adhd essay introduction

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2191 mowry ave. #600c, fremont ca 94538, mon-fri: 8:45 am – 5pm, sat/sun/holiday: call at 8 am for appointment, an introduction to attention deficit hyperactivity disorder (adhd).

Almost all children have times when their behavior veers out of control. They may speed about in constant motion, make noise nonstop, refuse to wait their turn, and crash into everything around them. At other times they may drift as if in a daydream, failing to pay attention or finish what they start.

However, for some children, these kinds of behaviors are more than an occasional problem. Children with attention-deficit/hyperactivity disorder (ADHD) have behavior problems that are so frequent and/or severe that they interfere with their ability to live normal lives. These children often have trouble getting along with siblings and other children at school, at home, and in other settings. Those who have trouble paying attention usually have trouble learning. Some have an impulsive nature and this may put them in actual physical danger. Because children with ADHD have difficulty controlling their behavior, they may be labeled as “bad kids” or “space cadets.” Left untreated, more severe forms of ADHD can lead to serious, lifelong problems such as poor grades in school, run-ins with the law, failed relationships, substance abuse and the inability to keep a job.

What is ADHD?

ADHD is a condition of the brain that makes it difficult for children to control their behavior. It is one of the most common chronic conditions of childhood. It affects 4% to 12% of school-aged children. About 3 times more boys than girls are diagnosed with ADHD.

What are the symptoms of ADHD?

ADHD includes 3 behavior symptoms: inattention, hyperactivity, and impulsivity. A child with inattention symptoms may have the following behaviors:

• Has a hard time paying attention, daydreams
• Does not seem to listen
• Is easily distracted from work or play
• Does not seem to care about details, makes careless mistakes
• Does not follow through on instructions or finish tasks
• Is disorganized
• Loses a lot of important things
• Forgets things
• Does not want to do things that require ongoing mental effort

A child with hyperactivity symptoms may have the following behaviors:

• Is in constant motion, as if “driven by a motor”
• Cannot stay seated
• Squirms and fidgets
• Talks too much
• Runs, jumps, and climbs when this is not permitted
• Cannot play quietly (video games do not count)

A child with impulsivity symptoms may have the following behaviors:

• Acts and speaks without thinking
• May run into the street without looking for traffic first
• Has trouble taking turns
• Cannot wait for things
• Calls out answers before the question is complete
• Interrupts others

What is the difference between ADD vs. ADHD?

ADD stands for Attention Deficit Disorder. This is an old term that is now officially called Attention Deficit Hyperactivity Disorder, Inattentive Type. More on this will discussed below.

Are there different types of ADHD?

Children with ADHD may have one or more of the 3 main symptoms categories listed above. The symptoms usually are classified as the following types of ADHD:

• Inattentive type (formerly known as attention-deficit disorder [ADD])—Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is most common.
• Hyperactive/Impulsive type—Children with this type of ADHD show both hyperactive and impulsive behavior, but can pay attention.
• Combined Inattentive/Hyperactive/Impulsive type—Children with this type of ADHD show all 3 symptoms. This is the most common type of ADHD.

How can I tell if my child has ADHD?

Remember, it is normal for all children to show some of these symptoms from time to time. Your child may be reacting to stress at school or home. She may be bored or going through a difficult stage of life. It does not mean he or she has ADHD. Sometimes a teacher is the first to notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to the parents’ attention. Sometimes questions from your pediatrician can raise the issue. Parents also may have concerns such as behavior problems at school, poor grades, difficulty finishing homework and so on. If your child is 6 years of age or older and has shown symptoms of ADHD on a regular basis for more than 6 months, discuss this with your pediatrician.

What causes ADHD?

ADHD is one of the most studied conditions of childhood but the cause of ADHD is still not clear at this time. The most popular current theory of ADHD is that ADHD represents a disorder of “executive function.” This implies dysfunction in the prefrontal lobes so that the child lacks the ability for behavioral inhibition or self-regulation of such executive functions as nonverbal working memory, speech internalization, affect, emotion, motivation, and arousal. It is believed that children with ADHD lack the right balance of neurotransmitters, which are specific chemicals in their brains, that help them to focus and inhibit impulses.

Research to date has shown the following:

• ADHD is a biological disorder, not just “bad behavior.” In a child with ADHD, the brain’s ability to properly use important chemical messengers (neurotransmitters) is impaired.
• A lower level of activity in the parts of the brain that control attention and activity level may be associated with ADHD.
• ADHD appears to run in families. Sometimes a parent is diagnosed with ADHD at the same time as the child.
• Environmental toxins can play a role in the development of ADHD, but that is extremely rare.
• Very severe head injuries may cause ADHD in rare cases.

There is no significant evidence that ADHD is caused by the following:

• Eating too much sugar
• Food additives
• Immunizations

Your pediatrician will determine whether your child has ADHD using standard guidelines developed by the American Academy of Pediatrics. Unfortunately, there is no single test that can tell whether your child has ADHD. The diagnosis process requires several steps and involves gathering a lot of information from multiple sources. You, your child, your child’s school, and other caregivers should be involved in assessing your child’s behavior.

Generally, if your child has ADHD:

• Some symptoms will occur in more than one setting, such as home, school, and social events
• The symptoms significantly impair your child’s ability to function in some of the activities of daily life, such as schoolwork and relationships with family and friends
• They will start before your child reaches 7 years of age
• They will continue for more than six months
• They will make it difficult for your child to function at school, at home, and/or in social settings

In addition to looking at your child’s behavior, your pediatrician will do a physical examination. A full medical history will be needed to put your child’s behavior in context and screen for other conditions that may affect your child’s behavior.

