member of ADDitude’s  ADHD Medical Review Panel .

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9 Things I Wish the World Knew About My Students’ ADHD

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ADHD is my superpower: A personal essay

A Story About a Kid

In 1989, I was 7 years old and just starting first grade. Early in the school year, my teacher arranged a meeting with my parents and stated that she thought that I might be “slow” because I wasn’t performing in class to the same level as the other kids. She even volunteered to my parents that perhaps a “special” class would be better for me at a different school.

Thankfully, my parents rejected the idea that I was “slow” out of hand, as they knew me at home as a bright, talkative, friendly, and curious kid — taking apart our VHS machines and putting them back together, filming and writing short films that I’d shoot with neighborhood kids, messing around with our new Apple IIgs computer!

The school, however, wanted me to see a psychiatrist and have IQ tests done to figure out what was going on. To this day, I remember going to the office and meeting with the team — and I even remember having a blast doing the IQ tests. I remember I solved the block test so fast that the clinician was caught off guard and I had to tell them that I was done — but I also remember them trying to have me repeat numbers back backwards and I could barely do it!

Being Labeled

The prognosis was that I was high intelligence and had attention-deficit disorder (ADD). They removed the hyperactive part because I wasn’t having the type of behavioral problems like running around the classroom (I’ll cover later why I now proudly identify as hyperactive). A week later, my pediatrician started me on Ritalin and I was told several things that really honestly messed me up.

I was told that I had a “learning disability” — which, to 7-year-old me, didn’t make any sense since I LOVED learning! I was told that I would take my tests in a special room so that I’d have fewer distractions. So, the other kids would watch me walk out of the classroom and ask why I left the room when tests were happening — and they, too, were informed that I had a learning disability.

As you can imagine, kids aren’t really lining up to be friends with the “disabled” kid, nor did they hold back on playground taunts around the issue.

These were very early days, long before attention deficit hyperactivity disorder (ADHD) was well known, and long before people had really figured out how to talk to kids with neurodiversities . And as a society, we didn’t really have a concept that someone who has a non-typical brain can be highly functional — it was a time when we didn’t know that the world’s richest man was on the autism spectrum !

Growing Past a Label

I chugged my way through elementary school, then high school, then college — getting consistent B’s and C’s. What strikes me, looking back nearly 30 years later, is just how markedly inconsistent my performance was! In highly interactive environments, or, ironically, the classes that were the most demanding, I did very well! In the classes that moved the slowest or required the most amount of repetition, I floundered.

Like, I got a good grade in the AP Biology course with a TON of memorization, but it was so demanding and the topics were so varied and fast-paced that it kept me engaged! On the opposite spectrum, being in basic algebra the teacher would explain the same simple concept over and over, with rote problem practice was torturously hard to stay focused because the work was so simple.

And that’s where we get to the part explaining why I think of my ADHD as a superpower, and why if you have it, or your kids have it, or your spouse has it… the key to dealing with it is understanding how to harness the way our brains work.

Learning to Thrive with ADHD

Disclaimer : What follows is NOT medical advice, nor is it necessarily 100% accurate. This is my personal experience and how I’ve come to understand my brain via working with my therapist and talking with other people with ADHD.

A Warp Speed Brain

To have ADHD means that your brain is an engine that’s constantly running at high speed. It basically never stops wanting to process information at a high rate. The “attention” part is just an observable set of behaviors when an ADHD person is understimulated. This is also part of why I now openly associate as hyperactive — my brain is hyperactive! It’s constantly on warp speed and won’t go any other speed.

For instance, one of the hardest things for me to do is fill out a paper check. It’s simple, it’s obvious, there is nothing to solve, it just needs to be filled out. By the time I have started writing the first stroke of the first character, my mind is thinking about things that I need to think about. I’m considering what to have for dinner, then I’m thinking about a movie I want to see, then I come up with an email to send — all in a second. 

I have to haullll myself out of my alternate universe and back to the task at hand and, like a person hanging on the leash of a horse that’s bolting, I’m struggling to just write out the name of the person who I’m writing the check to! This is why ADHD people tend to have terrible handwriting, we’re not able to just only think about moving the pen, we’re in 1,000 different universes.

On the other hand, this entire blog post was written in less than an hour and all in one sitting. I’m having to think through a thousand aspects all at once. My dialog: “Is this too personal? Maybe you should put a warning about this being a personal discussion? Maybe I shouldn’t share this? Oh, the next section should be about working. Should I keep writing more of these?”

And because there is so much to think through and consider for a public leader like myself to write such a personal post, it’s highly engaging! My engine can run at full speed. I haven’t stood up for the entire hour, and I haven’t engaged in other nervous habits I have like picking things up — I haven’t done any of it! 

