Attention-Deficit/Hyperactivity Disorder (ADHD)
Attention-deficit/hyperactivity disorder (ADHD), like any diagnosis, is a label that represents a cluster of specific symptoms. In ADHD, these symptoms include hyperactive, impulsive, and inattentive behaviors. Some examples of these behaviors in children and adolescents are described below.
- Fidgets with or taps hands or feet
- Leaves seat in situations when remaining seated is expected (e.g., at the dinner table)
- Acts as if "driven by a motor"
- Impulsive Behaviors:
- Blurts out an answer before the question is finished
- Has difficulty waiting their turn (e.g., during games or at the water fountain)
- Interrupts or intrudes on others (e.g., interrupts others’ conversations)
- Makes careless mistakes on schoolwork (e.g., mistakes plus and minus signs on math problems)
- Has difficulty following instructions (e.g., has difficulty understanding the teacher’s instructions, so looks around to see how other students are following them) loses focus, or becomes sidetracked easily
- Has difficulty organizing spaces and areas (e.g., backpack, cubby, or desk at school, or bedroom at home, is very messy)
- Loses things (e.g., school items such as pencils, books, or homework, or small apparel such as hats or mittens)
It should be noted that many children engage in at least some of these behaviors. In fact, childhood could be defined by behaviors such as being fidgety, having difficultly taking turns, and losing things. However, children with ADHD are hyperactive, impulsive, and/or inattentive to a greater degree than their peers. Additionally, children with ADHD have symptoms that interfere with family and peer relationships, self-esteem, and academic functioning.
In addition to the presence of symptoms, the following criteria must be met to receive a diagnosis of ADHD:
- The symptoms must have been present before the age of 12
- The symptoms must have been present for at least six months
- The behaviors must have occurred in two or more places or situations (e.g., at home or school, with friends or relatives, or in extracurricular activities)
- The symptoms are not better explained by another psychiatric disorder or medical issue
To learn more about ADHD, use the links below.
What are the different types of ADHD?
Who can diagnose ADHD and how is it diagnosed?
How is ADHD treated?
Important Facts to Take into Consideration
"So what do I do now?"
Services Offered at the Columbia University Medical Center and ColumbiaDoctors
Other Resources and Websites
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; APA, 2013) outlines three types of attention-deficit/hyperactivity disorder (ADHD) and their corresponding symptoms or behaviors. In order to meet the criteria for a diagnosis of each of these subtypes, a child or adolescent needs to have often shown at least six of these behaviors over a six-month period.
ADHD, Predominantly Hyperactive-Impulsive
- Fidgets with or taps hands or feet, or squirms in their seat
- Leaves seat in situations when remaining seated is expected
- Runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
- Is unable to play or take part in leisure activities quietly
- Is "on the go," acting as if "driven by a motor"
- Talks excessively
- Blurts out an answer before a question has been completed
- Has trouble waiting their turn
- Interrupts or intrudes on others (e.g., butts into conversations or games)
ADHD, Predominantly Inattentive Presentation
- Fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
- Has trouble keeping attention on tasks or play activities
- Does not seem to listen when spoken to directly
- Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, gets sidetracked)
- Has trouble organizing tasks and activities
- Avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
- Loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
- Is easily distracted
- Is forgetful in daily activities
ADHD, Combined Presentation
This diagnosis is given when a child presents with symptoms of both hyperactive-impulsive presentation and inattentive presentation.
As previously mentioned, some children who do not have ADHD will display one or even a few of the above symptoms. However, for ADHD to be considered, at least six symptoms must be present from the corresponding categories (e.g., hyperactive-impulsive or inattentive). If six are present from both categories, then the child is diagnosed with ADHD, combined presentation.
Many different health care professionals, including psychiatrists, psychiatric nurse practitioners, psychologists, neuropsychologists, developmental pediatricians, and licensed clinical social workers, can diagnose ADHD. With specific training, some pediatricians may also be able to diagnose clear-cut cases of ADHD. Certainly, discussing your concerns with the pediatrician is a very good starting place.