One of the challenges in diagnosing ADHD is that many disorders can look a lot like ADHD – including depression, anxiety, visual and hearing difficulties, seizures, learning disorders and even improper sleep quality. These conditions can show the same type of symptoms as ADHD. For example if your child has sleep apnea, a condition that involves disordered breathing during sleep, he may show signs of inattention and inability to focus that can sometimes be similar to a child with ADHD. Another example is a child that may have a learning disability. He/she may not pay attention in class due to inability to process that information and therefore be labeled with “inattention”. The same child may also be frustrated because he can’t process the material being taught in the classroom and therefore disturbs the classroom and acts as if he/she is “hyperactive.” In the case of this child with a learning disability, all the effort needs to be focused on the actual underlying problem, which again is the learning disability, and not on immediately trying to treat ADHD. Similarly, in our child with sleep apnea, parents need to address the sleeping problem first and not rush to place their child on medication for ADHD. As you will read below, it is possible to have ADHD with other conditions, so children who do have sleep apnea or learning disabilities MAY ALSO have ADHD and may eventually require treatment for both conditions.

The diagnosis of ADHD takes time, and the evaluation process usually takes at least 2-3 visits before the diagnosis can be made. Occasionally the process can take longer if referrals to psychologists or psychiatrists are warranted. Blood tests may or may not be indicated, and this will be discussed during your visit.

Coexisting conditions

• Oppositional defiant disorder or conduct disorder —Up to 35% of children with ADHD also have oppositional defiant disorder or conduct disorder. Children with oppositional defiant disorder tend to lose their temper easily and annoy people on purpose and are defiant and hostile toward authority figures. Children with conduct disorder break rules, destroy property, and violate the rights of other people. Children with coexisting conduct disorder are at much higher risk for getting into trouble with the law than children who have only ADHD. Studies show that this type of coexisting condition is more common among children with the primarily hyperactive/impulsive and combination types of ADHD. Your pediatrician may recommend counseling for your child if she has this condition.
• Mood disorders/depression —About 18% of children with ADHD also have mood disorders such as depression. There is frequently a family history of these types of disorders. Coexisting mood disorders may put children at higher risk for suicide, especially during the teenage years. These disorders are more common among children with inattentive and combined types of ADHD. Children with mood disorders or depression often require a different type of medication than those normally used to treat ADHD.
• Anxiety disorders —These affect about 25% of children with ADHD. Children with anxiety disorders have extreme feelings of fear, worry, or panic that make it difficult to function. These disorders can produce physical symptoms such as racing pulse, sweating, diarrhea, and nausea. Counseling and/or medication may be needed to treat these coexisting conditions.
• Learning disabilities —Learning disabilities are conditions that make it difficult for a child to master specific skills such as reading or math. ADHD is not a learning disability. However, ADHD can make it hard for a child to do well in school. Diagnosing learning disabilities requires evaluations such as IQ and academic achievement tests.
• Target outcomes for behavior
• Follow-up activities
• Education about ADHD
• Team work among doctors, parents, teachers, caregivers, other healthcare professionals, and the child

Behavior therapy

• Parent training
• Individual and family counseling

Treatment for ADHD uses the same principles that are used to treat other chronic conditions like asthma or diabetes. Long-term planning is needed because these conditions continue or recur for a long time. Families must manage them on an ongoing basis. In the case of ADHD, schools and other caregivers must also be involved in managing the condition. Educating the people involved with your child about ADHD is a key part of treating your child. As a parent, you will need to learn about ADHD. Read about the condition and talk to people who understand it. This will help you manage the ways ADHD affects your child and your family on a day-to-day basis. It will also help your child learn to help himself.

For most children, stimulant medications are a safe and effective way to relieve ADHD symptoms. As glasses help people focus their eyes to see, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their behavior. Stimulants may be used alone or combined with behavior therapy. Studies show that about 80% of children with ADHD who are treated with stimulants improve a great deal.

Different types of stimulants are available, in both short-acting (immediate-release) and long-acting forms. Short- acting forms usually are taken every 4 hours when the medication is needed. Long-acting medications usually are taken once in the morning. Children who use long-acting forms of stimulants can avoid taking medication at school or after school.

It may take some time to find the best medication, dosage, and schedule for your child. Your child may need to try different types of stimulants. Some children respond to one type of stimulant but not another. The amount of medication (dosage) that your child needs also may need to be adjusted. Realize that the dosage of the medicine is not based solely on your child weight. Our goal is for your child to be on the dose that is helping her to maximize her potential with the least amount of side effects.

The medication schedule also may be adjusted depending on the target outcome. For example, if the goal is to get relief from symptoms at school, your child may take the medication only on school days and none during weekends, summer time, and vacations if desired. Your child will have close follow up initially and once the optimal medication and dosage is found she will be seen every 2-3 months to monitor progress and possible side effects.

What side effects can stimulants cause?

Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived. The most common side effects include the following:

Decreased appetite/weight loss.

• Sleep problems
• Stomachaches

Some less common side effects include the following:

• Jitteriness
• Social withdrawal
• Rebound effect (increased activity or a bad mood as the medication wears off)
• Transient tics

Very rare side effects include the following:

• Increase in blood pressure or heart rate
• Growth delay

Most side effects can be relieved using one of the following strategies:

• Changing the medication dosage
• Adjusting the schedule of medication
• Using a different stimulant

There are many forms of behavior therapy, but all have a common goal— to change the child’s physical and social environments to help the child improve his behavior. Under this approach, parents, teachers, and other caregivers learn better ways to work with and relate to the child with ADHD. You will learn how to set and enforce rules, help your child understand what he needs to do, use discipline effectively, and encourage good behavior. Your child will learn better ways to control his behavior as a result.

Behavior therapy has 3 basic principles:

• Set specific goals. Set clear goals for your child such as staying focused on homework for a certain time or sharing toys with friends.
• Provide rewards and consequences. Give your child a specified reward (positive reinforcement) when she shows the desired behavior. Give your child a consequence (unwanted result or punishment) when she fails to meet a goal.
• Keep using the rewards and consequences. Using the rewards and consequences consistently for a long time will shape your child’s behavior in a positive way.

