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Adult ADHD Self-Report Scale (ASRS) v1.1

Kessler et al. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological medicine, 35 (2), 245–256. https://doi.org/10.1017/s0033291704002892

The ASRS v1.1 has been validated for adults as well as adolescents ages 13 and up. For more information, click here .

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with a physician or healthcare provider. Mental Health America Inc., sponsors, partners, and advertisers disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, of the use and application of these screens.

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• Adult attention-deficit/hyperactivity disorder (ADHD)

Signs and symptoms of ADHD in adults can be hard to spot. However, core symptoms start early in life — before age 12 — and continue into adulthood, creating major problems.

No single test can confirm the diagnosis. Making the diagnosis will likely include:

• Physical exam, to help rule out other possible causes for your symptoms
• Information gathering, such as asking you questions about any current medical issues, personal and family medical history, and the history of your symptoms
• ADHD rating scales or psychological tests to help collect and evaluate information about your symptoms

Other conditions that resemble ADHD

Some medical conditions or treatments may cause signs and symptoms similar to those of ADHD . Examples include:

• Mental health disorders, such as depression, anxiety, conduct disorders, learning and language deficits, or other psychiatric disorders
• Medical problems that can affect thinking or behavior, such as a developmental disorder, seizure disorder, thyroid problems, sleep disorders, brain injury or low blood sugar (hypoglycemia)
• Drugs and medications, such as alcohol or other substance misuse and certain medications

Standard treatments for ADHD in adults typically involve medication, education, skills training and psychological counseling. A combination of these is often the most effective treatment. These treatments can help manage many symptoms of ADHD , but they don't cure it. It may take some time to determine what works best for you.

Medications

Talk with your doctor about the benefits and risks of any medications.

• Stimulants, such as products that include methylphenidate or amphetamine, are typically the most commonly prescribed medications for ADHD , but other medications may be prescribed. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters.
• Other medications used to treat ADHD include the nonstimulant atomoxetine and certain antidepressants such as bupropion. Atomoxetine and antidepressants work slower than stimulants do, but these may be good options if you can't take stimulants because of health problems or if stimulants cause severe side effects.

The right medication and the right dose vary among individuals, so it may take time to find out what's right for you. Tell your doctor about any side effects.

Psychological counseling

Counseling for adult ADHD generally includes psychological counseling (psychotherapy), education about the disorder and learning skills to help you be successful.

Psychotherapy may help you:

• Improve your time management and organizational skills
• Learn how to reduce your impulsive behavior
• Develop better problem-solving skills
• Cope with past academic, work or social failures
• Improve your self-esteem
• Learn ways to improve relationships with your family, co-workers and friends
• Develop strategies for controlling your temper

Common types of psychotherapy for ADHD include:

• Cognitive behavioral therapy. This structured type of counseling teaches specific skills to manage your behavior and change negative thinking patterns into positive ones. It can help you deal with life challenges, such as school, work or relationship problems, and help address other mental health conditions, such as depression or substance misuse.
• Marital counseling and family therapy. This type of therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help. Such counseling can improve communication and problem-solving skills.

Working on relationships

If you're like many adults with ADHD , you may be unpredictable and forget appointments, miss deadlines, and make impulsive or irrational decisions. These behaviors can strain the patience of the most forgiving co-worker, friend or partner.

Therapy that focuses on these issues and ways to better monitor your behavior can be very helpful. So can classes to improve communication and develop conflict resolution and problem-solving skills. Couples therapy and classes in which family members learn more about ADHD may significantly improve your relationships.

More Information

• Cognitive behavioral therapy

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Lifestyle and home remedies

Because ADHD is a complex disorder and each person is unique, it's hard to make recommendations for all adults who have ADHD . But some of these suggestions may help:

• Make a list of tasks to accomplish each day. Prioritize the items. Make sure you're not trying to do too much.
• Break down tasks into smaller, more manageable steps. Consider using checklists.
• Use sticky pads to write notes to yourself. Put them on the fridge, on the bathroom mirror, in the car or in other places where you'll see the reminders.
• Keep an appointment book or electronic calendar to track appointments and deadlines.
• Carry a notebook or electronic device with you so that you can note ideas or things you'll need to remember.
• Take time to set up systems to file and organize information, both on your electronic devices and for paper documents. Get in the habit of using these systems consistently.
• Follow a routine that's consistent from day to day and keep items, such as your keys and your wallet, in the same place.
• Ask for help from family members or other loved ones.

Alternative medicine

There's little research to indicate that alternative medicine treatments can reduce ADHD symptoms. However, studies indicate that mindfulness meditation may help improve mood and attention in adults who have ADHD , as well as those who don't have ADHD .

Before using alternative interventions for ADHD , talk with your doctor about risks and possible benefits.

Coping and support

While treatment can make a big difference with ADHD , taking other steps can help you understand ADHD and learn to manage it. Some resources that may help you are listed below. Ask your health care team for more advice on resources.

• Support groups. Support groups allow you to meet other people with ADHD so that you can share experiences, information and coping strategies. These groups are available in person in many communities and also online.
• Social support. Involve your spouse, close relatives and friends in your ADHD treatment. You may feel reluctant to let people know you have ADHD , but letting others know what's going on can help them understand you better and improve your relationships.
• Co-workers, supervisors and teachers. ADHD can make work and school a challenge. You may feel embarrassed telling your boss or professor that you have ADHD , but most likely he or she will be willing to make small accommodations to help you succeed. Ask for what you need to improve your performance, such as more in-depth explanations or more time on certain tasks.

Preparing for your appointment

You're likely to start by first talking to your primary care provider. Depending on the results of the initial evaluation, he or she may refer you to a specialist, such as a psychologist, psychiatrist or other mental health professional.

What you can do

To prepare for your appointment, make a list of:

• Any symptoms you've had and problems they've caused, such as trouble at work, at school or in relationships.
• Key personal information, including any major stresses or recent life changes you've had.
• All medications you take, including any vitamins, herbs or supplements, and the dosages. Also include the amount of caffeine and alcohol you use, and whether you use recreational drugs.
• Questions to ask your doctor.

Bring any past evaluations and results of formal testing with you, if you have them.

Basic questions to ask your doctor include:

• What are the possible causes of my symptoms?
• What kinds of tests do I need?
• What treatments are available and which do you recommend?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health problems. How can I best manage these conditions together?
• Should I see a specialist such as a psychiatrist or psychologist?
• Is there a generic alternative to the medicine you're prescribing?
• What types of side effects can I expect from the medication?
• Are there any printed materials that I can have? What websites do you recommend?

Don't hesitate to ask questions anytime you don't understand something.

What to expect from your doctor

Be ready to answer questions your doctor may ask, such as:

• When do you first remember having problems focusing, paying attention or sitting still?
• Have your symptoms been continuous or occasional?
• Which symptoms bother you most, and what problems do they seem to cause?
• How severe are your symptoms?
• In what settings have you noticed the symptoms: at home, at work or in other situations?
• What was your childhood like? Did you have social problems or trouble in school?
• How is your current and past academic and work performance?
• What are your sleep hours and patterns?
• What, if anything, appears to worsen your symptoms?
• What, if anything, seems to improve your symptoms?
• What medications do you take?
• Do you consume caffeine?
• Do you drink alcohol or use recreational drugs?

Your doctor or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor.

• Attention-deficit/hyperactivity disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Jan. 26, 2019.
• Attention-deficit/hyperactivity disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml. Accessed Jan. 26, 2019.
• AskMayoExpert. Attention-deficit/hyperactivity disorder. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
• What is ADHD? American Psychiatric Association. https://www.psychiatry.org/patients-families/adhd/what-is-adhd. Accessed Jan. 26, 2019.
• ADHD. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/ADHD/Overview. Accessed Jan. 26, 2019.
• Adult ADHD (attention deficit hyperactive disorder). Anxiety and Depression Association of America. https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd. Accessed Feb. 11, 2019.
• Geffen J, et al. Treatment of adult ADHD: A clinical perspective. Therapeutic Advances in Psychopharmacology. 2018;8:25.
• Adult ADHD. American Association for Marriage and Family Therapy. https://www.aamft.org/Consumer_Updates/Adult_ADHD.aspx. Accessed Feb. 11, 2019.
• Kooij JJS, et al. Updated European consensus statement on diagnosis and treatment of adult ADHD. European Psychiatry. 2019;56:14.
• Fields SA, et al. Adult ADHD: Addressing a unique set of challenges. Journal of Family Practice. 2017;66:68.
• Mitchell JT, et al. Mindfulness meditation training for attention-deficit/hyperactivity disorder in adulthood: Current empirical support, treatment overview, and future direction. Cognitive and Behavioral Practice. 2015;22:172.
• Bhagia J (expert opinion). Mayo Clinic, Rochester, Minn. June 13, 2019.
• Hyperthyroidism (overactive). American Thyroid Association. https://www.thyroid.org/hyperthyroidism/. Accessed June 13, 2019.
• Low blood glucose (hypoglycemia). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia. Accessed June 13, 2019.

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Adult ADHD Assessment and Diagnosis

Evaluation approach.

Evaluation of adults presenting with ADHD symptoms typically requires at least two visits. As well as allowing for a thorough evaluation, two visits allows the clinician to assess motivation for follow up, persistence of symptoms and dysfunction, and likelihood for alternative diagnoses. The following components of a complete evaluation should be considered during both visits:

• Review and corroboration of current symptoms and dysfunction
• Determination of a childhood onset
• Evaluation for comorbid and /or mimicking psychiatric problems, medical disorders or substance abuse.