This is what’s called hyperfocus, and it’s the part of ADHD that can make us potentially far more productive than our peers. I’ve almost arranged my whole life around making sure that I can get myself into hyperfocus as reliably as possible.

Harnessing What My Brain Is Built For

Slow-moving meetings are very difficult for me, but chatting in 20 different chat rooms at the same time on 20 different subjects is very easy for me — so you’ll much more likely see me in chat rooms than scheduling additional meetings. Knowing what my brain is built for helps me organize my schedule, work, and commitments that I sign up for to make sure that I can be as productive as possible.

If you haven’t seen the movie “Everything Everywhere All At Once,” and you are ADHD or love someone who is, you should immediately go watch it! The first time I saw it, I loved it, but I had no idea that one of its writers was diagnosed with ADHD as an adult , and decided to write a sci-fi movie about an ADHD person! The moment I read that it was about having ADHD my heart exploded. It resonated so much with me and it all made sense.

Practically, the only real action in the movie is a woman who needs to file her taxes. Now, don’t get me wrong — it’s a universe-tripping adventure that is incredibly exciting, but if you even take a step back and look at it, really, she was just trying to do her taxes.

But, she has a superpower of being able to travel into universes and be… everywhere all at once. Which is exactly how it feels to be in my mind — my brain is zooming around the universe and it’s visiting different thoughts and ideas and emotions. And if you can learn how to wield that as a power, albeit one that requires careful handling, you can do things that most people would never be able to do!

Co-workers have often positively noted that I see solutions that others miss and I’m able to find a course of action that takes account of multiple possibilities when the future is uncertain (I call it being quantum brained). Those two attributes have led me to create groundbreaking new technologies and build large teams with great open cultures and help solve problems and think strategically. 

It took me until I was 39 to realize that ADHD isn’t something that I had to overcome to have the career I’ve had — it’s been my superpower .

Published Jul 15, 2022

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• Ann Med Surg (Lond)
• v.85(5); 2023 May
• PMC10205222

Adult attention deficit hyperactivity disorder: a comprehensive review

Ozge c. williams.

a Department of Psychiatry, Ozark Center Joplin, Joplin, MO

Sakshi Prasad

b Department of Psychiatry National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Amanda McCrary

c Student of Medicine, University of Medicine and Health Sciences—St. Kitts

Erica Jordan

d Medical University of the Americas, St. Kitts & Nevis

Vishi Sachdeva

e Adesh Institute of Medical Sciences and Research, Bathinda

Sheryl Deva

f Kamineni Academy of Medical Sciences and Research Centre, Hyderabad

Harendra Kumar

i Dow University of Health Sciences, Karachi

Jayati Mehta

g Dr ND Desai Medical College & Hospital, Nadiad, Gujarat

Purushottam Neupane

j Punjab Medical college,faisalabad, Pakistan

Aditi Gupta

h Jawaharlal Nehru Medical College, Belgaum, Karnataka, India

Associated Data

The data supporting this review are from previously reported studies and datasets, which have been cited. Please refer to the manuscript for this data.

Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder, with only 2–3% prevalence into adulthood. The epidemiology and proposed causes of ADHD are multifactorial, including genetic, prenatal and environmental influences. The diagnosis of ADHD is often complicated by masking coping mechanisms, an overlap of symptoms with other, more commonly diagnosed disorders. Traditionally, it has been treated with stimulant medications. Non-stimulant options often target norepinephrine and dopamine regulation and are preferred in cases of comorbid substance use disorder, anxiety and other complicating factors, due to an improved side-effect profile and patient preference. They include atomoxetine and viloxazine. The latter, Viloxazine, in the form of extended-release capsules, is the first novel, non-stimulant option approved for adults with ADHD, in the past two decades. Its therapeutic effects are predominantly produced by its action as a norepinephrine reuptake inhibitor and may also modulate the serotonergic system. Viloxazine is relatively safe and effective in treating other disorders such as depression, anxiety, epilepsy and substance use disorder. Its pharmacokinetics includes metabolization by CYP enzymes. As antiepileptics inhibit CYP1A2, therefore, a special consideration would be needed, when co-administering with anti-epileptic drugs. Similarly, individuals with liver or cardiovascular disease and a personal or family history of bipolar disorder require close monitoring, while on this medication. A thorough review of the history, mechanism of action, pharmacokinetics and drug–drug interactions has been presented here, with special attention on treatment in adults with comorbid conditions. This study conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar until December 2022. The following search strings and Medical Subject Headings (MeSH) terms were used: “Viloxazine,” “ADHD,” “Stimulants,” and “adult ADHD.” We explored the literature on the growing knowledge of Viloxazine. A thorough review of the history, mechanism of action, pharmacokinetics, and drug–drug interactions are reviewed here with special attention on treatment in adults with comorbid conditions.