Behavior therapy recognizes the limits that having ADHD puts on a child. It focuses on how the important people and places in the child’s life can adapt to encourage good behavior and discourage unwanted behavior. It is different from play therapy or other therapies that focus mainly on the child and his emotions. Specific behavior therapy techniques that can be effective with children with ADHD include:

• Positive reinforcement: Parents provide rewards or privileges in response to desired behavior. For example, your child completes an assignment and he is permitted to play on the computer.
• Time-out: one removes access to desired activity because of unwanted behavior. For example, your child hits a sibling and, as a result, must sit for 5 minutes in the corner of the room.
• Response cost: Parents withdraw rewards or privileges because of unwanted behavior. For example, your child loses free-time privileges for not completing homework.
• Token economy: Combining reward and consequence. The child earns rewards and privileges when performing desired behaviors. He loses the rewards and privileges as a result of unwanted behavior. For example, you child can earn stars for completing assignments and loses stars for getting out of seat. Then, he cashes in the sum of her stars at the end of the week for a prize.

Tips for helping your child control his behavior

• Keep your child on a daily schedule . Try to keep the time that your child wakes up, eats, bathes, leaves for school, and goes to sleep the same each day.
• Cut down on distractions . Loud music, computer games, and television can be over-stimulating to your child. Make it a rule to keep the TV or music off during mealtime and while your child is doing homework. Whenever possible, avoid taking your child to places that may be too stimulating, like busy shopping malls.
• Organize your house . If your child has specific and logical places to keep his schoolwork, toys, and clothes, he is less likely to lose them. Save a spot near the front door for his school backpack so he can grab it on the way out the door.
• Reward positive behavior . Offer kind words, hugs, or small prizes for reaching goals in a timely manner or good behavior. Praise and reward your child’s efforts to pay attention.
• Set small, reachable goals . Aim for slow progress rather than instant results. Be sure that your child understands that he can take small steps toward learning to control himself.
• Help your child stay “on task.” Use charts and checklists to track progress with homework or chores. Keep instructions brief. Offer frequent, friendly reminders.
• Limit choices . Help your child learn to make good decisions by giving your child only 2 or 3 options at a time.
• Find activities at which your child can succeed. All children need to experience success to feel good about themselves and boost their self-confidence.
• Use calm discipline. Use consequences such as time-out, removing the child from the situation, or distraction. Sometimes it is best to simply ignore the behavior. Physical punishment, such as spanking or slapping, is not helpful. Discuss your child’s behavior with him when both of you are calm.

How can I help my child control her behavior?

Taking care of yourself also will help your child. Being the parent of a child with ADHD can be tiring and trying. It can test the limits of even the best parents. Parent training and support groups made up of other families who are dealing with ADHD can be a great source of help. Learn stress-management techniques to help you respond calmly to your child. Seek counseling if you feel overwhelmed or hopeless.

Ask us to help you find parent training, counseling, and support groups in your community. Under the resources section we will leave the link of a few handouts published by the NICHQ (National Initiative for Children’s Healthcare Quality) including:

• How to Establish a School-Home Daily Report Card

Unproven treatments

You may have heard media reports or seen advertisements for “miracle cures” for ADHD. Carefully research any such claims. Consider whether the source of the information is valid. At this time, there is no scientifically proven cure for this condition. The following methods have not been proven to work in scientific studies:

• Optometric vision training (asserts that faulty eye movement and sensitivities cause the behavior problems)
• Megavitamins and mineral supplements
• Anti–motion-sickness medication (to treat the inner ear)
• Treatment for candida yeast infection
• EEG biofeedback (training to increase brain-wave activity)
• Applied kinesiology (realigning bones in the skull)

Always tell your pediatrician about any alternative therapies, supplements, or medications that your child is using. These may interact with prescribed medications and harm your child.

Frequently asked questions

Will my child outgrow adhd.

ADHD continues into adulthood in most cases. However, by developing their strengths, structuring their environments, and using medication when needed, adults with ADHD can lead very productive lives. In some careers, having a high-energy behavior pattern can be an asset.

Are stimulant medications “gateway drugs” leading to illegal drug or alcohol abuse?

People with ADHD are naturally impulsive and tend to take risks. But those with ADHD who are taking stimulants are actually at lower risk of using other drugs. Children and teenagers who have ADHD and also have coexisting conditions may be at high risk for drug and alcohol abuse, regardless of the medication used.

Are children getting high on stimulant medications?

There is no evidence that children are getting high on stimulant drugs used to treat ADHD. These drugs also do not sedate or tranquilize children and have no addictive properties. Stimulants are classified as Schedule II drugs by the US Drug Enforcement Administration. There are recent reports of abuse of this class of medication, especially by college students who trying to obtain an edge during exam times to stay up and study more. 
If your child is on medication, it is always best to supervise the use of the medication closely.

Why do so many children have ADHD?

The number of children who are being treated for ADHD has risen. It is not clear whether more children have ADHD or more children are being diagnosed with ADHD. ADHD is now one of the most common and most studied conditions of childhood. Because of more awareness and better ways of diagnosing and treating this disorder, more children are being helped.

• AAP (American Academy of Pediatrics)
• About Our Kids (from NYU Child Study Center)
• Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

Adapted directly from

• American Academy of Pediatrics
• The Zukerman Parker Handbook of Development and Behavioral Pediatrics for Primary care

How to Tackle an Essay (an ADHD-friendly Guide)

6 steps and tips.

Most of the college students I work with have one major assignment type that gets them stuck like no other: the dreaded essay. It has become associated with late nights, requesting extensions (and extensions on extensions), feelings of failure, and lots of time lost staring at a screen. This becomes immensely more stressful when there is a thesis or capstone project that stands between you and graduation.

The good news?

An essay doesn’t have to be the brick wall of doom that it once was. Here are some strategies to break down that wall and construct an essay you feel good about submitting.