View the Adult ADHD Assessment, Diagnosis and Treatment Approach Algorithm

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, outlines diagnostic criteria for making a diagnosis of ADHD in children and adults. For a formal diagnosis of ADHD, symptoms of hyperactivity-impulsivity and/or inattention should meet the diagnostic criteria outlined in DSM-5 ( DSM-5 Diagnostic Criteria for ADHD ).

Differential Diagnosis

The symptoms of ADHD are common in other mental health disorders and non-psychiatric conditions. An appropriate evaluation must consider whether the symptoms belong to ADHD, another mental health condition, another physical health condition, or if they represent more than one disorder. Other explanations for presenting symptoms should also be ruled out ( Overview of Possible Causes for Presenting Symptoms Similar to ADHD and Differential Diagnosis of ADHD in Adults ).

Screening and Assessment Tools

The following scales have been developed to screen, evaluate and monitor adults with ADHD. Since rating scales are based on self-reported perceptions, and are, therefore, subjective, it is recommended that significant persons in the adult’s life also complete the forms. These can include the person’s spouse, a close relative, employer and/or colleague.

ADHD Screeners:

(see ADHD Screeners and Quality of Life Assessments )

• ADHD Rating Scale IV (ADHD-RS-IV) With Adult Prompts
• Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2
• Adult ADHD Investigator Rating Scale (AISRS)
• Adult ADHD Self-Report Scale (ASRS) v1.1
• Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS DSM-5) Screener
• Adult ASRS Symptom Checklist v1.1
• Barratt Impulsiveness Scale (BIS-11)
• Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults
• Clinical Global Impression (CGI)
• Conners’ Adult ADHD Rating Scales (CAARS)
• Diagnostic Interview for ADHD in Adults (DIVA) 2.0
• Wender Utah Rating Scale (WURS)

Informant Questionnaires: 

• Childhood Behavior Scale - Parent Report (See Informant - Parent )
• Current Behavior Scale - Partner Report (See Informant - Partner )

Note: there may be a fee associated with the use of some of these tools for you and/or the patient.

Quality of Life Assessments:

• Adult ADHD Quality of Life Measure (AAQoL) 2
• Driving Behavior Survey (DBS) 3
• Work Productivity and Activity Impairment Questionnaire General Health V2.0 (WPAI:GH) 4

References:

1. Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of Attention Deficit/Hyperactivity Disorder in Adult Patients: A Review of the Literature . Prim Care Companion CNS Disord. 2014;16(3).

2. Brod, M., Perwien, A., Adler, L., Spencer, T., & Johnston, J. (2005). Conceptualization and Assessment of Quality of Life for Adults with Attention-Deficit/Hyperactivity Disorder . Primary Psychiatry, 12(6), 58-64.

3. Clapp JD, Olsen SA, Beck JG, et al. The Driving Behavior Survey: Scale Construction and Validation . J Anxiety Disord. 2010;25(1):96–105. doi:10.1016/j.janxdis.2010.08.008

4. Reilly MC, Zbrozek AS, Dukes EM. The Validity and Reproducibility of a Work Productivity and Activity Impairment Instrument . Pharmaco Economics 1993; 4(5):353-65.

Copyright © 2023 American Academy of Family Physicians. All Rights Reserved.

NICHQ Vanderbilt Assessment Scales (Archived)

The NICHQ Vanderbilt Assessment Scales are used by health care professionals to help diagnose ADHD in children between the ages of 6- and 12-years. NICHQ is proud to have published the first edition in 2002 and has been at the forefront of supporting children and families affected by ADHD. 

Since the first edition, there have been two subsequent editions: the 2 nd Edition (2011) and 3 rd Edition (2019). If the first edition is still valuable to your work, you are welcome to download it for free here. If you choose to reference the first edition in any publications, please include a reference to NICHQ.

NOTE: NICHQ is not able to receive or process any completed Vanderbilt assessments. Please consult with your pediatrician for an assessment.

Below are some helpful links for accessing and learning about the latest version of the scales.

• The 3 rd edition of the Vanderbilt Assessment Scales can be purchased from the  American Academy of Pediatrics (AAP) Bookstore
• The most recent ADHD guidelines from the AAP can be found here .

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ADHD or attention deficit hyperactivity disorder, is a mental disorder related to attention span, impulsive decision making, and activity. It is not a detrimental condition, and there is long term treatment that makes people with ADHD able to live healthy, productive lifestyles. Below are some frequently asked questions about ADHD, as well as more information about the disorder:

What are 3 types of ADHD?

There are three major types of ADHD. First, ADHD impulsive/hyperactive type which presents itself as impulsive and hyperactive activities, but does not include inattentive behaviors, it's the least common of the three diagnoses of ADHD. Then, ADHD inattentive and distractible type, characterized by inattention and distracted behavior, usually does not include clinical hyperactive behaviors. Lastly, ADHD combined type, this is the most common disorder diagnosis, characterized by both hyperactivity and inattention. Children with ADHD are most likely to be diagnosed with the latter disorder. 

What are the nine symptoms of ADHD?

Nine of the most common symptoms of ADHD include: fidgeting, excessive movement, inability to concentrate long term, impulsivity, inattention, hyperactivity, difficulty staying seated, hard time reading for long periods of time, and distractibility. More symptoms will be discussed below. 

What causes ADHD? 

There is no specific cause for a diagnosis of ADHD, and researchers are still developing and understanding of main causes or risk factors. Some mental health professionals have said that you may be more likely to develop ADHD if  a blood relative has had ADHD. There are also medically reviewed studies suggesting that environmental toxins or issues during pregnancy may increase chances of an ADHD diagnosis. 

Is ADHD a bad thing?

No! People with ADHD may have a variety of lifestyle changes to make to cope with some challenges that come with an ADHD diagnosis and symptoms, like finding working habits that help them focus, or taking medication, or seeking treatment with a mental health professional, but that is not a bad thing. People with ADHD can use their ADHD to empower them and create a community aware of mental health disorders and what others are experiencing!

Will ADHD go away? Can ADHD go away?

People with ADHD will find a variety of ways to cope with their ADHD symptoms, making them more manageable overtime. The symptoms themselves may also change over time, for example children with ADHD may have different experiences that adults with ADHD. Taking an ADHD test can help you figure out if symptoms are present, but is not a substitute for speaking with a medical professional.

What are people with ADHD good at?

People with ADHD can be good at a variety of things, like any person, whatever they put their mind to or want to be good at, they can accomplish, possibly with some challenges due to their ADHD, however they are still capable of success as much as any other person. Specifically, many people with ADHD are good at being creative and inventive with their ideas, their ADHD may give them a perspective that the rest of the population may not have!

For more information on what ADHD is, symptoms, signs, and treatment, continue reading:

What is Adult ADHD?

If you are wondering whether you or a loved one are experiencing signs of ADHD, please don't hesitate to take this online test to learn more information, including helpful next steps.

Signs of Adult ADHD

How is adult adhd treated.

Therapy involves a multidisciplinary approach (psychiatry, neurology, psychology) and the involvement of friends and family members who can provide social support to those with ADHD. With the addition of these treatment methods, people can live a healthy and productive lifestyle while managing their symptoms.

Most experts agree that the best approach to treat adult ADHD is a combination of pharmacological treatment and psychotherapy focused on addressing signs and symptoms discussed in the quiz above.

Medication for ADHD Symptoms

Since the disorder is often accompanied by depression or anxiety, psychiatrists can prescribe medication to help patients cope with symptoms and achieve mental balance.

However, a therapeutic approach based solely on medication is not sufficient for adults with the disorder, as medication only diminishes the symptoms, but does not fundamentally change how the brain works. Due to this, most professionals will recommend a combination treatment method to treat the disorder.

Psychotherapy for ADHD Symptoms

Psychotherapy is an extremely useful tool in the treatment of most disorders. Many clinicians believe cognitive-behavioral therapy (CBT) can have a significantly positive effect on adults who have the disorder in terms of gaining valuable organizational and time management skills.

With the help of a counselor or therapist, adults with ADHD can find ways to avoid distractions, control their impulsive decisions associated with it, and cultivate peace of mind through meditation and relaxation techniques.

Furthermore, if the person is dealing with co-occurring conditions (e.g. bipolar disorder, OCD, anxiety, depression, along with ADHD) then psychotherapy becomes an absolute necessity.

Where to Read More Online about ADHD

What are the common adhd symptoms in toddlers - https://www.mind-diagnostics.org/blog/adhd/an-overview-of-common-adhd-symptoms-in-toddlers an overview of adhd types - https://www.mind-diagnostics.org/blog/adhd/an-overview-of-the-adhd-types can you grow out of adhd adhd and adulthood - https://www.mind-diagnostics.org/blog/adhd/can-you-grow-out-of-adhd-adhd-and-adulthood living with adhd: adhd treatment for adults - https://www.mind-diagnostics.org/blog/adhd/living-with-adhd-adhd-treatment-for-adults adhd meaning: what is the meaning of adhd - https://www.mind-diagnostics.org/blog/adhd/adhd-meaning-what-is-the-meaning-of-adhd find out what the benefits of adhd are - https://www.mind-diagnostics.org/blog/adhd/find-out-the-benefits-of-adhd, if you or a loved one resonate with the signs and symptoms of adhd mentioned in this article, don't hesitate to take this online quiz today and find out where to get help., reviews for this test, overall rating.

It was absolutely amazing and I was so happy to see the results, it makes sense to me now!!

I am medically diagnosed, and treated for adult ADHD. This test felt very accurate because of that. The questions are very good!