Introduction

• Attention deficit hyperactivity disorder (ADHD) is a common disorder of childhood, with only 2–3% prevalence into adulthood.
• The epidemiology and proposed causes of ADHD are multifactorial.
• ADHD has an estimated adult prevalence of ~2–3%.
• ADHD has been shown to be significantly correlated with a wide range of psychiatric disorders.
• Compared with ADHD in childhood, ADHD in adults has been relatively neglected in epidemiological studies, mainly due to the lack of established valid diagnostic criteria.

ADHD is a neurological and neurodevelopmental disorder that begins in childhood and is characterized by persistent patterns of inattention, impulsivity, restlessness and hyperactivity 1 . ADHD is well recognized in the paediatric population, first described as a clinical diagnosis in the 1930s, but the focus has shifted to recognition and treatment of the disorder in adults 2 . ADHD has an estimated adult prevalence of ~2–3% 3 . In addition, ADHD has been shown to be significantly correlated with a wide range of psychiatric disorders, including mood disorders, oppositional and antisocial personality disorders, self-harm and substance abuse, which impose a significant social and family burden increase 4 . Compared with ADHD in childhood, ADHD in adults has been relatively neglected in epidemiological studies, mainly due to the lack of established valid diagnostic criteria 4 . The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is a widely used approach for diagnosing ADHD in adults and requires childhood onset 4 . The purpose of this review is to describe the characteristics and the associated comorbidities of Adult ADHD and to depict the scope of available treatment. In this review, treatment options are summarized with a special emphasis on non-stimulants.

Several factors contribute to ADHD symptoms, including genetics, neurodevelopmental disorders, abnormal neuronal maturation, brain injury, environmental exposure and consanguinity. A recent study by Posner and colleagues reported that environmental risk factors contribute to ADHD symptoms at prenatal, perinatal, and postnatal stages. Prenatal and perinatal risk factors such as prematurity, low birth weight, maternal smoking history, stress, trauma and obesity are substantially associated with ADHD. Postnatal risk factors such as trauma, parenting style, artificial colours and fragrances, pollutants, and pesticides can exacerbate ADHD symptoms 1 . Medication-based treatment strategies have proven effective and inexpensive in the short term, and many compounds are available, recommended and widely used. The long-term efficacy of these treatments on clinical, occupational and social outcomes remains unknown. It is clear that better long-term treatments for ADHD are urgently needed 5 .

Gender differences

Studies in children and adolescents have shown that the disorder is at least three times more common in men, but that the adult male/female ratio here tends to decrease to 2:1 5 . The prevalence of ADHD is estimated at 7.1% in children and adolescents, 2.5–5% in adults, and ~2.8% in the elderly. Sex differences in the prevalence of ADHD are well documented. Male clinical referrals typically outnumber females, with ratios ranging from 3:1 to 16:1 6 .

The observed sex difference could be explained by the higher frequency of hyperactivity and behavioural problems in boys and their greater likelihood of referral to a clinician. Conversely, girls with ADHD may exhibit more attentional symptoms and fewer hyperactivity/impulsivity symptoms, coupled with better coping skills, making them less likely to be referred. Sex differences also appear to influence the prevalence of comorbidities. In particular, women who suffer from ADHD are more likely to have depression and eating disorders, and men are more likely to have substance use disorders 7 . This increase in awareness of ADHD among women is partly due to the growing awareness of gender differences in ADHD symptoms. ADHD men are more likely than women to exhibit the core symptoms of her ADHD-I (inattentiveness), HI (hyperactivity/impulsiveness) and C (combined) symptoms. ADHD-I is more common in women and ADHD-HI is more common in men. HI presentation is associated with impulsive and hyperactive behaviours, and I presentation is associated with hypo arousal, inattentiveness and withdrawal. Her ADHD-I symptoms, characteristic of women, are often reflected in mood and emotional dysregulation, making differential diagnosis very difficult and interfering with internalizing disorders such as mood disorders, anxiety disorders and depression and lead to misdiagnosis 8 .

Clinical presentation and comorbidities

ADHD in adults is characterized by the following behavioural criteria: inattentiveness, impulsivity, hyperactivity and restlessness 6 .

ADHD is recognized by the DSM- IV to fit into three different subtypes-hyperactive or impulsive, inattentive and combined 9 . According to Wilens, 90% of individuals suffering with ADHD show inattentive symptoms, who recognized it as the most prevalent symptom domain 10 . Literature shows that females present with far higher levels of inattentiveness leading to infrequent access to care 11 – 13 . In contrast, the least represented domain is the hyperactive subtype 9 .

Lahey and colleagues found 66% of adolescents displaying the combined subtype 14 which has been linked to a greater incidence of comorbid conditions, neuroticism and substance abuse disorders 15 – 17 .