Step 1:  Remember you’re beginning an essay, not finishing one.

Without realizing it, you might be putting pressure on yourself to have polished ideas flow from your brain onto the paper. There’s a reason schools typically bring up having an outline and a rough draft! Thoughts are rarely organized immediately (even with your neurotypical peers, despite what they may say). Expecting yourself to deliver a publishing-worthy award winner on your first go isn’t realistic. It’s allowed to look messy and unorganized in the beginning! There can be unfinished thoughts, and maybe even arguments you aren’t sure if you want to include. When in doubt, write it down.

Step 2: Review the rubric

Make sure you have a clear understanding of what the assignment is asking you to include and to focus on. If you don’t have an understanding of it, it’s better to find out in advance rather than the night before the assignment is due. The rubric is your anchor and serves as a good guide to know “when you can be done.” If you hit all the marks on the rubric, you’re looking at a good grade.

I highly recommend coming back to the rubric multiple times during the creative process, as it can help you get back on track if you’ve veered off in your writing to something unrelated to the prompt. It can serve as a reminder that it’s time to move onto a different topic - if you’ve hit the full marks for one area, it’s better to go work on another section and return to polish the first section up later. Challenge the perfectionism!

Step 3: Divide and conquer

Writing an essay is not just writing an essay. It typically involves reading through materials, finding sources, creating an argument, editing your work, creating citations, etc. These are all separate tasks that ask our brain to do different things. Instead of switching back and forth (which can be exhausting) try clumping similar tasks together.

For example:

Prepping: Picking a topic, finding resources related to topic, creating an outline

Gathering: reading through materials, placing information into the outline

Assembling: expanding on ideas in the outline, creating an introduction and conclusion

Finishing: Make final edits, review for spelling errors and grammar, create a title page and reference page, if needed.

Step 4: Chunk it up

Now we’re going to divide the work EVEN MORE because it’s also not realistic to expect yourself to assemble the paper all in one sitting. (Well, maybe it is realistic if you’re approaching the deadline, but we want to avoid the feelings of panic if we can.) If you haven’t heard of chunking before, it’s breaking down projects into smaller, more approachable tasks.

This serves multiple functions, but the main two we are focusing on here is:

• it can make it easier to start the task;
• it helps you create a timeline for how long it will take you to finish.

If you chunk it into groups and realize you don’t have enough time if you go at that pace, you’ll know how quickly you’ll need to work to accomplish it in time.

Here are some examples of how the above categories could be chunked up for a standard essay. Make sure you customize chunking to your own preferences and assignment criteria!

Days 1 - 3 : Prep work

• ‍ Day 1: Pick a topic & find two resources related to it
• Day 2: Find three more resources related to the topic
• Day 3: Create an outline

Days 4 & 5 : Gather

• ‍ Day 4: Read through Resource 1 & 2 and put information into the outline
• Day 5: Read through Resource 3 & 4 and put information into the outline

Days 6 - 8 : Assemble

• ‍ Day 6: Create full sentences and expand on Idea 1 and 2
• Day 7: Create full sentences and expand on Idea 3 and write an introduction
• Day 8: Read through all ideas and expand further or make sentence transitions smoother if need be. Write the conclusion

Day 9: Finish

• ‍ Day 9: Review work for errors and create a citation page

Hey, we just created an outline about how to make an outline - how meta!

Feel like even that is too overwhelming? Break it down until it feels like you can get started. Of course, you might not have that many days to complete an assignment, but you can do steps or chunks of the day instead (this morning I’ll do x, this afternoon I’ll do y) to accommodate the tighter timeline. For example:

Day 1: Pick a topic

Day 2: Find one resource related to it

Day 3: Find a second resource related to it

Step 5: Efficiently use your resources

There’s nothing worse than stockpiling 30 resources and having 100 pages of notes that can go into an essay. How can you possibly synthesize all of that information with the time given for this class essay? (You can’t.)

Rather than reading “Article A” and pulling all the information you want to use into an “Article A Information Page,” try to be intentional with the information as you go. If you find information that’s relevant to Topic 1 in your paper, put the information there on your outline with (article a) next to it. It doesn’t have to be a full citation, you can do that later, but we don’t want to forget where this information came from; otherwise, that becomes a whole mess.

By putting the information into the outline as you go, you save yourself the step of re-reading all the information you collected and trying to organize it later on.

*Note: If you don’t have topics or arguments created yet, group together similar ideas and you can later sort out which groups you want to move forward with.

Step 6: Do Some Self-Checks

It can be useful to use the Pomodoro method when writing to make sure you’re taking an adequate number of breaks. If you feel like the 25 min work / 5 min break routine breaks you out of your flow, try switching it up to 45 min work / 15 min break. During the breaks, it can be useful to go through some questions to make sure you stay productive:

• How long have I been writing/reading this paragraph?
• Does what I just wrote stay on topic?
• Have I continued the "write now, edit later" mentality to avoid getting stuck while writing the first draft?
• Am I starting to get frustrated or stuck somewhere? Would it benefit me to step away from the paper and give myself time to think rather than forcing it?
• Do I need to pick my energy back up? Should I use this time to get a snack, get some water, stretch it out, or listen to music?

General Tips:

• If you are having a difficult time trying to narrow down a topic, utilize office hours or reach out to your TA/professor to get clarification. Rather than pulling your hair out over what to write about, they might be able to give you some guidance that speeds up the process.
• You can also use (and SHOULD use) office hours for check-ins related to the paper, tell your teacher in advance you’re bringing your rough draft to office hours on Thursday to encourage accountability to get each step done. Not only can you give yourself extra pressure - your teacher can make sure you’re on the right track for the assignment itself.
• For help with citations, there are websites like Easybib.com that can help! Always double check the citation before including it in your paper to make sure the formatting and information is correct.
• If you’re getting stuck at the “actually writing it” phase, using speech-to-text tools can help you start by transcribing your spoken words to paper.
• Many universities have tutoring centers and/or writing centers. If you’re struggling, schedule a time to meet with a tutor. Even if writing itself isn’t tough, having a few tutoring sessions scheduled can help with accountability - knowing you need to have worked on it before the tutoring session is like having mini deadlines. Yay, accountability!