Very interesting. We were trying to figure out if my son had a DHD so this was interesting and helpful to us. Thank you

i took this knowing i have adhd and i got 6/6 for it so i say it works

Painless and easy to understand

I'll be honest, I was diagnosed with ADHD at a young age, I just wanted to see how accurate these tests were and it actually worked really well. I took some of the other tests too and they all seem accurate as well, so I was decently surprised. This was fun and helpful.

I found this test incredibly useful and have shown results to my therapist

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ADHD Screening

What is adhd screening.

ADHD screening is also called ADHD testing. It helps find out if a child, teen, or adult has ADHD. ADHD stands for attention deficit hyperactivity disorder . It used to be called ADD (attention-deficit disorder).

A person who has ADHD has a hard time paying attention and focusing on tasks. ADHD is a common developmental disorder that begins in childhood and often lasts into adulthood. Although it's usually diagnosed in childhood, some people with ADHD don't get diagnosed with ADHD until they are adults.

There are three types of ADHD:

• Mostly Inattentive ADHD. People with this type of ADHD have trouble paying attention and are easily distracted. It's hard for them to organize or finish tasks. They may have trouble following instructions or conversations.
• With hyperactivity , people feel a need to always be moving. They have trouble sitting still and may fidget and/or talk too much.
• With impulsivity , people have trouble controlling their actions and words. They tend to act on sudden ideas or feelings without thinking about the possible results. They may interrupt others a lot or have trouble waiting their turn.
• Combined ADHD. People with this type of ADHD have a mix of inattentive and hyperactive-impulsive symptoms. Combined ADHD is the most common type.

It's normal to sometimes have trouble paying attention or sitting still, especially for children. But people with ADHD have more severe symptoms that cause serious problems, for example, failing grades for a child or a job loss for an adult. The symptoms are ongoing and may affect family and social life, too.

There's no single test to show whether a person has ADHD. Instead, a health care provider will follow a set of professional guidelines for gathering information, doing tests, and diagnosing the cause of a person's symptoms. Treatment is available to help people of all ages who have been diagnosed with ADHD.

Other names: ADHD test

What is it used for?

ADHD screening is used to check for ADHD in people who have frequent, serious problems with attention, hyperactivity, and/or impulsive behavior. The screening also checks for other mental disorders that often happen with ADHD. Sometimes symptoms of these other disorders are mistaken for ADHD.

ADHD screening is used with children as young as age four. If you have a younger child with symptoms that could be ADHD, ask your child's provider which type of testing might be best.

Why do I need ADHD screening?

Your child may need screening if you, a teacher, or another caregiver thinks your child has symptoms of ADHD.

Adults who have had challenges since childhood (before age 12) with focusing, impulsive behavior, restlessness, and/or being organized can ask their providers if they need to be screened for ADHD. The symptoms depend on the type of ADHD a person has.

People with symptoms of attention problems may often:

• Miss details or make careless mistakes in schoolwork, at work, or in other activities
• Have trouble staying focused on play activities or work tasks
• Not seem to listen when spoken to directly
• Find it hard to follow instructions or finish tasks, or may start but get easily sidetracked
• Have trouble being organized, keeping belongings in order, and managing time
• Avoid doing tasks that require long periods of mental effort
• Lose important items, such as books, wallets, keys, eyeglasses, and cellphones
• Forget about doing daily activities

People with symptoms of hyperactivity-impulsivity may often:

• Fidget and squirm while seated
• Get up when staying seated is expected, such as at school or work
• Run around or climb when it's not appropriate (children) or feel restless (teens and adults)
• Have trouble doing quiet activities
• Be constantly moving or "on the go"
• Talk much more than is normal
• Blurt out answers before questions are completed
• Have trouble waiting for their turn
• Interrupt others for example during conversations or games

People with combined ADHD show a mix of inattention and hyperactivity-impulsivity symptoms.

What happens during an ADHD screening?

The general screening process is similar for people of all ages. It involves several steps. A primary care provider may do the entire screening or refer the person to a mental health provider. A mental health provider is a health care professional who specializes in diagnosing and treating mental health problems.

During an ADHD screening, the provider will:

• Do a physical exam. An exam by a primary care provider checks for certain health conditions that can cause symptoms similar to ADHD. The exam may include vision and hearing tests (for children and adults ), thyroid tests , and other tests.
• Review medical history, family health history, and other records. The cause of ADHD isn't known, but it often runs in families . So, family history is important. The results of any past tests and school reports provide valuable information, too. For adults, old school records can help a provider find out if symptoms began in childhood.
• Interview the person about their symptoms. For children, questions and activities are geared toward their age. Parents are usually interviewed, too.
• For children and teens: Teachers, babysitters, coaches, and other family members who spend time with the child. Parents may also complete checklists and/or questionnaires.
• For adults: Family members who know the person from childhood, and spouses, friends, and co-workers.
• Screen for other mental health disorders. People who have ADHD often have other mental health disorders. It's also possible that another disorder, and not ADHD, is causing symptoms. So, mental health screening tests are often done as needed to check for conditions such as, anxiety , depression , and bipolar disorder . Children and may also be tested for learning disabilities , autism spectrum disorder , or behavior disorders .

Will I need to do anything to prepare for ADHD screening?

You usually don't need any special preparations for ADHD screening. Your provider will let you know what health and school records you may need to gather.

Are there any risks to screening?

There is no risk to a physical exam, written test, or questionnaire.

What do the results mean?

The provider will usually write up the results of an ADHD screening in a report that includes a diagnosis. To diagnose ADHD, the screening must find all of these things:

• Several symptoms of ADHD that began before age 12.
• Children up to age 16 must have at least 6 ongoing symptoms.
• People 17 and older must have at least 5 ongoing symptoms.
• Symptoms that happen in 2 or more settings, for example, at home and at work or school.
• Symptoms that clearly get in the way of functioning well at school, work, and/or in social situations.
• Symptoms aren't caused by another mental health disorder.

If there is a diagnosis of ADHD, the report will include the type of ADHD (inattentive, hyperactive-impulsive, or combined). It will also say whether ADHD is mild, moderate, or severe. Any other disorders that may have been found will be included in the report.

There's no cure for ADHD, but treatment may help reduce symptoms. Treatment may include medicine, talk therapy, behavioral therapy, and lifestyle changes. Usually, two or more treatments are combined. Parents of children with ADHD may also receive training to help their children manage ADHD.

Learn more about laboratory tests, reference ranges, and understanding results .

• ADDA: Attention Deficit Disorder Association [Internet]. Attention Deficit Disorder Association; c2015-2022. ADHD: The Facts; [cited 2022 Dec 8]; [about 6 screens]. Available from: https://add.org/adhd-facts
• American Psychiatric Association [Internet]. Washington D.C.: American Psychiatric Association; c2022. What Is ADHD?; [reviewed 2022 Jun; cited 2022 Dec 8]; [about 7 screens]. Available from: https://www.psychiatry.org/patients-families/adhd/what-is-adhd
• Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Attention-Deficit/Hyperactivity Disorder; [updated 2022 Aug 9; cited 2022 Dec 8]; [about 4 screens]. Available from: https://www.cdc.gov/ncbddd/adhd/facts.html
• CHADD [Internet]. Lanham (MD): CHADD; c2022. About ADHD; [cited 2022 Dec 8]; [about 3 screens]. Available from: https://chadd.org/understanding-adhd
• HealthyChildren.org [Internet]. Itaska (IL): American Academy of Pediatrics; c2022. Diagnosing ADHD in Children: Guidelines & Information for Parents; [updated 2017 Jan 9; cited 2022 Dec 8]; [about 3 screens]. Available from: https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Diagnosing-ADHD-in-Children-Guidelines-Information-for-Parents.aspx
• Johns Hopkins Medicine [Internet]. Johns Hopkins Medicine; Health Library: Attention-Deficit /Hyperactivity Disorder (ADHD) in Children; [cited 2022 Dec 8]; [about 3 screens]. Available from: https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/mental_health_disorders/attention-deficit_hyperactivity_disorder_adhd_in_children_90,P02552
• Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998-2022. Attention-deficit/hyperactivity disorder (ADHD) in children: Diagnosis and treatment; [cited 2022 Dec 8]; [about 4 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/adhd/diagnosis-treatment/drc-20350895
• Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998-2022. Attention-deficit/hyperactivity disorder (ADHD) in children: Symptoms and causes; [cited 2022 Dec 8]; [about 7 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889
• Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c2022. Attention-Deficit/Hyperactivity Disorder (ADHD); [reviewed 2022 Feb; cited 2022 Dec 8]; [about 7 screens]. Available from: https://www.merckmanuals.com/home/children-s-health-issues/learning-and-developmental-disorders/attention-deficit-hyperactivity-disorder-adhd
• National Institute of Mental Health [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Attention-Deficit/Hyperactivity Disorder; [reviewed 2022 Sep; cited 2022 Dec 8]; [about 3 screens]. Available from: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
• National Institute of Mental Health [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Mental Health Brochures and Fact Sheets: Attention-Deficit/Hyperactivity Disorder in Children and Teens: What You Need to Know; [revised 2021; cited 2022 Dec18]; [about 6 screens]. Available from: https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-in-children-and-teens-what-you-need-to-know#part_9999
• Nemours Kids Health [Internet]. Jacksonville (FL): The Nemours Foundation; c1995-2022. ADHD; [reviewed 2022 May; cited 2022 Dec 8]; [about 3 screens]. Available from: https://kidshealth.org/en/parents/adhd.html
• University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2022. Health Encyclopedia: Attention Deficit-Hyperactivity Disorder (ADHD); [cited 2022 Dec 8]; [about 9 screens]. Available from: https://www.urmc.rochester.edu/childrens-hospital/developmental-disabilities/conditions/adhd.aspx
• UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2022. Health Information: Attention Deficit-Hyperactivity Disorder (ADHD);[updated 2022 Feb 9; cited 2022 Dec 8]; [about 2 screens]. Available from: https://patient.uwhealth.org/healthwise/article/en-us/aa170419
• Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W; SUBCOMMITTEE ON CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVE DISORDER . Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019 Oct [cited 2022 Dec 18];144(4):e20192528. doi: 10.1542/peds.2019-2528. Erratum in: Pediatrics. 2020 Mar;145(3): PMID: 31570648; PMCID: PMC7067282. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067282/

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Adhd test for kids and teens.