Adults usually present with difficulties in organizing, planning and make impulsive decisions which result in unstable employment and relationships 18 . ADHD is associated with poor academic and professional performance because it presents with reading disabilities which lead to repeating grades and attending special educational facilities hindering higher educational opportunities 19 . As these adults have recurrent employment changes and exhibit poor performance in their jobs , they are unable to maintain stability in their profession 20 . While they are able to manage inter-personal relationships, it is reported that they have difficulty in forming and keeping close friends. ADHD adults hold a negative impression of marriage leading to separation and divorces 21 . It has also been associated with driving accidents and jail time 22 , 23 .

Recently, focus has shifted to symptoms arising from emotional dysregulation like irritability, emotional fluctuations, low frustration tolerance and daydreaming, which increase the risk of misdiagnosing patients as having mood disorders resulting in many adults not receiving the required intervention 22 , 24 , 25 .

ADHD adults often feel different from others due to their inability to comprehend social cues and because they lack propriety. But there are positive aspects of ADHD.

The patients are creative and thus usually prosper in the art industry. Accomplishing tasks is rewarding when it is in their interest. They develop coping strategies to overcome their deficits by keeping track of to-do lists, setting alarms. Diagnosis is essential as it helps them to come to term with their shortcomings 26 .

Two-thirds of ADHD adults present with one comorbid psychiatric disorder 27 . Studies also show that ADHD is found in 15% of psychiatric patients 28 . These comorbidities are responsible for masking ADHD which reduces the frequency of correct diagnosis 29 . Comorbidity rates of 57–92% have been shown in various studies 15 . Bipolar disorder, Personality disorders, depression, anxiety disorders, Substance abuse disorders are the common comorbidities that occur with ADHD 2 .

For many years, psychostimulant medications have been regarded as the mainstay of ADHD therapy. As per evidence, they have shown to enhance the presence of dopamine as well as norepinephrine in the frontal lobes. This ensures increased effectiveness of processing information in the brain, especially at the site of pyramidal cells. This in turn helps to alleviate manifestations of ADHD 30 .

Stimulants are considered to be the primary pharmacologic therapy for ADHD. A study review article conducted by Steingard et al . 31 in 2013 showed that amphetamine have a success rate of 70% to treat the patient with Adult onset ADHD

Some of the popular treatments for ADHD include psychostimulant drugs like methylphenidate, dextroamphetamine, and combined isomers of amphetamine 32 .

ADHD manifestations include inattentiveness, hyperactivity, impulsiveness and poor concentration. Additionally, stimulants enhance alertness, comprehension, response inhibition and immediate memory 33 .

Amphetamine salts

Dexamphetamine, lisdexamfetamine, and mixed amphetamine salts are a few of the various formulations of amphetamine available and effective for ADHD therapy 34 . There are three key modes of action that amphetamines exhibit 31 .

Firstly, it inhibits the reuptake of neurotransmitters after adhering to transporters of monoamine, norepinephrine and dopamine.

It also enables the phosphorylation of the dopamine transporter by trace-amine-associated receptor 1. This leads to decreased transportation of dopamine. It may also cause outflow of the neurotransmitters in the direction of the synapse as a result of its entry into presynaptic vesicles 31 .

A study conducted in 2018 by Castells and colleagues ( n =2521) explored the effects of three forms of amphetamine. This included: dexamphetamine, lisdexamfetamine and mixed amphetamine salts. The study showed that the magnitude of ADHD-associated complaints was successfully reduced with the use of any of all the 3 forms of amphetamine. The effectiveness of amphetamines did not seem to fluctuate while varying the dose. The study looked into the effects of both immediate- and sustained-release formulations, but there were no variations in the results 35 .

A study conducted in 2017 by Lenard A Adler and colleagues ( N =40) analyzes the efficacy ,validity and reliability of lisdex amphetamine Dimesylate by measuring the ADHD Rating scale , Adult ADHD Medication Smoothness of Effect Scale and Adult ADHD Medication Rebound Scale concluded that effectiveness of LDX is good by showing the untroubled effect whole day with less rebound symptoms with reliable measure of Adult ADHD Medication Smoothness of Effect Scale and Adult ADHD Medication Rebound Scale 36 .

Side effects

When amphetamines are used to treat ADHD, anorexia, and a decrease in body weight are some of the anticipated side effects. Other negative effects brought on by amphetamine use include vomiting, nausea, aches in the abdomen, hypertension and tachycardia. 37 Administration of an additional in the noon may be beneficial if side effects, such as agitation, start to manifest subsequently in the day and when patients exhibit rebound phenomena. A relatively frequent side effect of stimulants is initial sleeplessness. It is crucial to determine whether insomnia is a side effect of the drug or in fact, preexists this treatment modality. By limiting doses in the latter part of the day and adopting healthy sleep schedules, insomnia as a side effect can be avoided 33 .