Of course, if writing just isn’t your jam, you may also struggle with motivation . Whatever the challenge is, this semester can be different. Reach out early if you need help - to your professor, a tutor, an ADHD coach , or even a friend or study group. You have a whole team in your corner. You’ve got this, champ!

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Last updated March 22, 2024

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Blog > Common App , Essay Advice , Personal Statement > How to Write a College Essay About ADHD

How to Write a College Essay About ADHD

Admissions officer reviewed by Ben Bousquet, M.Ed Former Vanderbilt University

Written by Ben Bousquet, M.Ed Former Vanderbilt University Admissions

Key Takeaway

ADHD and ADD are becoming more prevalent, more frequently diagnosed, and better understood.

The exact number of college students with ADHD is unclear with estimates ranging wildly from just 2% to 16% or higher.

Regardless of the raw numbers, an ADHD diagnosis feels very personal, and it is not surprising that many students consider writing a college essay about ADHD.

If you are thinking about writing about ADHD, consider these three approaches. From our experience in admissions offices, we’ve found them to be the most successful.

First, a Note on the Additional Information Section

Before we get into the three approaches, I want to note that your Common App personal statement isn’t the only place you can communicate information about your experiences to admissions officers.

You can also use the additional information section.

The additional information section is less formal than your personal statement. It doesn’t have to be in essay format, and what you write there will simply give your admissions officers context. In other words, admissions officers won’t be evaluating what you write in the additional information section in the same way they’ll evaluate your personal statement.

You might opt to put information about your ADHD (or any other health or mental health situations) in the additional information section so that admissions officers are still aware of your experiences but you still have the flexibility to write your personal statement on whatever topic you choose.

Three Ways to Write Your College Essay About ADHD

If you feel like the additional information section isn’t your best bet and you’d prefer to write about ADHD in your personal statement or a supplemental essay, you might find one of the following approaches helpful.

1) Using ADHD to understand your trends in high school and looking optimistically towards college

This approach takes the reader on a journey from struggle and confusion in earlier years, through a diagnosis and the subsequent fallout, to the present with more wisdom and better grades, and then ends on a note about the future and what college will hold.

If you were diagnosed somewhere between 8th and 10th grade, this approach might work well for you. It can help you contextualize a dip in grades at the beginning of high school and emphasize that your upward grade trend is here to stay.

The last part—looking optimistically towards college—is an important component of this approach because you want to signal to admissions officers that you’ve learned to manage the challenges you’ve faced in the past and are excited about the future.

I will warn you: there is a possible downside to this approach. Because it’s a clear way to communicate grade blips in your application, it is one of the most common ways to write a college essay about ADHD. Common doesn’t mean it’s bad or off-limits, but it does mean that your essay will have to work harder to stand out.

2) ADHD as a positive

Many students with ADHD tell us about the benefits of their diagnosis. If you have ADHD, you can probably relate.

Students tend to name strengths like quick, creative problem-solving, compassion and empathy, a vivid imagination, or a keen ability to observe details that others usually miss. Those are all great traits for college (and beyond).

If you identify a strength of your ADHD, your essay could focus less on the journey through the diagnosis and more on what your brain does really well. You can let an admissions officer into your world by leading them through your thought processes or through a particular instance of innovation.

Doing so will reveal to admissions officers something that makes you unique, and you’ll be able to write seamlessly about a core strength that’s important to you. Of course, taking this approach will also help your readers naturally infer why you would do great in college.

3) ADHD helps me empathize with others

Students with ADHD often report feeling more empathetic to others around them. They know what it is like to struggle and can be the first to step up to help others.

If this rings true to you, you might consider taking this approach in your personal statement.

If so, we recommend connecting it to at least one extracurricular or academic achievement to ground your writing in what admissions officers are looking for.

A con to this approach is that many people have more severe challenges than ADHD, so take care to read the room and not overstate your challenge.

Key Takeaways + An Example

If ADHD is a significant part of your story and you’re considering writing your personal statement about it, consider one of these approaches. They’ll help you frame the topic in a way admissions officers will respond to, and you’ll be able to talk about an important part of your life while emphasizing your strengths.

And if you want to read an example of a college essay about ADHD, check out one of our example personal statements, The Old iPhone .

As you go, remember that your job throughout your application is to craft a cohesive narrative —and your personal statement is the anchor of that narrative. How you approach it matters.

Liked that? Try this next.

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ADHD is my superpower: A personal essay

Our clinical and medical experts , ranging from licensed therapists and counselors to psychiatric nurse practitioners, author our content, in partnership with our editorial team. In addition, we only use authoritative, trusted, and current sources. This ensures we provide valuable resources to our readers. Read our editorial policy for more information.

Thriveworks was established in 2008, with the ultimate goal of helping people live happy and successful lives. We are clinician-founded and clinician-led. In addition to providing exceptional clinical care and customer service, we accomplish our mission by offering important information about mental health and self-improvement.

We are dedicated to providing you with valuable resources that educate and empower you to live better. First, our content is authored by the experts — our editorial team co-writes our content with mental health professionals at Thriveworks, including therapists, psychiatric nurse practitioners, and more.

We also enforce a tiered review process in which at least three individuals — two or more being licensed clinical experts — review, edit, and approve each piece of content before it is published. Finally, we frequently update old content to reflect the most up-to-date information.