Our free Symptom Checker can help you determine if your child might have ADHD

Writer: Hannah Sheldon-Dean

Attention-deficit hyperactivity disorder, or ADHD, can be hard to spot and easy to misunderstand. Our free ADHD test, the Symptom Checker , can help you determine if your child might have ADHD.

To take the test, you mark the symptoms that you’re worried about by answering a series of questions. The quiz uses your answers to give you a list of disorders that are associated with those symptoms.

The Symptom Checker was developed in partnership with expert clinicians and is aligned with the Child Mind Institute’s rigorous editorial standards .

Is any online ADHD test reliable?

Individual symptoms can reflect more than one mental health or learning disorder. That’s why our Symptom Checker gives you a range of possible disorders and points you toward next steps.

The free ADHD test cannot diagnose your child. But it can help you know if your child’s symptoms could be signs of ADHD, or of another disorder. You’ll learn about possible diagnoses, find links to articles where you can learn more, and gain information you can use to facilitate a conversation with a mental health professional.

Signs of ADHD

The Symptom Checker quiz can help you spot possible signs of ADHD in your child. If you think your child might have ADHD, it’s important to get them a thorough evaluation from a professional.

The first signs of ADHD are often hyperactive or impulsive behaviors. They usually show up in children between three and six years old. Hyperactive or impulsive behaviors include: 

• Having a lot of energy and struggling to sit still 
• Fidgeting all the time 
• Often running around and climbing on things  
• Constantly talking or interrupting others 
• Being very impatient 

The other symptoms of ADHD are inattentive behaviors. These usually show up once the child starts school. Inattentive behaviors include:  

• Being easily distracted  
• Making careless mistakes 
• Having a hard time following instructions 
• Often forgetting or losing things 
• Having trouble staying organized  
• Appearing not to listen when someone speaks to them  
• Avoiding things that involve a lot of thinking or effort 
• Seeming unaware of what’s going on around them 

Not all kids with ADHD have both kinds of symptoms. Some have only hyperactive symptoms, and others have only inattentive symptoms.

ADHD symptoms in girls vs. boys

About twice as many boys as girls are diagnosed with ADHD. But that is partly because girls may be more likely to have inattentive symptoms of ADHD. For example, they might get distracted easily and struggle to pay attention in class, but their teacher might not notice or else dismiss them as just spacey. A child who has hyperactive symptoms, like getting up and running around the classroom, is much harder to miss or ignore.

If you think your daughter might have ADHD, the Symptom Checker can give you more information and next steps.

What should I do if I’m worried my child might have ADHD?

The best thing to do if you think your child might have ADHD is get them an evaluation by a professional who is skilled in diagnosing ADHD.

Not all attention problems are ADHD, so it’s important to rule out other possible causes of your child’s symptoms. For example, kids with anxiety are sometimes so preoccupied with worry that they seem very distracted in school. Or kids with learning disorders might disrupt class in order to avoid schoolwork that they’re not able to complete.

The Symptom Checker test can gather information about your child’s symptoms and give you a list of possible disorder to consider. An accurate diagnosis is the key to getting your child the right support.

How is ADHD tested?

ADHD can be diagnosed by a number of different professionals, including pediatricians, psychiatrists, and clinical psychologists.

There is no blood test or brain scan that can tell whether or not a child has ADHD. Instead, the professional evaluating the child relies on information about the child’s behavior in order to make an accurate diagnosis. This includes reports from their parents, teachers, and other adults who know them well. It also includes evaluating the child in person and using standardized measurements that measure their ability to do certain tasks.

Kids should never be diagnosed with ADHD just because a parent or teacher says that they are hyperactive or distracted.

How much does our online ADHD test cost?

The Symptom Checker is a free to use ADHD test. It cannot diagnose your child with ADHD, but it can help you identify possible signs of ADHD.

Further Reading

• How to Get an ADHD Diagnosis
• Complete Guide to ADHD
• How to Tell if Your Daughter Has ADHD
• Preschoolers and ADHD
• How Is the ADHD Brain Different?
• Common ADHD Myths
• ADHD in Teenagers
• ADHD and Behavior Problems
• Do Kids Outgrow ADHD?

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Attention Deficit Hyperactivity Disorder (ADHD)

The AAP provides clinical guidance and other resources to assist with the diagnosis and treatment of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Tools are provided for pediatricians, patients, families and teachers to ensure a comprehensive assessment of the patients functioning and behaviors leading to a proper diagnosis and successful treatment plan.

ADHD Overview

ADHD is the most common neurobiological disorder in the United States and more than 9 percent of children aged 2-17 receive an ADHD diagnosis during their childhood. Most children diagnosed with ADHD had at least 1 comorbidity and approximately 18 percent had 3 or more. These comorbidities increase the complexity of diagnosis, evaluation and treatment of these children. The majority of care for children with ADHD is provided by their primary care physician, though multiple barriers exist that are impediments to providing excellent ADHD care.

AAP Recommendations

In this clinical practice guideline, AAP addresses the challenges in evaluation, diagnosis and treatment of children and adolescents from 4 to 18 years of age. An update of the 2011 guideline, the guideline now includes an additional key action statement to address coexisting and comorbid conditions in children with ADHD. The guideline is accompanied by two additional documents, (1) a process of care algorithm for the diagnosis and treatment of children and adolescents with ADHD and (2) an article on systemic barriers to the care of children and adolescents with ADHD.

• Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
• Process of Care Algorithm
• Systemic Barriers to the Care of Children and Adolescents with ADHD

Quality Improvement Tools & Resources

Caring for Children with ADHD: A Resource Toolkit for Clinicians

Toolkit available for purchase; offers the latest updates and guidance for health care professionals who provide care for children and adolescents with Attention-Deficit/Hyperactivity Disorder in the medical home.

Attention Deficit / Hyperactivity Disorder (ADHD) Quality Improvement (QI) Metrics

Measurable outcomes that are typically based on key action statements. This resource consists of inclusion/exclusion criteria, overall aim/goal and descriptions of the numerators/denominators needed to calculate the metric.

Attention Deficit / Hyperactivity Disorder (ADHD) Key Driver Diagram

This resource serves as a map or guide to quality improvement. Aims are usually identified with key drivers serving as the “what” you need to do and the secondary drivers or implementation tools/resources serving as the “how” you will achieve the desired change.

Chapter Quality Network (CQN): ADHD Change Package

This change package was created for a CQN project. The change package is designed for primary care pediatricians interested in improving care for children and families using quality improvement methodologies to support process change at the practice level.

Get Involved

Section on developmental and behavioral pediatrics, last updated.

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Understanding Attention-Deficit/Hyperactivity Disorder From Childhood to Adulthood

Timothy e. wilens.

1 Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital and Harvard Medical School, Boston, MA

Thomas J. Spencer

Attention deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders presenting for treatment in children and adolescents. ADHD is often chronic with prominent symptoms and impairment spanning into adulthood. ADHD is often associated with co-occurring disorders including disruptive, mood, anxiety, and substance abuse. The diagnosis of ADHD is clinically established by review of symptoms and impairment. The biological underpinning of the disorder is supported by genetic, neuroimaging, neurochemistry and neuropsychological data. Consideration of all aspects of an individual’s life needs to be considered in the diagnosis and treatment of ADHD. Multimodal treatment includes educational, family, and individual support. Psychotherapy alone and in combination with medication is helpful for ADHD and comorbid problems. Pharmacotherapy including stimulants, noradrenergic agents, alpha agonists, and antidepressants plays a fundamental role in the long-term management of ADHD across the lifespan.

INTRODUCTION AND OVERVIEW

Attention-deficit/hyperactivity disorder (ADHD) is among the most common neurobehavioral disorders presenting for treatment in children 1 , 2 . It carries a high rate of comorbid psychiatric problems such as oppositional defiant disorder (ODD), conduct disorder, mood and anxiety disorders, and cigarette and substance use disorders 3 . Across the life span, the social and societal costs of untreated ADHD are considerable, including academic and occupational underachievement, delinquency, motor vehicle safety, and difficulties with personal relationships 3 - 5 , 6 .

ADHD affects an estimated 4% to 12% of school-aged children worldwide 7 with survey and epidemiologically derived data showing that 4 to 5% of college aged students and adults have ADHD 8 . In more recent years, the recognition and diagnosis of ADHD in adults have been increasing although treatment of adults with ADHD continues to lag substantially behind that of children 8 , 9 . In contrast to a disproportionate rate of boys diagnosed with ADHD relative to girls in childhood, in adults, an equal number of men and women with ADHD are presenting for diagnosis and treatment 10 .

PSYCHIATRIC COMORBIDITY

During the past decade, epidemiological studies have documented high rates of concurrent psychiatric and learning disorders among individuals with ADHD 3 , 11 , 12 , 13 . Consistent with childhood studies, studies of ADHD adults have found high rates of childhood conduct disorder as well as adult antisocial disorders in these subjects 3 .