Like other psychiatric diagnoses, ADHD is diagnosed using a careful interview (also called a psychological or psychiatric evaluation) that assesses current functioning in the home, at school, and during extracurricular activities. The health care professional will ask about symptoms, the child’s or teen’s history in relation to reported problematic behaviors, and any family history of psychiatric issues. It is not uncommon for the health care provider to request report cards from school, as these can contain helpful information about a child’s behavior and presentation in school. It is also very common for the health care provider to request that the parents, teachers, and other adults in the child’s life complete questionnaires (or rating scales) related to issues of hyperactivity, impulsivity, or inattention. The health care provider may even visit the school, observe the child in class, and discuss the child’s behavior with teachers.
It should also be noted that, at least for the moment, there is not one test that can diagnose ADHD. While many families seek neuropsychological evaluations , to help gather information supporting the diagnosis of ADHD, it is usually not necessary when making the diagnosis. Instead, comprehensive interviews with the child and the parents, and a possible phone call with a teacher, are typically satisfactory.
There is good news and bad news. Let’s start with the bad news: ADHD is not like a bacterial infection, where you take medication, take care of yourself, and—in the majority of cases—the infection goes away. As indicated above, the symptoms of ADHD can manifest throughout the lifespan, and for some people, these symptoms can be debilitating without treatment. The good news, however, is that, as long as the symptoms are treated, they can be well managed and the negative impact can be reduced. There are two types of treatments that are utilized with ADHD: psychosocial and medication. Research on which treatment to use, which treatment to start with first, or if it is indicated to use both, is debated among professionals and the general public alike. Nevertheless, most families seem to prefer starting with psychosocial treatments and then, if there is no significant positive effect, trying medication with the guidance of a healthcare professional.
Psychosocial Treatments Include
- Behavioral parent training (BPT)—Parents are taught numerous “how-to” skills, with the goal of increasing positive behaviors, decreasing negative behaviors, improving the relationship between the parent and the child, and boosting the child’s self-esteem. Some skills taught include effective ways to use:
- Praise, point systems, reward charts, and other methods of positive reinforcement
- Active ignoring, time-outs, and other methods of “extinction,” which is reducing or eliminating unwanted behaviors
- Directions or commands
- Behavioral classroom management (BCM)—Teachers are encouraged to implement interventions (similar to those taught to parents in BPT, such as positive reinforcement and extinction) and often use a daily report card (DRC) to help track behavior and reward positive behaviors in school and at home.
- Behavioral peer interventions (BPI)—Often occurring in summer treatment programs (STPs), this intervention is intensive and usually occurs in day-long programs for many weeks (5–8), with a focus on social skills, guided group play with professionals observing, and utilizing behavioral interventions such as point systems and time-outs. Often, home-based rewards are used in conjunction with the strategies used in the treatment program. However, BPI is costly, difficult to implement in a community setting, and not as widely used as BPT or BCM.
- Organization training—Children and adolescents learn strategies and skills to improve their organizational, time-management, and planning skills. Additionally, both the parents and the teachers are taught and/or review effective behavioral strategies, as well as ways to reinforce skills the child learns during organizational training.
Medication, properly managed, is a safe and effective intervention for ADHD. The medications prescribed for ADHD help reduce hyperactivity, impulsivity, and inattentive symptoms. This reduction of distracting symptoms frees up the child so he or she is better able to attend to directions, academic work, and relationships.
Two types of medications—stimulants and non-stimulants—are often prescribed. Stimulants usually have a better effect [SR5] and are prescribed more often.
Like all medications, stimulants can have side effects, such as decreased appetite and sleeping problems. Since stimulants can raise a person’s blood pressure, people with a history of, or a family history of, heart conditions should notify their doctor prior to receiving a prescription.