Methylphenidate salts

Methylphenidate was first developed in 1944 and was initially employed as an analeptic to treat barbiturate-induced coma. However, these days, it is most commonly utilized to treat ADHD 38 .

Methylphenidate amplifies neuronal dopamine efflux and inhibits dopamine reuptake from the synapse. The drug adheres to the dopamine transporter of the presynaptic cell. This prevents dopamine reuptake and leads to an increased amount of extracellular dopamine 33 , 38 .

Methylphenidate is present in the form of four stereoisomers: dextro- / levo-threo , dextro- /levo-erythro. The majority of MPH preparations present in the market contain a racemic combination of both d-MPH and l-MPH. According to studies, d- Methylphenidate is found to be the most potent among these.The alkaline characteristic of Methylphenidate hydrochloride makes it extremely soluble in the gastrointestinal tract, allowing for its oral administration. It is suggested that due to the acidic nature of the stomach, minimal degradation of the drug occurs there. When taken orally, immediate-release MPH is quickly and entirely absorbed. One to three hours may pass before the maximum plasma concentration is reached, taking into account its variability in different individuals 39 .

Methylphenidate hydrochloride has been developed to be effective in individuals who require management of their ADHD symptoms from morning to evening. Multilayer-release methylphenidate has shown to have safe and positive efficacy 40 . A randomized controlled trial (RCT) conducted in 2021 by Margaret D Weiss and colleagues to evaluate safety and efficacy of the 16 h multilayer-release methylphenidate(PRC-063) in a community based adult ADHD population ( n =375) concludes PRC-063 led to a greater symptoms relief in the ADHD-RS-5 total score from baseline compared with Placebo.Headache,decrease in sleep deprivation and loss of appetite were the most commonly seen adverse effect 41 .

When compared with a placebo, immediate-release methylphenidate was successful in treating the three main symptoms of ADHD: hyperactivity, impulsiveness and inattentiveness. The general clinical status was found to be improved with the use of immediate-release methylphenidate. However, results were inconsistent, making it unclear if immediate-release methylphenidate therapy is beneficial for accompanying anxiety or depression 42 .

In 2017, Childress and colleagues conducted a clinical trial to investigate the effects of HLD200 in children and adults. It is a delayed-release/extended-release MPH composition given during the evening. It was found to be efficacious and the pharmacokinetic properties met its objectives in the tested age groups. Between children, and healthy adults with ADHD, there were no discernible variations in the pharmacokinetic results when body weight was taken into consideration 43 .

Methylphenidate is linked to a higher risk of mild side effects including sleep issues and reduced appetite, however, it is not associated with major adverse effects. 33 Additional side effects include increased heart rate, blood pressure, anxiety and sleeplessness. Its use can rarely be linked with arrhythmias, rash, and urticaria. Methylphenidate may produce a sense of euphoria when administered intravenously 39 .

Non-stimulants

Even though stimulants are incredibly effective in short-term RCTs, not all patients react to or tolerate them adequately 40 . Various innovative non-stimulant approaches for treating ADHD are presently under development 40 . The FDA has only recently approved the non-stimulants atomoxetine (ATX), guanfacine (guanfacine-XR), and clonidine (clonidine-XR) for the treatment of ADHD. Adult usage has only been approved for ATX. Due to the many drugs now undergoing clinical investigations and having completed Phase 2 and Phase 3 trials, there will likely be a growth in the number of non-stimulant choices available in the following years. Each candidate differs chemically and may have different molecular targets. Based on their pharmacologic characteristics, non-stimulants may be divided into three groups:

• Monoamine reuptake (transporter) inhibitors (like ATX)
• Receptor modulators (like guanfacine-XR and clonidine-XR)
• Multimodal drugs

In this section, we examine the clinical characteristics of both approved and licensed CII stimulant substitutes that have shown effectiveness in double-blind, placebo-controlled Phase 2 or Phase 3 studies. In addition to a multimodal stimulant with a lower abuse potential (mazindol controlled release), several monoamine reuptake inhibitors (dasotraline, OPC-64005) and multimodal non-stimulants (vortioxetine, viloxazine extended-release) are being developed as substitutes for CII stimulants.

Monoamine reuptake (Transporter) inhibitors

Atomoxetine.