Mood & Anxiety

Anxiety often confounds the diagnosis and treatment of ADHD 3 , 11 , 12 . High rates of the various anxiety symptoms exist in ADHD and may manifest as social, generalized or panic-like symptoms. Similarly, ADHD increases the likelihood of having a depressive disorder by at least two-fold 8 , 14 . Interestingly, recent data suggest that stimulant treatment of ADHD over time may decrease the ultimate risk for anxiety and depressive disorders 15 .

A growing literature reports the co-occurrence of bipolar disorder and ADHD. Systematic studies of children and adolescents indicate rates of ADHD ranging from 57% to 98% in bipolar children; and conversely, rates of bipolar disorder in 22% of ADHD children and adolescents 16 . There continues to be much controversy about the validity of the concurrent diagnoses of ADHD and severe mood instability or bipolar disorder. Whereas ADHD is characterized by the typical cognitive and hyperactive/impulsive features of the disorder, bipolar disorder (BPD) is characterized by mood instability, pervasive irritability/rage, grandiosity, psychosis, cyclicity, and lack of response to structure 17 . When individuals experience both sets of symptoms, they may suffer from both ADHD and BPD 17 .

Substance Use Disorders

Combined data from retrospective accounts of adults and prospective observations of youth indicate that juveniles with ADHD are at increased risk for cigarette smoking and substance abuse (SA) during adolescence 18 . ADHD adolescents and adults become addicted to cigarette smoking at twice the rate compared to non-ADHD individuals 19 , 20 . ADHD youth disproportionately become involved with cigarettes, 19 which increases the risk for subsequent alcohol and drug use 21 . Individuals with ADHD tend to have more severe substance abuse and maintain their addictions longer compared to their non-ADHD peers 19 , 22 - 24 .

Concerns of the abuse liability of stimulants and the potential kindling of substance abuse secondary to early stimulant exposure in ADHD children have been raised. 25 These concerns are based largely on data from animal studies. 25 However, the preponderance of clinical data and consensus in the field do not appear to support such a contention. For example, in a prospective study of ADHD girls followed into adolescence, a significant reduction in the risk for SA was reported in treated compared to untreated ADHD youth 26 with no increase (or decreased) SUD risk associated with stimulant treatment into adulthood 27 .

DIAGNOSING ADHD

ADHD can be reliably diagnosed in children, adolescents, and adults 28 . Using the current guidelines, the child or adult patient must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 29 . It is important to note, however, that the DSM-IV-TR criteria for ADHD symptoms were derived from youth to age 17 years and therefore were not specifically tailored to adults and hence, may not always “fit” adults with the disorder 28 , 30 . The symptoms of the disorder are categorized as follows: inattention-difficulty sustaining attention and mental effort, forgetfulness, and distractibility; hyperactivity-fidgeting, excessive talking, and restlessness; and impulsivity-difficulty waiting one’s turn and frequent interruption of others. The DSM-IV-TR criteria also include onset by age 7, impaired functioning in at least 2 settings (home, work, school, job), and more than 6 months of duration 30 . Three subtypes of the syndrome are currently recognized: predominantly inattentive, predominantly hyperactive-impulsive, and the combined type, which is the most common and typically more severe and with more comorbidity 29 , 31 , 32 . Between 90 to 95% of adolescents and adults with ADHD manifest the inattention cluster of symptoms at least as a component of their disorder 31 . Of interest, the combined subtype of ADHD may simply represent a more severe and debilitating presentation of ADHD (e.g. more symptoms) and there may be relatively more stability of the subtype with development 32 , 33 .

To meet the diagnostic criteria for the inattentive or hyperactive-impulsive subtypes, an individual must have 6 or more of the 9 symptoms from either group of criteria (18 possible traits in all) 30 . For the combined subtype, an individual must have 6 or more inattentive symptoms and 6 or more hyperactive-impulsive symptoms. To warrant the ADHD diagnosis, symptoms must cause significant impairment. Adults diagnosed with the disorder must have had childhood onset and persistent and current symptoms, although allowance is made for incomplete persistence of full criteria (ADHD-in partial remission) or lack of clear childhood symptoms (ADHD NOS).

Of interest, whereas clinicians are concerned as to the possibility of purposely misrepresenting or over-reporting of ADHD symptoms by college students or adults, data suggest the opposite may be operant. Mannuzza et al. 34 in a prospective 16-year follow-up of children with ADHD now at a mean age of 25, found that of the 176 individuals with a well characterized past history of ADHD, only 28% of the adults through direct interviews were identified as having childhood ADHD. These data further highlight issues around the relatively poor sensitivity of recalling symptoms (and establishing the diagnosis of ADHD) by adult self-report, particularly when not anchoring symptoms in childhood.

The diagnosis of ADHD is made clinically with scales used in an ancillary manner. The patient’s symptoms, severity of impairment, possible comorbidity, family history, and psychosocial stressors may be determined during the patient and/or parent interview. In pediatric evaluations, the adolescent’s behavior and parent-child interaction are observed, and the child’s school, medical, and neurological status are evaluated 2 . A number of diagnostic and follow-up scales are available (see www.schoolpsychiatry.org ) 35 . Symptom scales used with all age groups (to assess home, school, and job performance) include, but are not limited to, the ADHD Symptom Checklist, SNAP-IV Teacher and Parent Rating Scale, Conners Rating Scales-Revised,, Brown Attention-Deficit Disorder Scales for Children, and the ADHD Symptoms Rating Scale 36 . Although these tools quantify behavior deviating from norms, they should not be used alone to make or refute the diagnosis.

Diagnosing adults involves careful querying for developmentally appropriate criteria from the DSM-IV-TR concerning the childhood onset, persistence, and current presence of symptoms 29 . Diagnostic aids are available for adult ADHD 36 , 37 . For instance, the Adult Self Report Scale, Conners Adult ADHD Scales, and Brown Attention scales for adults are among instruments available to assist in the diagnosis of ADHD 36 , 37 . For a briefer screening of adults, the World Health Organization Adult ADHD self-report scale ( Figure 1 ) can be downloaded ( www.who.org ) and has been validated as a manner of identifying those at risk for ADHD who necessitate further screening 38 .

Follow-up studies show that prominent symptoms and impairment related to the disorder persist into adulthood in approximately one-half of cases 39 , 40 . There appears to be developmental variance in the ADHD symptom profile across the life span 31 , 32 , 39 - 41 . Longitudinally derived data in ADHD youth growing up indicate that the symptom cluster of hyperactivity and impulsivity decays over time, while the symptoms of inattention largely persist 32 , 39 - 41 , 31 . In support of this notion, data derived from a group of clinically referred adults with ADHD indicate that approximately half of adults endorse clinically significant levels of hyperactivity/impulsivity, but 90% endorse prominent attentional symptoms 32 , 31 .

A substantial body of literature implicates abnormalities of brain structure and function in the pathophysiology of both childhood and adult ADHD 42 - 48 , 49 - 51 . We have known for decades that ADHD youth show impaired performance on tasks assessing vigilance, motoric inhibition, organization, planning, complex problem solving, and verbal learning and memory 52 , 53 . Prominent neuropsychologically-derived executive dysfunction is associated with learning disabilities and poorer overall prognosis over time in ADHD youth 54 . Similar findings are emerging in adults with ADHD 52 . While neuropsychological testing is not used clinically to diagnose ADHD in adults, such testing aids in identifying learning disabilities, sub average intelligence, and specific information processing deficits.

PATHOPHYSIOLOGY AND GENETICS

Neurobiology.

ADHD has been conceptualized as a disorder affecting “frontal” circuitry due to associated deficits in executive cognitive functioning. Structural imaging studies have documented diffuse abnormalities in children and adults with ADHD. A large study by Castellanos and colleagues 55 reported smaller total cerebrum, cerebellum, and the four cerebral lobes that did not change over time. A structural magnetic resonance imaging (MRI) study 56 in adults with and without ADHD also revealed a smaller anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC). The DLPFC controls working memory that involves the ability to retain information while processing new information. These differences are thought to account for deficits in goal-directed and on task behavior in ADHD. The ACC is thought to be a key region of regulation involving the ability to focus on one task and choose between options.

Investigators have also examined the developmental pattern of cortical maturation in ADHD. Shaw and colleagues 57 reported a delay in cortical thickness among ADHD patients. The pattern of brain development, from sensorimotor to associative areas, was similar in children with and without ADHD. However, the age of peak development was delayed in those with ADHD. Using the same measure of cortical thickness data in adults, Makris and associates 58 have shown that cortical thickness is not normalized and that the areas of the brain that are affected in children with ADHD remain affected in adulthood. In this study the DLPFC, parietal areas, and ACC had thinner measures of cortical thickness in adults with ADHD than in adults without ADHD.

Functional magnetic resonance imaging (fMRI) has been used to examine brain activity during selective cognitive challenges in individuals with ADHD. One study that measures brain activity using a neuropsychological test (go/no-go) found that both youth and adults with ADHD showed attenuated activity in the frontostriatal regions of the brain that are key for inhibitory control and for attention (prefrontal cortex and caudate) 59 . Adults with ADHD also activated non-frontostriatal regions (ACC, parietal areas) moreso than controls. The amount of brain activation observed correlated closely with the degree of efficiency on the task in both children and adults with ADHD.