A Story About a Kid

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

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

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

Being Labeled

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

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

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

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

Growing Past a Label

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

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

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

Learning to Thrive with ADHD

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

A Warp Speed Brain

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

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

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

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

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

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

Harnessing What My Brain Is Built For

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

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

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

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

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

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

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Published Jul 15, 2022

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Home — Essay Samples — Nursing & Health — Adhd — Understanding ADHD: An Informative Overview

Understanding ADHD: an Informative Overview

• Categories: Adhd

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Introduction, body 1: symptoms and diagnosis of adhd, body 2: causes and treatment options for adhd.

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• ADHD in Real Life
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Thanks for the Memories: An Essay on Life with ADHD

• Posted by ADDA Editorial Team
• Categories ADHD in Real Life
• Date November 3, 2022
• Comments 2 comments

By Irene Grey

In a moment…it’s gone. The fully-formed sentence sprung from nowhere, a perfect start to a story that might unfold over hundreds of pages. By the time I found my pen, all that remained was a faint memory.

This is the downside of ADHD…falling in love with ideas, images, sounds, smells, and half-formed thoughts several times within one minute.

My thoughts are almost within reach, then slip somewhere I can’t access. As one thought slides away, it’s replaced by one, two or even three more, without order or sequence. The unease lingers.

As a self-employed adult woman recently diagnosed with ADHD, I consider myself moderately successful. I’ve started taking medication, which enables me to reach previously unknown levels of self-awareness.

Medication has given me a fresh perspective. There’s no prescribed way to live or think; it all depends on whom you ask.

The difficulties with ADHD come when you feel and act wildly out-of-step with the majority of society and can’t keep pace.

Originally published on July 13, 2016, this post was republished on November 03, 2022.

What’s It like to Have ADHD (for me):

I can relate to the impulsivity of the Road Runner cartoon. When the wolf runs off the cliff’s edge, his legs cycle rapidly while suspended mid-air. It’s only when he looks down and realizes the enormity of his situation that he plummets down the canyon.

I’ve always empathized with him. Propelling myself forward, and never looking back or down, probably saves me from descending permanently into my own canyon.

Having ADHD, energy, resourcefulness, and optimism fuel me, but mental chaos can overwhelm me, and I grind to a halt. Staring into space, dulled and unable to move without huge effort, the desire for order becomes as overwhelming as it is hopelessly unattainable.

It can last a few minutes, or occasionally all day. I really wouldn’t want it hanging around longer, as the more prolonged times reveal a bleaker view of life.

At least I can explain this now, after a lifetime of inarticulate thought. In the past, I’d try to rationalize what was happening, but if it didn’t make sense to me, what could I say?

I’d always assumed I was terrible at living a normal life. Teachers said, “Only boring people get bored.” They said a lot of other things which confirmed our suspicions I was rebellious, sweet, but slightly simple, and hopelessly forgetful.

I was eventually invited to leave school. The Girl Guides had extended the same invitation a couple of years prior. Friends say, “Remember when…?” I nod, but I don’t really remember.

Everything moves too fast. It’s one reason why I fidget. Trying hard to remember or prevent something which is slipping away is taxing.

I’d like to focus, hold some memories, and have the chance to reflect. These are the big things, although not without drawbacks.

Everyone has elements of their past they’d rather forget, but when you’ve never really learned from your mistakes, a glimpse in the rearview mirror at the mangled wreckage of destructive relationships, dreadful job experiences, and reckless choices can be shocking.

I’ll shift my viewpoint now to say ADHD can be fantastic. Every day offers endless possibilities. Life without self-imposed limits means freedom to go anywhere and speak to anyone.

It’s not so much fearlessness, as simply not considering possible consequences before plunging in.

I’m constantly amazed by what I find out and humbled by what people want to share. I’m trusted, probably because I’m non-threatening. Surrendering yourself, unwittingly or otherwise, to living in the moment attracts people who want to join in.

The irony is I’ve always been shy, so attracting strangers creates a tension that I struggle to overcome. It’s like having an all-access pass for life; it’s a gift you’re not sure you want.

On Relationships with Others:

Friendships are easily formed, and the tenacious ones survive. Constantly forgetting birthdays, meetings, and dinners takes its toll.

I always answer my texts, but often only in my head. It can lead people to think I don’t care about them or am shallow, selfish, and unfeeling. It’s an understandable impression, but couldn’t be further from the truth.

“I forgot” is met with instructions to get a diary (planner), set alerts on my phone, or find another way to get organised. After all, everyone forgets, so you can, too. You just have to focus, plan ahead, and generally get a grip.

How can you tell them you’ve lost your third diary (planner), and it’s only April? Your replacement phone is also gone and you thought today was Tuesday instead of Thursday.

Getting any kind of grip on the stuff sliding in and out of my head is quite tricky. So, to the people I’ve let down, I’d like to say, “It’s not you. It really is me.”

“I can’t believe I let you talk me into this” has been screamed at me more times than I could obviously hope to remember. The last time was halfway up a mountainside, sheltering in a pine forest from driving rain. It probably wasn’t the moment to confess that my car keys seemed to have gone.

Everything would be ok, and if we just retraced the last 10 miles, we’d definitely find them. I did find them, inside the unlocked car, so everything worked out well.

To that particular friend, I’d like to say that you always complain about wanting more exercise and, as I pointed out at the time, human skin is waterproof, so can we please move on?

I get blamed for quite a lot. When you’re the forgetful, accident-prone one, it comes with the territory. It can’t always be your fault, and small doses of support and understanding go a long way with those of us who think and operate a bit differently in the world.

I’m good at adventures and spontaneous decisions. I’m open to anything because I have few defenses. Although I generally believe what I’m told, which has got me into trouble.

Keeping secrets comes easily, but hiding my own is hard. I’m a magnet for children and animals and try to cherish and look after everyone around me.

Visitors are well-fed and listened to. I’m known for giving good, at times unorthodox, advice and cocooning those in need of understanding.

The problem comes when transferring this care to myself, or recognizing when I should ask for help. I’m not invincible, but the irrational, hopeful side still can’t quite shake the belief that I just might be.