With a strong affinity for presynaptic norepinephrine transporters (NET), atomoxetine inhibits noradrenergic reuptake 41 , 42 . Even though ATX was initially researched as a potential treatment for major depressive disorder in adults in the 1980s, depression research was discontinued due to its ineffectiveness 43 .Atomoxetine was the first non-stimulant medication authorized by the FDA for the treatment of ADHD, and it was based on a series of double-blind, RCTs in children under 6 years of age, adolescents, and adults. In a thorough, in-depth meta-analysis that included information from 24 RCTs in paediatric ADHD, the effect size for overall ADHD symptom improvement with ATX was 0.64 44 . It was often 4 weeks after the commencement of therapy before significant changes in ADHD symptoms versus placebo were seen 44 . Atomoxetine was linked to a bimodal response, meaning that 40% of patients were classified as nonresponders at the end of the study while 45% of patients fared noticeably better 44 .

Dasotraline

Since dasotraline primarily inhibits dopamine transporters (DAT) and NET while inhibiting serotonin transporters (SERT) less, it is categorized as a dual reuptake inhibitor 45 . Similar to ATX, dasotraline development in adults was stopped due to inefficiency 46 , 47 . The effects of dasotraline on adults and kids with ADHD were then studied in a series of RCTs, starting with a Phase 2 proof-of-concept study in adults given either 4 mg or 8 mg (estimated DAT receptor occupancy, 56% and 71%, respectively) 48 . In this exploratory investigation, just 8 mg of dasotraline was more effective than a placebo in reducing all-around ADHD symptoms (effect size, 0.41), although it was poorly tolerated (discontinuation owing to AEs, 28%). Dasotraline dosages between 2 and 6 mg were tested in later Phase 3 RCTs for ADHD 49 – 51 .

OPC-64005 (SERT, NET and DAT) is a triple reuptake inhibitor 52 . OPC-64005 (titrated up to 30 mg/day) was contrasted with placebo and ATX (titrated up to 80 mg/day) in a Phase 2 flexible-dose study in patients with ADHD 53 . The study’s findings were kept confidential.

Receptor modulators - clonidine and guanfacin

The two extended-release forms of the α2 adrenoreceptor agonists, guanfacine and clonidine, are the only FDA-approved ADHD medicines with pharmacologic actions presumably restricted to receptor modification. Clonidine appears to be more selective for presynaptic α2A, α2B and α2C receptors than postsynaptic 2A receptors, whereas guanfacine appears to be more selective for postsynaptic α2A receptors 54 . Contradictory results have been found in clinical studies on a number of receptor modulators, including nicotinic acid, histamine, gamma-aminobutyric acid (GABA), 5-HT, and adenosine A2A, despite the fact that these compounds have attracted a lot of interest for their potential to treat ADHD 55 . None have advanced to Phase 3 studies in people with ADHD; as a result, it is doubtful that they will ever be clinically accessible 56 .

Multimodal agents

Pharmaceuticals known as “multimodal” drugs combine receptor modulation (agonist and/or antagonist) action with transporter modulation or inhibition (e.g. NET, SERT and DAT). Many of these substances are being studied as possible therapies for ADHD 55 .

The United States Food and Drug Administration (FDA) approved a novel stimulant viloxazine extended-release (ER), also called SPN-812, after nearly 10 years 49 . It was marketed under the trade name QELBREE™, targeted to treat ADHD in paediatric and adult patients 50 . In several open-labelled randomized controlled studies, Viloxazine has been proven effective in various kinds of mood disorders (depression, anxiety) and associated comorbid conditions like alcohol dependence, obesity, and substance abuse 51 , 56 . A recent case report by Naguy and colleagues also reported that add-on Viloxazine to Clozapine-Responsive Schizophrenia successfully mitigated metabolic parameters and addressed clozapine-sialorrhea 57 .

Further studies by Yu and colleagues suggest a powerful mechanism for increased serotonin is the inhibition of the inhibitory 5-HT-2B-GABA interneurons, which generally decrease the release of serotonin at the synapse. By modulating the interneuron, there is an increased release of serotonin, especially in the prefrontal cortex area. It is likely that the therapeutic effect of ADHD is due in significant part to these serotonergic effects with some enhancement by norepinephrine and dopamine 58 .

Viloxazine blocks the reuptake of norepinephrine in the amygdala, nucleus accumbens, and prefrontal cortex of the brain 58 . On a stereochemical level, the S isomer of Viloxazine resembles the R-isomer of norepinephrine 58 . Additionally, this results in increased dopamine via the inhibition of the norepinephrine transporter, which also is responsible for the uptake of dopamine in some areas of the cortex. The increased dopamine effects from reuptake inhibition are seen primarily on the prefrontal cortex and amygdala but notably not in the nucleus accumbens, which is one of the brain’s reward centres. It is possible the lack of dopamine modulation in the nucleus accumbens reduces the potential for addiction, which differentiates Viloxazine in an essential way from stimulant medications currently used to treat ADHD 49 .