The results of fMRI studies were reviewed by Casey and Durston 60 who hypothesized that top-down and bottom-up control systems were affected in ADHD. They speculated that bottom-up neural systems detect the regularities and irregularities in the environment to activate the frontal brain systems to alter behavior. These systems are key regulators of maintaining sustained attention vs. shifting attention due to sensory input. Casey and Durston 60 posited that the striatum regulates what to expect (type of task), the cerebellum regulates when to expect it (timing of task), and the parietal lobe alerts one to novel or newer competing stimuli.

Interestingly, medication may normalize some of these functional deficits. Bush and colleagues published a study showing that 7 weeks of treatment with methylphenidate normalized activation in the ACC 61 . Those receiving medication showed increases in activation of the ACC and DLPFC at follow-up as compared to baseline and to those receiving placebo treatment. Hence, those areas of the brain that were underactive in adults without treatment normalized with treatment.

The neurobiology of ADHD is strongly influenced by genetic factors. As highlighted in a special issue of Science dedicated to the human genome project, ADHD is among the most recognized genetic-based disorders in psychiatry 62 . Family studies of ADHD have shown that the relatives of ADHD children are at high risk for ADHD, comorbid psychiatric disorders, school failure, learning disability and impairments in intellectual functioning 63 . Additional lines of evidence from twin, adoption and segregation analysis studies suggest that the familial aggregation of ADHD has a substantial genetic component. Twin studies find greater similarity for ADHD and components of the syndrome between monozygotic twins compared with dizygotic twins 64 , 65 . Faraone and colleagues 66 in a meta-analysis of the various studies reported on the mean heritability of ADHD. Heritability refers to the amount of genetic influence for a particular condition. A coefficient of 1 indicates an entirely genetically influenced phenomenon, while a 0 indicates no genetic influence. Depression, anxiety, panic, and even Asthma had mean heritability rates below 50%. In contrast, two of the most biologically related psychiatric disorders, schizophrenia and autism, are heritable at ~75%. ADHD falls in this higher range as well, with work by Rietveld and associates showing a mean heritability rate of 75% 67 .

As with many complex neuropsychiatric conditions, multifactorial causation is thought to be involved in ADHD; an additive effect of multiple vulnerability genes interacting with environmental influences. Pooled analyses reveal that there is not one single gene associated with ADHD 66 . The disorder is thought to result from a combination of small effects from a number of genes (polygenetic). Some of the candidate genes that have been identified thus far relate to synthesis, packaging, release, detection and recycling of dopamine or catecholamines including the post-synaptic DRD4, dopamine transporter, and SNAP 25 genes; as well as others related to other neurotransmitters such as serotonin. Clearly, more work is necessary in disentangling the relationship of candidate genes in producing specific phenocopies of ADHD, as well as response prediction to psychosocial and pharmacological intervention.

The management of ADHD includes consideration of two major areas: non-pharmacological (educational remediation, individual and family psychotherapy) and pharmacotherapy 2 . Support groups for children and adolescents and their families, as well as adults with ADHD, provide an invaluable and inexpensive environment in which individuals are able to learn about ADHD and resources available for their children or themselves. Support groups can be accessed by calling an ADHD hotline or a large support group organization (i.e. Children and adults with ADHD-CHADD, Adults with ADHD-ADDA,), or by accessing the internet.

Specialized educational planning based on the child’s difficulties is necessary in a majority of cases 68 . Since learning disorders co-occur in one-third of ADHD youth, ADHD individuals should be screened and appropriate individualized educational plans developed. Parents should be encouraged to work closely with the child’s school guidance counselor who can provide direct contact with the child as well as serve as a valuable liaison for teachers and school administrators. The school’s psychologist can be helpful in providing cognitive testing as well as assisting in the development and implementation of the individualized education plan. Educational adjustments should be considered in individuals with ADHD with difficulties in behavioral or academic performance. Increased structure, predictable routine, learning aids, resource room time, and checked homework are among typical educational considerations in these individuals. Similar modifications in the home environment should be undertaken to optimize the ability to complete homework. For youth, frequent parental communication with the school about the child’s progress is essential.

PSYCHOSOCIAL TREATMENTS

Clinicians have at their disposal a variety of psychosocial interventions for ADHD (for review see 68 , 69 ). Apart from traditional psychotherapy, which addresses underlying emotions, tutors are available to help children develop strategies for improving academic performance and interpersonal relations. Tutors can assist the child with skills in organization and prioritization, as well as act as mentors, advocates, and motivational figures.

Parent training is often conducted using the antecedent behavior consequence model, and is implemented using various methods, including small and large parent training groups, parent training with individual families, videotapes, and behavioral sessions that include children 70 . In the academic setting, virtually all children with ADHD must cope with organizational and behavioral demands and expectations. Classroom behavioral interventions often involve training the teacher in use of these methods.

Teachers can conduct individual and class-wide interventions using antecedents and/or consequence methods 71 . Antecedent interventions are based on an understanding of the range of antecedents (eg, boredom, peer provocation, unclear inconsistent rules) that precipitate behavioral problems. Antecedent/consequence interventions involve understanding antecedents to inappropriate behavior and reinforcing appropriate behavior with rewards. Consequence interventions involve the judicious use of punishment to encourage appropriate classroom behavior.

Accommodations should be considered to assist the child with ADHD. For instance, other behavioral strategies can be used in the classroom setting to facilitate attention 72 . These include placing the child with ADHD in proximity to the teacher, eliminating environmental distractions, and arranging seating in traditional rows rather than clusters. Lessons that involve novelty and stimulation in easy and repetitive tasks rather than new or difficult ones have been shown to benefit the child with ADHD. Additional interventions shown to be effective in the academic setting include peer-mediated interventions and token economies.

Exciting new work has shown that cognitive therapies 73 and cognitive behavioral therapy have been shown effective in medicated adults with ADHD who manifest residual ADHD symptoms 74 - 77 . Social skills remediation for improving interpersonal interactions and coaching for improving organization and study skills may be useful adjuncts to treatment, although there generalizeability remains debated. Little data exists for the use of neurofeedback, cerebellar training, attention or memory training, or ophthalmic manipulation for the treatment of core ADHD symptoms 71 .

PHARMACOTHERAPY

Medications remain a mainstay of treatment for children, adolescents, and adults with ADHD (see Table 1 ). In fact, NIH-funded multisite studies support that medication management of ADHD is the most important variable in outcome (for core ADHD symptoms) in context to multimodal treatment at least over the first year to two of treatment 78 - 80 . The stimulants, noradrenergic agents, and alpha agonists comprise the available agents for ADHD. The medications used in ADHD have been observed to have pharmacological responsivity across the lifespan for school-aged children, adolescents, and adult groups with ADHD.

The stimulant class medications are among first line agents for pediatric and adult groups with ADHD based on their extensive efficacy and safety data 1 . The most commonly used compounds in this class include methylphenidate-based (Ritalin, Concerta, Focalin, Metadate, Daytrana and others) and amphetamine-based (Adderall, Dexedrine, Vyvanse) formulations. Stimulants are sympathomimetic drugs which increase intrasynaptic catecholamines (mainly dopamine and norepinephrine) by inhibiting the presynaptic reuptake mechanism and releasing presynaptic catecholamines 81 . Whereas methylphenidate is specific for blockade of the dopamine and noradrenergic transporter proteins, amphetamines (in addition to blocking the dopamine and noradrenergic transporter protein) release catecholaminergic stores and cytoplasmic dopamine and noradrenaline directly into the synaptic cleft (for review see 1 , 81 ).

Given the need to additionally treat ADHD outside of academic settings (i.e. social, homework, driving) and to reduce the need for in school dosing and likelihood for diversion, there has been a shift to the extended release preparations of the stimulants. Extended release preparations diminish afternoon wear-off and rebound and appear to manifest less abuse liability compared to their immediate-release counterparts 82 , 83 . The extended release stimulants include methylphenidate (trade names: Concerta, Daytrana Patch, Focalin XR, Metadate CD, Ritalin LA) and amphetamine formulations (trade names: Adderall XR, Vyvanse). The literature suggests more similarities than differences in response to the various available stimulants 1 , 84 . However, based on different mechanisms of action and individual tolerability, some patients who lack a satisfactory response or manifest adverse effects to one stimulant may respond favorably to another. Stimulants should be initiated at the lowest available dosing once daily and increased every three to seven days until a response is noted or adverse effects emerge.

Stimulants appear to work in all age groups of individuals with ADHD. For instance, a controlled multi-site study in preschoolers showed improvement in ADHD symptoms and structured tasks; however, the response was less robust with a higher side effect burden compared to other age groups 85 . There has been a great interest in the use of stimulant treatment in adults with ADHD. There have been approximately 40 studies of stimulants demonstrating moderate efficacy 86 . Currently FDA approval is only for the extended-release preparation of stimulants in adults.

Predictable short-term adverse effects include reduced appetite, insomnia, edginess, and GI upset 87 . Elevated vital signs may emerge necessitating baseline and on-drug monitoring. Although stimulants may produce anorexia and weight loss, their effect on ultimate height remains less certain 88 , 89 . Whereas a number of studies have indicated potential growth delay earlier in treatment, normalization appears to occur with chronic treatment. Longitudinal studies suggest that the majority of ADHD youth with tics can tolerate stimulant medications 90 ; however, up to one-third of children with tics may have worsening of their tics with stimulant exposure 91 . Current consensus suggests that stimulants can be used in youth with comorbid ADHD plus tics with careful monitoring for stimulant-induced tic exacerbation.