These medications should always be taken under the careful observation of a medical doctor.
Finally—and important to note—people respond differently to medications. It is not uncommon to try many different medications and/or dosages before figuring out which is the most effective medication for a specific individual.
Children who present with hyperactive and impulsive symptoms (usually boys) are often identified earlier than those who present with inattentive symptoms (usually girls). Therefore, children who present with hyperactive and impulsive symptoms usually receive a therapeutic intervention at a younger age.
Conversely, children who present with inattentive symptoms are often “missed” and generally do not receive an appropriate intervention until much later in their life.
The risks for those who have not received treatment for ADHD is clearly documented in the research literature and includes:
- Severe academic impairment
- Poor peer relationships
- Accident-proneness and injury
- Driving risks and auto accidents
- Sleep problems
- Substance use
- Stay informed (which you are already doing by reading this).
- Support and be supported: Don’t be afraid to ask for help. Find educational and medical professionals who support you and your child. Treatment will not work (or certainly not optimally) without you.
- If you have concerns, ask questions; look for answers and do not be afraid to ask for a second opinion.
- Try to stay positive and not blame either you or your child. This can be a difficult time for many families. Setting aside time for fun activities with your child can improve their mood and your relationship.
- Like most challenges, intervening early can help tremendously! If your child does have ADHD, the sooner they receive appropriate assessment and interventions, the better their prognosis will be.
Both CUCARD Westchester's ADHD Program and CUCARD Manhattan's Program for ADHD and Behavioral Disorders provide evidence-based assessment and treatment services for children and adolescents with ADHD. These may include:
- Diagnostic evaluations
- School observations
- Medication consultation and management
- Parent-child interaction therapy
- Cognitive behavioral therapy
- Parent management training
- Organizational skills training
Children and teens with ADHD are also sometimes referred to the Child & Adolescent Behavioral Health Outpatient (CHONY-6) Clinic. The clinic offers evaluations to confirm a diagnosis, evidence-based behavioral and organizational treatments (in both group and individual formats), and consultation with a provider who can prescribe medication if necessary. Practitioners at the clinic aim to offer efficient evidence-based interventions with a primary focus on behavioral parent training and psychopharmacology.
- ADHD & You > If You Suspect a Loved One Has ADHD
- American Academy of Child and Adolescent Psychiatry (AACAP) > What Is ADHD?
- Centers for Disease Control and Prevention (CDC) > ADHD
- CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder)
- CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) > About ADHD
- Effective Child Therapy > ADHD
- Mayo Clinic > ADHD in Children
- National Alliance on Mental Illness (NAMI) > ADHD
- NHS Choices > ADHD
- National Institute of Mental Health (NIMH) > ADHD
- NewYork-Presbyterian (NYP) > ADHD in Children
- Understood: For Learning and Attention Issues > Understanding ADHD
- verywell.com > ADHD in Children
 ADHD includes 18 possible symptoms. Individuals under age 17 must have 6 of them endorsed by a parent or teacher to receive the diagnosis of ADHD.
 Pelham, W. E. (n.d.). Evidence-based Psychosocial and Combined Approaches to Treating ADHD in Children and Adolescents. http://effectivechildtherapy.fiu.edu/files/pdf/pelham_keynote.pdf
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 Evans, S. W., Owens, J. S., & Bunford, N (2014) Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 43(4), 527–551. doi: 10.1080/15374416.2013.850700
 Pelham, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 37(1), 184–214.
 Gallagher, R., & Abikoff, H. B. (2014). Organizational skills training for children with ADHD: An empirically supported treatment. New York, NY: Guilford.
Dr. Zachary Blumkin completed his clinical internship and postdoctoral fellowship at New York-Presbyterian's Morgan Stanley Children's Hospital/Columbia University Medical Center. He is currently an Assistant Professor of Medical Psychology (in Psychiatry) at Columbia University Medical Center, where he supervises, teaches, and meets with children, teens, and families.