Many patients under psychiatric care are taking drugs that are substrates or inhibitors of CYP enzymes. Because Viloxazine is majorly metabolized by CYP2D6, special care must be taken to monitor possible side effects. One single sequence study on the pharmacokinetics of Viloxazine showed only a modest increase in Viloxazine and its metabolites when taken with paroxetine, a potent CYP inhibitor, and no adverse toxicities or side effects were noted 59 . Because Viloxazine is also minorly metabolized by other CYP enzymes, the effects of an inhibitor, in this case, were not clinically significant. Based on this data, interaction with multiple CYP inhibitors or substrates is theoretically possible and should be monitored in patients treated for depression and other psychiatric comorbidities (Figure ​ (Figure1 1 ).

Mechanism of action of non-stimulant drugs.

In patients treated for co-occurring anxiety and ADHD, first-line treatment with stimulants can exacerbate anxious feelings 60 . In this case, non-stimulant options such as atomoxetine along with non-pharmacological therapies are used. Viloxazine is a non-stimulant drug that may be helpful for patients whose anxiety is worsened with first-line medications. Viloxazine is another drug in the toolbox of practitioners co-treating ADHD and substance use disorder. It is hypothesized that because Viloxazine does not antagonize dopamine reuptake in the reward centre of the brain, it lacks the addictive effects of methylphenidate and dexamphetamine 50 .

One study, a bayesian meta-analysis of the use of antidepressants, disulfiram and anti-epileptic medications in subjects with alcohol use disorder, found Viloxazine to be highly effective in reducing depressive symptoms when compared to SSRIs and venlafaxine. There were no additional adverse effects of viloxazine use in the alcohol use disorder cohort 61 , 62 .

In comparison to medications used for depression, the drug viloxazine seems to have anti-epileptic properties at low doses 63 . However, patients concurrently being treated with phenytoin and carbamazepine run the risk of increased serum concentrations and toxicity, which remit when viloxazine therapy is withdrawn 64 . This seems to be due to viloxazine inhibitory effects on CYP1A2, as several anti-epileptic medications are substrates. Levels of anti-epileptic medications or other CYP1A2 substrates should be carefully monitored when co-administering Viloxazine and doses adjusted as needed to avoid adverse effects.

Viloxazine is generally metabolized by the liver before being excreted in the urine. There have been modest elevations in serum liver aminotransferases without a report of jaundice or liver injury in paediatric patients taking Viloxazine for ADHD 65 . Patients with significant liver disease should not use Viloxazine, or if needed, levels need to be monitored and doses adjusted accordingly. Adults with liver disease needing viloxazine therapy should be monitored closely (Tables ​ (Tables1, 1 , ​ ,2 2 ).

Aetiological factors associated with ADHD.

ADHD, attention deficit hyperactivity disorder.

Comorbidities associated with ADHD.

ADHD, attention deficit hyperactivity disorder, SUD, Substance use disorder.

Prognosis ADHD

For individuals with ADHD, a meta-analysis of follow-up studies depicted that at 25 years of age:

• Approximately 15% retained the full ADHD diagnosis(Persistent ADHD).
• Approximately 65% were in partial remission; (with persistence of some symptoms and continuing significant functional impairment, such as psychological, social or educational difficulties) 32 .

While symptoms of hyperactivity tend to remit over time, impairments in attention persist. In fact, due to the lack of hyperactivity and impulsivity in patients with predominantly inattentive presentation of ADHD, they are usually less disruptive in primary school than children with combined ADHD and often present later (e.g. middle school, high school) 62 .

Adolescents and adults with ADHD symptoms are more likely to struggle in school and at work, have maladaptive relationships, increased injuries and car accidents, and teen pregnancies 79 – 81 . ADHD is associated with increased risks of psychiatric disorders, including oppositional defiant disorder, conduct disorder, substance abuse, and possibly mood disorders, such as depression and mania. Autism spectrum disorder, dyslexia, dyscalculia and dyspraxia are also over-represented. Therefore, the overall prognosis of the individual depends on the severity and management of any comorbid disorders 32 .

However, the adult prognosis for the ADHD child is not fully revealed by these relative impairments. In fact, majority of these individuals were gainfully employed. In addition, two-thirds of these children showed no signs of any mental illness in adulthood. In conclusion, although ADHD children, as a group, fare poorly compared with their non-ADHD counterparts, the childhood syndrome does not preclude achieving high educational and vocational goals, and most children no longer exhibit clinically significant emotional or behavioural difficulties once they reach their mid-twenties 19 .

Thus, it is crucial that these individuals get medical attention as early as possible. In the long run, these recommended therapies and medications will aid the affected individuals in coming to terms with their condition and coping with their situation. Timely diagnosis, appropriate medications and supportive therapies along with an empathetic environment will help patients with ADHD lead fulfilling lives.