Why not? I’ve been tremendously lucky so far.

On Seeking Treatment and Disclosing My Diagnosis:

I could continue living in the moment without planning ahead. Forgetting most of it, then starting over the next day.

It’s often great, but I’m tired of reacting and acting impulsively, searching for new ways to keep boredom at bay. I’m weary of losing track of time, thoughts, and people.

I want to build something solid that I can keep going back to. Seeing each day as a clean slate has got me this far, and it’s fascinating, if chaotic.

Endless curiosity feeds the cycle, but it’s all so temporary. I want to pick up where I left off.

These are the reasons why I wanted treatment. A bit of control over my rapid impulses, combined with the chance to focus and untangle the constant, shifting thoughts, has shown it to be the right decision for me.

I’ve told three of my closest friends about the diagnosis, and no one has been surprised, despite having the good grace to pretend otherwise. It seems each one suspected something wasn’t quite ‘right’ at times.

Realizing I’ve been quietly understood and cared for over the years is touching but also difficult to accept – especially as I like to believe I’m invincible.

My abrupt disappearances are par for the course, and those who know me well no longer expect an explanation. Instead, they gently inquire and don’t take it personally.

Like my diary (planner) and phone, I misplace my loved ones sometimes. They’ve all said they need me to stay the way I am, for the adventures and sheer living in the moment thing. Although I’ve always hidden the worst of it from them by retreating.

I’ve reassured them I wouldn’t take medication. It’s dishonest, but I didn’t want them to start preparing to miss the old me. What if I become unrecognizable, stunned into submission by a chemical taser?

The great news is they haven’t noticed anything different, although I have. I’m more focused, and my energy levels are now steady.

I no longer feel the sudden need to run down the street — something that can be alarming to other pedestrians, especially when you’re a grown woman in high heels. (It looks like you’re being chased.)

The sudden development of a verbal filter is a welcome relief after years of unintentionally insulting people who ask for an opinion. It turns out diplomacy doesn’t mean lying.

It’s more choosing words carefully that don’t eviscerate friends, family, or complete strangers. “But you asked me” isn’t a reasonable defense after all, especially for the many times they didn’t ask.

Sleeping well in bed is a new treat. Funnily enough, for me, slipping into unconsciousness in cinemas, theatres, and on all forms of public transport was never a problem.

Most welcome of all the improvements is my memory. I’m forgetting less and thinking more clearly.

I’ll always be a more flawed, impulsive wolf than a perfect, predictable roadrunner, but that’s okay now.

Recently I was gripped by a sudden fear that controlling my symptoms would mean the saturated technicolour that life can be would drain into a perfectly pleasant, slightly dull, black and white. Like a rainy-day film without much pace or plot.

Fortunately, finding a balance between the extremes of falling in love with everything, or disconnecting completely, leaves scope.

Depending on when in the day you ask, I might say that ADHD has been a constant, invasive shadow, falling across every aspect of my life.

Ask me again, and I might say it’s been a brilliantly illuminating shaft of sunlight, throwing everything it hits into stark relief. It can be blinding, but more often reveals the perfect, glorious detail that might have been missed.

Life is enhanced, elevated, and made rather lovely. It depends on your perspective. Who wouldn’t want a little bit of that?

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Wishing I could share this family members! Hearing with sensitive ears of even the unspoken word, sends me in self defeating thoughts. Some of my high achieving family can’t understand all that I go though to be heard or being ignored feels. This is my battle at this time. My understanding is that many of us suffering with ADHD also have Dislexia which I experience as well of being Ambedextrious, with Major Depression. Thank you for this article, it that the wrong out of my life, even if a few understand!

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2024 International Conference on ADHD

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• Writing Help for ADHD Students

Updated 2024.

Typically, students with ADHD produce a wealth of ideas about an essay writing topic. Yet over 60% of students with ADHD struggle to get their ideas down on paper.

For most students with ADHD, writing assignments are torturous.

Because students with ADHD often have trouble separating dominant (main) ideas from less dominant (subordinate) ideas, even starting a writing assignment can be an arduous and anxiety filled experience.

But none of these difficulties needs to keep your ADHD child from writing successfully in school. Use the eight strategies below to help your child write more easily and successfully.

• What is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought). ADHD is considered a chronic and debilitating disorder and is known to impact the individual in many aspects of their life including academic and professional achievements, interpersonal relationships, and daily functioning (Harpin, 2005). ADHD can lead to poor self-esteem and social function in children when not appropriately treated (Harpin et al., 2016). Adults with ADHD may experience poor self-worth, sensitivity towards criticism, and increased self-criticism possibly stemming from higher levels of criticism throughout life (Beaton, et al., 2022). Of note, ADHD presentation and assessment in adults differs; this page focuses on children.

An estimated 8.4% of children and 2.5% of adults have ADHD (Danielson, 2018; Simon, et al., 2009). ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It is more commonly diagnosed among boys than girls given differences in how the symptoms present. However, this does not mean that boys are more likely to have ADHD. Boys tend to present with hyperactivity and other externalizing symptoms whereas girls tend to have inactivity.

Symptoms and Diagnosis

Many children may have difficulties sitting still, waiting their turn, paying attention, being fidgety, and acting impulsively. However, children who meet diagnostic criteria for ADHD, differ in that their symptoms of hyperactivity, impulsivity, organization, and/or inattention are noticeably greater than expected for their age or developmental level. These symptoms lead to significant suffering and cause problems at home, at school or work, and in relationships. The observed symptoms are not the result of an individual being defiant or not being able to understand tasks or instructions.

There are three main types of ADHD:

• Predominantly inattentive presentation.
• Predominantly hyperactive/impulsive presentation.
• Combined presentation.

A diagnosis is based on the presence of persistent symptoms that have occurred over a period of time and are noticeable over the past six months. While ADHD can be diagnosed at any age, this disorder begins in childhood. When considering the diagnosis, the symptoms must be present before the individual is 12 years old and must have caused difficulties in more than one setting. For instance, the symptoms can not only occur at home.