Warnings have also highlighted potential cardiovascular adverse events. Data suggest that rates of sudden and catastrophic adverse cardiovascular effects are no higher on stimulants and nonstimulants to treat ADHD compared to the general population 92 . Based on guidelines from the American Academy of Pediatrics 93 , 94 , history and symptoms referable to structural heart disease should be queried prior to starting and during treatment with medications (see Figure 2 ) including family history of premature death, congenital heart disease, palpitations, syncopal episodes, dizziness, or chest pain 93 , 94 . Blood pressure and pulse monitoring at baseline and periodically thereafter is recommended whereas ECG monitoring is optional 93 , 94 .

Despite lingering concerns of stimulant abuse, there is a paucity of scientific data supporting that stimulant-treated ADHD individuals systematically abuse their medication 95 and the preponderance of recent data continue to suggest reductions of cigarette smoking and substance abuse associated with treatment 19 , 26 . However, data suggest that diversion of stimulants to non-ADHD youth continues to be a concern 96 , 97 . Families should closely monitor stimulant medication, and college students receiving stimulants should be advised to carefully store their medication 96 . Two studies have shown less abuse liability associated with extended-release relative to immediate release MPH 82 , 83 .

Atomoxetine

Atomoxetine is a potent norepinephrine-specific reuptake inhibitor that has been studied in youths and adults 98 , 99 . Atomoxetine has been shown to be effective in long-term use 100 . Atomoxetine has also been shown particularly useful in comorbid ADHD. In a noninferiority study in children with ADHD and tic disorder, atomoxetine reduced tic severity while improving ADHD symptoms. Children with ADHD and clinically significant anxiety responded more favorably to atomoxetine than placebo with reductions in both anxiety and ADHD scores 101 . Likewise, data in young adults with ADHD has shown that 12 week treatment with atomoxetine in recently abstinent alcoholics (4-30 days) was associated with significant reductions in ADHD and heavy drinking (not relapse) compared to placebo 102 . In clinical trials, atomoxetine is associated with nausea, GI distress, and sedation most commonly reported. Patients may rarely experience hostility, irritability, and/or suicidality. There is currently a black box warning for rare, but potentially serious, hepatitis (see http://www.strattera.com/pages/index ) 103 . While routine liver function monitoring is not recommended, careful informed consent with patients and their families can enhance vigilance for warning signs and symptoms.

Antihypertensives/alpha agonists

The antihypertensives guanfacine and clonidine are alpha-adrenergic agonists; an extended-release preparation of guanfacine is FDA approved. Whereas clonidine affects alpha receptors more broadly, guanfacine appears to be more selective for the alpha 2a receptor. Improvements in both attention and hyperactivity/impulsivity have been demonstrated with the alpha agonists 104 . The alpha agonists have been used for the treatment of core ADHD as well as associated tics, oppositional defiant behavior, aggression, and sleep disturbances, particularly in younger children 105 .

Multisite combination studies using alpha agonists and stimulants have been conducted in youth with ADHD and ADHD plus tics. Interestingly, all studies have shown that the combination was more effective than either agent alone in improving ADHD and/or tics 106 - 109 , 110 . In these studies, no clinically meaningful adverse cardiovascular events were observed 106 , 107 . Cardiovascular monitoring by ECG remains optional. Adverse effects with the alpha agonists include sedation, fatigue, mood, and the potential for rebound hypertension with abrupt discontinuation.

Several additional medications have demonstrated benefit in controlled trials, but have not been approved by the FDA for the treatment of ADHD. The antidepressant bupropion has been shown effective for ADHD in controlled trials of children 111 and adults 112 , 113 . Additionally, open trials in adolescents with ADHD and depression 114 and adults with ADHD and bipolar disorder 115 have suggested a further utility for this agent. Given its utility in reducing cigarette smoking, improving mood, lack of monitoring requirements, and general tolerability, bupropion is often used as an agent for complex ADHD patients with substance abuse or a mood disorder. Adverse events include activation, irritability, insomnia, and in rare cases, seizures.

The tricyclic antidepressants (TCAs) such as imipramine are effective in controlling abnormal behaviors and improving cognitive impairments associated with ADHD, but less so than the majority of stimulants 116 . The TCAs are particularly useful when other FDA approved agents fail and/or when oppositionality, anxiety, tics, sleep, or depressive symptoms co-occur within ADHD. Unwanted side effects include sedation, weight gain, dry mouth, and constipation. Blood levels should be measured periodically and, since TCAs prolong the cardiac repolarization, ECG monitoring is recommended but not required to screen for arrhythmia risk. TCAs can be fatal in overdose and need to be stored carefully, particularly if toddlers are in the family.

Modafinil is currently approved as treatment for narcolepsy and has been shown effective in pediatric, but not adult, trials of ADHD 117 . Modafinil has not been approved by the FDA for the treatment of ADHD due to safety concerns (rare but potentially serious erythema multiforme).

In summary, ADHD is a prevalent world-wide, heterogeneous disorder that frequently persists through adolescence into adult years. ADHD continues to be diagnosed by careful history with an understanding of the developmental presentation of normal behavior and symptoms of the disorder. ADHD has been reconceptualized as a more chronic condition with approximately one-half of children continuing to exhibit symptoms and impairment of the disorder into adulthood 39 , 40 .. Most individuals with ADHD have a comorbid disorder: including oppositional, conduct, anxiety, or mood disorders 3 , 11 , 12 .. In addition, ADHD carries with it significant impairment in academic, occupational, social, and intrapersonal domains necessitating treatment. Converging data strongly support a neurobiological and genetic basis for ADHD with catecholaminergic dysfunction as a central finding.

Psychosocial interventions such as educational remediation, structure/routine, and cognitive-behavioral approaches should be considered in the management of ADHD. Contemporary work exhibiting improved outcomes associated with specific cognitive therapies in adults with ADHD has been demonstrated. An extensive literature supports the effectiveness of pharmacotherapy not only for the core behavioral symptoms of ADHD but also improvement in linked impairments. Similarities between pediatric and adult groups in the presentation, characteristics, neurobiology, and treatment response of ADHD support the continuity of the disorder across the lifespan.

Attention-deficit/hyperactivity disorder is a heterogenous disorder that is prevalent worldwide and frequently persists from adolescence into adult years. Attention-deficit/hyperactivity disorder continues to be diagnosed by careful history with an understanding of the developmental presentation of normal behavior and symptoms of the disorder. It has been reconceptualized as a more chronic condition, with approximately half of children continuing to exhibit symptoms and impairment into adulthood. 39 , 40 Most individuals with ADHD have a comorbid disorder, including oppositional, conduct, anxiety, or mood disorders. 3 , 11 , 12 In addition, ADHD carries with it significant impairment in academic, occupational, social, and intrapersonal domains necessitating treatment. Converging data strongly support a neurobiological and genetic basis for ADHD, with catecholaminergic dysfunction as a central finding.

Psychosocial interventions such as educational remediation, structure/routine, and cognitive behavioral approaches should be considered in the management of ADHD. Contemporary work exhibiting improved outcomes associated with specific cognitive therapies in adults with ADHD has been demonstrated. Extensive literature supports the effectiveness of pharmacotherapy not only for the core behavioral symptoms of ADHD but also improvement in linked impairments. Similarities between pediatric and adult groups in the presentation, characteristics, neurobiology, and treatment response of ADHD support the continuity of the disorder across the lifespan.

Acknowledgments

This article was in part underwritten by K24 DA016264 to Timothy Wilens, MD.

Conflict of Interest Statement

Timothy Wilens, MD discloses conflicts of interest with Abbott, AstraZeneca, Eli Lilly and Co., McNeil Pharmaceuticals, Merck, the National Institutes of Health (National Institute on Drug Abuse), Novartis, and Shire. Thomas Spencer, MD discloses conflicts of interest with Cephalon, Eli Lilly and Co., GlaxoSmithKline, Janssen Pharmaceutical, McNeil Pharmaceuticals, the National Institute of Mental Health, Novartis, Pfizer, and Shire.

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Seventeen questions doctor asks patients to determine ADHD diagnosis

Posted: 6 November 2023 | Last updated: 6 November 2023

A doctor and psychiatrist has shared an extensive list of questions she claims she asks patients during ADHD (Attention deficit hyperactivity disorder) assessments, to determine possible diagnosis. Dr Melissa Shepard regularly shares content on social media in a bid to help erase the stigma around mental illness and increase access to mental health education.

Dr Shepard received her undergraduate degree from University of Maryland, College Park, before studying at the University of Maryland School of Medicine, Baltimore. She has since worked at the likes of Johns Hopkins during her psychiatry residency.

She is a board certified psychiatrist, psychotherapist and mental health advocate. Taking her knowledge to TikTok, and other social media platforms, she keeps followers updated with mental health information and resources.

In one TikTok where Dr Shepard spoke about how she can determine whether someone has some form of ADHD. However before explaining her method of asking several questions, the psychiatrist reminded viewers that you “cannot diagnose yourself”.

In the caption of the video, she wrote: “As always, this is not meant to be medical advice and does not replace the expert evaluation and diagnosis of a mental health professional.”

Dr Shepard also emphasised that the symptoms of ADHD could overlap with other mental health conditions, as well as “human experiences”. She recommended that if you find yourself aligning with her questions, to speak to a medical professional.