Future challenges

Many national and international guidelines recommend a multimodal approach to ADHD treatment 82 , 83 . The American Academy of Pediatrics (AAP) suggests that children with academic or behavioural problems and difficulty with attention, hyperactivity or impulsivity should be evaluated for ADHD. The guidelines encourage medical professionals to gain reports and statements regarding the child’s symptoms from parents, teachers, caregivers and, importantly, the child. The DSM-5 criteria must be met, as well as the exclusion of other medical conditions that may present similarly. The recommendations also suggest screening for comorbid conditions that commonly occur with ADHD to ensure comprehensive management.

Parent training in behaviour management is recommended as first-line therapy in children ages 4–18. If the child/adolescent’s school programme offers behavioural classroom interventions, it is considered a necessary aspect of the treatment plan. For children ages 4–6 years, methylphenidate is used after the first-line treatments of behavioural therapy and interventions have been exhausted. Children and adolescents ages 6–18 years are recommended to utilize approved medications, behavioural classroom interventions or parent training in behaviour management. Schools often offer Individualized Education Programs (IEP) or a 504 plan for extra support. Lastly, the AAP guidelines encourage adjusting medication dosages to optimize treatment while minimizing side effects. Once the child reaches adolescence, the patient should begin to partake in their treatment plan and ultimately approve their care 82 , 83 .

Due to the newness of Viloxazine for use in ADHD, it has not yet been proven efficacious to other pharmaceuticals. Although many studies, including a meta-analysis of 1605 participants across five RCTs, concluded Viloxazine ER to be more productive than placebo 84 , additional studies are needed to conclude comparative efficacy. Whether Viloxazine’s usefulness will outweigh others is still to be determined; its recent widened approval should allow more studies to reveal its potential advantage in ADHD treatment. An article from the Carlat Child Psychiatry Report compared Viloxazine with Strattera (Atomoxetine), noting the newly approved ADHD medication could have an advantage due to its more significant rapid onset 85 .

Diagnostic materials such as the DSM-V, vision and hearing tests, and neurologic assessments are used throughout a patient’s care to aid in correctly diagnosing the condition. Many reviews are used during the diagnosis, treatment, and follow-up of patients of various age groups with ADHD. Once other psychiatric disorders and learning disabilities have been ruled out, the appropriate scales may be utilized. It is important to note that the various ADHD scales are only a contribution to the overall assessment and treatment and are recommended to be used in conjunction with other modalities of ADHD treatment. Focusing on a child’s symptoms or treatment progression may be difficult due to the various people and places the patient encounters daily. The scales are a valuable set of tools that allow the child, parents, teachers, coaches, etc., to collect and evaluate information in an organized manner 86 .

Clinicians can utilize a variety of tools depending on the age of a patient, as well as which stage of ADHD they are managing. The use of the tools can be beneficial before and after treatment with an ADHD pharmaceutical agent(s), such as Viloxazine. Children and adolescent scales primarily consist of questionnaires that are targeted at the patient’s parents, teachers, or caregivers. It is recommended that multiple people who regularly interact with the patient complete the same forms to gain a more comprehensive picture of the child and how they interact in various environments 87 . For instance, the Child Behaviour Checklist (CBCL/6–18) is a 120-question form that assesses a child based on questions that use a scale from 0 to 2, with 0 being “not true” to 2 being “very true/often true” 88 . Other ADHD assessment scales, such as Conners’ and Vanderbilt, are utilized similarly 89 , 90 .

The following scales could be used before and during treatment with Viloxazine to enhance the patient’s overall treatment plans. Adult Rating Scales are also used during diagnosis, treatment, and follow-up of patients with ADHD symptoms or diagnosed with ADHD 91 . The Adult ADHD Self-Report Scale is constructed for individuals to self-report, as stated in its title. This short, 18-item tool is beneficial as a first-line assessment for adults who may be experiencing ADHD symptoms 92 . To follow patients who have ADHD symptoms, the ADHD Rating Scale-IV is an 18-item assessment that has patients score the frequency and severity of their symptoms on a 4-point scale ranging from 0 (never) to 3 (very often) 93 .

In conclusion, adult ADHD is a complex condition that has a significant impact on the quality of life of people who have it. It is a relatively new area of study that has garnered a lot of interest recently. The considerable research has provided fresh perspectives on the causes, symptoms and therapies of adult ADHD. There are effective medications available that could aid people with ADHD in improving their symptoms and functioning, despite the challenges associated with diagnosis and therapy. To ensure that individuals with ADHD receive the required assistance and treatment, it is imperative to increase awareness of ADHD among medical professionals and the general public. Further research is needed to develop more effective treatments for this population and to better understand the complex nature of adult ADHD.

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Published online 12 April 2023