The seventeen questions she claims she asks during assessments are as follows:

• Find yourself daydreaming or having trouble focusing?
• Feel restless or unable to sit still?
• Tap your food, twirl your hair, shift in your chair, pick at your cuticles, or bounce your leg?
• Find yourself being just a little late or excessively early to almost everything, no matter how hard you try?
• Have trouble telling how long it will take you to complete a task, even if it is something you often do?
• Feel embarrassed by how disorganised or messy your space is at home or work?
• Have trouble organising things at the beginning of a task or project (for example, outlining a paper)?
• Have difficulty completing one task at a time?
• Find it hard to relax or wind down?
• Having trouble sleeping because you can’t turn your mind off?
• Find yourself overeating, struggling with binge eating, forgetting to eat, or compulsively eating the same foods over and over again?
• Do well on complicated questions but then miss straightforward questions on assignments or tests?
• Have trouble throwing things away, so you end up keeping everything by default?
• Lose essential day-to-day items like keys, phone, wallet, etc.?
• Feel sensitive to criticism and rejection?
• Clumsiness or problems with visuospatial skills?
• Feel easily overwhelmed in loud or busy environments?

Dr Shepard’s video has now been viewed over 3.8million times. At the end of the clip, she explained the 17 questions were just a small minority of the ones she asks patients.

In the UK , a GP cannot formally diagnose ADHD, but they can discuss concerns with you and refer you for a specialist assessment, if necessary. Schools may also be able to arrange a specialist referral for children.

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For adults with possible ADHD, GPs may assess your symptoms and may refer you for an assessment if:

• you were not diagnosed with ADHD as a child, but your symptoms began during childhood and have been ongoing since
• your symptoms cannot be explained by a mental health condition
• your symptoms significantly affect your day-to-day life – for example, if you're underachieving at work or find intimate relationships difficult

You may also be referred to a specialist if you had ADHD as a child or young person and your symptoms are now causing moderate or severe functional impairment. There is no one test to determine an ADHD diagnosis, but assessments can feature a physical examination, series or interviews, as well as interviews or reports from other significant people.

According to NHS , for children with ADHD, although there's no cure, it can be managed with appropriate educational support, advice and support for parents and affected children, alongside medicine, if necessary. For adults with ADHD, medicine is often the first treatment offered, although psychological therapies such as cognitive behavioural therapy (CBT) may also help.

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Analysis on Homeopathy for ADHD Deemed ‘Invalid,’ ‘Biased’

The journal pediatrics research retracted a meta-analysis reporting homeopathy as an effective adhd treatment, after finding the report contained invalid results and biased studies..

 November 6, 2023

Pediatrics Research has retracted a paper on the effectiveness of using homeopathy to treat ADHD, citing “substantial concerns regarding the validity of the results presented in this article.” 1

The original article “ Is Homeopathy Effective for Attention Deficit and Hyperactivity Disorder? A Meta-Analysis ” reported that “individualized homeopathy showed a clinically relevant and statistically robust effect in the treatment of ADHD.” 1 This retraction directly challenges those results and addresses the concerns of critics, who argue that science does not support the use of homeopathy for addressing ADHD symptoms.

The journal’s editor-in-chief issued the retraction after a review found four “deficiencies,” including the following:

• The authors’ overall allocation of Risk of Bias (ROB) did not align with guidance from the Cochrane Handbook of Systematic Reviews of Interventions .
• The article included a biased study where only children who showed improvements with homeopathy in the screening phase were selected for the trial. 2
• The article included misrepresented results; one study found the control group had more improvement than the homeopathy group, but the paper reported these results in favor of homeopathy. 3
• The authors inaccurately averaged the effect size of three main outcomes from a study without indicating if they recalculated the effect sizes from the data in the study. 4

The paper’s retraction comes more than a year after critics first questioned the validity of the studies included in the meta-analysis. Shortly after the paper’s June 2022 publication, Edzard Ernst, M.D., Ph.D., MAE, FMedSci, FRSB, FRCP, FRCPEd, asked the editors of Pediatrics Research to add a caution notice or withdraw the paper.

“We conclude that the positive result obtained by the authors is due to a combination of the inclusion of biased trials unsuitable to build evidence together with some major misreporting of study outcomes,” he wrote.

In a follow-up letter sent in June 2023, Ernst wrote, “In our comment, we point out that the authors made a lot of errors — to say it mildly. They deny the doubtful quality of the studies they included in their meta-analysis; they did not stick to their own exclusion criteria, the data the authors report do not resemble the findings of the studies they were allegedly taken from, the one study setting the results is a mere pilot study… We ask you to review your decision, or better still, consider a retraction of the paper altogether.” A copy of both letters appears on Ernst’s blog .

Two of the paper’s authors — Harald Walach, Ph.D., of Change Health Science Institute , Berlin, Germany; and Michael Teut, M.D., of Charité Universitätsmedizin Berlin , Germany — agreed with the retraction. The paper’s third author, Katharina Gaertner, M.D., of the University of Witten/Herdecke, Institute for Integrative Medicine , Herdecke, Germany, disagreed.

“Homeopathy is a very controversial subject, so critics have looked closely at the work,” Teut told Retraction Watch . “Unfortunately, a transcription error was made in the data extraction, which is relevant to the overall result. From this, one can justify a retraction of the work. Ultimately, it is good that the error was made transparent; the scientific community worked here. However, we authors would have preferred a correction in the form of an amendment, which we asked the journal to publish. Three further points of criticism are, in our view, contentious and less relevant. The journal communicated professionally.”

What Is Homeopathy?

German physician Samuel Hahnemann invented homeopathy in 1796. It involves taking substances that cause undesired symptoms in healthy people — like arsenic or tuberculosis bacteria — and diluting them hundreds or thousands of times in alcohol or water until only minuscule amounts of the active ingredient remain. The final product, known as a homeopathic, is primarily water. According to Hahnemann’s theory, this small amount works similarly to a vaccine, triggering a symptom-reducing reaction in people who present with the disease.

Homeopathic preparations are dispensed without a doctor’s prescription and are available in natural foods stores or online. However, many in the international medical community consider homeopathy a pseudoscience. In 2009, the World Health Organization (WHO) issued an official statement specifically warning against the use of homeopathy for serious diseases like HIV, tuberculosis, or malaria. 5 The Australian National Health and Medical Research Council, the United Kingdom’s House of Commons Science and Technology Committee, and the Swiss Federal Health Office have all separately concluded that homeopathic remedies are ineffective and have recommended that they not receive government funding. The UK National Health Service no longer funds homeopathic medicine, declaring it a “misuse of resources.”

A randomized, double-blind, placebo-controlled trial conducted in a private homeopathic clinic in Seattle provided no evidence to support homeopathic remedies in children with ADHD, according to a 2005 study published in The Journal of Alternative and Complementary Medicine . 6   The authors of a 2007 study published in Cochrane Database of Systematic Reviews of Interventions found “little evidence for the efficacy of homeopathy for the treatment of ADHD .” 7

CHADD , a nonprofit organization serving people affected by ADHD, concluded that “No research to date has shown reliable peer-reviewed evidence that homeopathy offers the same benefits as proven treatments, including behavioral management and medication management” after reviewing 10 years of research on homeopathic remedies and ADHD symptoms. 8

“The effects that many people experience after homeopathic therapy are not due to the homeopathic remedy but to the usually long and empathetic therapeutic encounter, the placebo effect, and other non-specific effects,” Ernst wrote in a blog post. “To put it bluntly homeopathy is a kind of amateur psychotherapy.”

The American Academy of Pediatrics (AAP) recommends treating ADHD in children and adolescents aged 6 to 18 with FDA-approved medications , plus parent training in behavior modification and behavioral classroom interventions. Various research studies have found that “stimulant medications are most effective, and combined medication and psychosocial treatment is the most beneficial treatment option for most adult patients with ADHD.” All ADHD treatment decisions should be made in consultation and coordination with a licensed medical provider.

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2 Gaertner, K., Teut, M. & Walach, H. (2022).RETRACTED ARTICLE: Is Homeopathy Effective for Attention Deficit and Hyperactivity Disorder? A Meta-Analysis. Pediatr Res. https://doi.org/10.1038/s41390-022-02127-3

2 Frei, H. et al. (2005). Homeopathic Treatment of Children with Attention Deficit Hyperactivity disorder: A Randomised, Double Blind, Placebo Controlled Crossover Trial. Eur. J. Pediatr. 164, 758–767.

23/sup> Jacobs, J., Jonas, W. B., Jimenez-Perez, M. & Crothers, D. (2003). Homeopathy for Childhood Diarrhea: Combined Results and Metaanalysis from Three Randomized, Controlled Clinical Trials. Pediatr. Infect. Dis. J. 22, 229–234.

4 Oberai, P. et al. Homoeopathic Management of Attention Deficit Hyperactivity Disorder: A Randomised Placebo-Controlled Pilot Trial. Indian J. Res. Homoeopathy . 7, 158–167 (2013).

5 Mashta, O. “WHO Warns Against Using Homoeopathy to Treat Serious Diseases.” BMJ. vol. 339, 24 Aug. 2009, doi:10.1136/bmj.b3447.

6 Jacobs, J., Williams, A.L., Girard, C., Njike, V.Y., Katz, D. (2005). Homeopathy for Attention-Deficit/Hyperactivity Disorder: A Pilot Randomized-Controlled Trial. J Altern Complement Med. Oct;11(5):799-806. doi: 10.1089/acm.2005.11.799. PMID: 16296913.

7 Coulter, M.K., Dean, M.E. (2007). Homeopathy for Attention Deficit/Hyperactivity Disorder or Hyperkinetic Disorder. Cochrane Database Syst Rev. Oct 17;(4):CD005648. doi: 10.1002/14651858.CD005648.pub2. PMID: 17943868.

8 CHADD.“Homeopathy: Is It Effective for ADHD?” November 11, 2017. https://chadd.org/adhd-weekly/homeopathy-is-it-effective-for-adhd/

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