Inattentive type

Inattentive refers to challenges with staying on task, focusing, and organization. For a diagnosis of this type of ADHD, six (or five for individuals who are 17 years old or older) of the following symptoms occur frequently:

• Doesn’t pay close attention to details or makes careless mistakes in school or job tasks.
• Has problems staying focused on tasks or activities, such as during lectures, conversations or long reading.
• Does not seem to listen when spoken to (i.e., seems to be elsewhere).
• Does not follow through on instructions and doesn’t complete schoolwork, chores or job duties (may start tasks but quickly loses focus).
• Has problems organizing tasks and work (for instance, does not manage time well; has messy, disorganized work; misses deadlines).
• Avoids or dislikes tasks that require sustained mental effort, such as preparing reports and completing forms.
• Often loses things needed for tasks or daily life, such as school papers, books, keys, wallet, cell phone and eyeglasses.
• Is easily distracted.
• Forgets daily tasks, such as doing chores and running errands. Older teens and adults may forget to return phone calls, pay bills and keep appointments.

Hyperactive/impulsive type

Hyperactivity refers to excessive movement such as fidgeting, excessive energy, not sitting still, and being talkative. Impulsivity refers to decisions or actions taken without thinking through the consequences. For a diagnosis of this type of ADHD, six (or five for individuals who are 17 years old or older) of the following symptoms occur frequently:

• Fidgets with or taps hands or feet, or squirms in seat.
• Not able to stay seated (in classroom, workplace).
• Runs about or climbs where it is inappropriate.
• Unable to play or do leisure activities quietly.
• Always “on the go,” as if driven by a motor.
• Talks too much.
• Blurts out an answer before a question has been finished (for instance may finish people’s sentences, can’t wait to speak in conversations).
• Has difficulty waiting for his or her turn, such as while waiting in line.
• Interrupts or intrudes on others (for instance, cuts into conversations, games or activities, or starts using other people’s things without permission). Older teens and adults may take over what others are doing.

Combined type

This type of ADHD is diagnosed when both criteria for both inattentive and hyperactive/impulse types are met.

ADHD is typically diagnosed by mental health providers or primary care providers. A psychiatric evaluation will include a description of symptoms from the patient and caregivers, completion of scales and questionnaires by patient, caregivers and teachers, complete psychiatric and medical history, family history, and information regarding education, environment, and upbringing. It may also include a referral for medical evaluation to rule out other medical conditions.

It is important to note that several conditions can mimic ADHD such as learning disorders, mood disorders, anxiety, substance use, head injuries, thyroid conditions, and use of some medications such as steroids (Austerman, 2015). ADHD may also co-exist with other mental health conditions, such as oppositional defiant disorder or conduct disorder, anxiety disorders, and learning disorders (Austerman, 2015). Thus, a full psychiatric evaluation is very important. There are no specific blood tests or routine imaging for ADHD diagnosis. Sometimes, patients may be referred for additional psychological testing (such as neuropsychological or psychoeducational testing) or may undergo computer-based tests to assess the severity of symptoms.

The Causes of ADHD

Scientists have not yet identified the specific causes of ADHD. While there is growing evidence that genetics contribute to ADHD and several genes have been linked to the disorder, no specific gene or gene combination has been identified as the cause of the disorder. However, it is important to note that relatives of individuals with ADHD are often also affected. There is evidence of anatomical differences in the brains of children with ADHD in comparison to other children without the condition. For instance, children with ADHD have reduced grey and white brain matter volume and demonstrate different brain region activation during certain tasks (Pliszka, 2007). Further studies have indicated that the frontal lobes, caudate nucleus, and cerebellar vermis of the brain are affected in ADHD (Tripp & Wickens, 2009). Several non-genetic factors have also been linked to the disorder such as low birth weight, premature birth, exposure to toxins (alcohol, smoking, lead, etc.) during pregnancy, and extreme stress during pregnancy.

ADHD treatment usually encompasses a combination of therapy and medication intervention. In preschool-age and younger children, the recommended first-line approach includes behavioral strategies in the form of parent management training and school intervention. Parent-Child Interaction Therapy (PCIT) is an evidence-based therapy modality to help young children with ADHD and oppositional defiant disorder.

According to current guidelines, psychostimulants (amphetamines and methylphenidate) are first-line pharmacological treatments for the management of ADHD (Pliszka, 2007). In preschool-aged patients with ADHD, amphetamines are the only FDA-approved medication, although guidelines suggest that methylphenidate rather than amphetamines may be helpful if behavioral interventions prove insufficient. Alpha agonists (clonidine and guanfacine) and the selective norepinephrine reuptake inhibitor, atomoxetine, are the other FDA-approved options for treating ADHD. There are newer FDA-approved medications for ADHD treatment, including Jornay (methylphenidate extended-release) which is taken at night and starts the medication effect the next morning, Xelstrym (dextroamphetamine) which is an amphetamine patch, Qelbree (viloxazine) which is a non-stimulant, Adhansia (methylphenidate hydrochloride), Dyanavel (amphetamine extended-release oral suspension), Mydayis (mixed salts amphetamine product), and Cotempla (methylphenidate extended-release orally disintegrating tablets).

Many children and families can alternate between various medication options depending on the efficacy of treatment and tolerability of the medication. The goal of treatment is to improve symptoms to restore functioning at home and at school.

ADHD and School-Aged Children

Teachers and school staff can provide parents and doctors with information to help evaluate behavior and learning problems and can assist with behavioral training. However, school staff cannot diagnose ADHD, make decisions about treatment or require that a student take medication to attend school. Only parents and guardians can make those decisions with the child’s health care clinician.

Students whose ADHD impairs their learning may qualify for special education under the Individuals with Disabilities Education Act or for a Section 504 plan (for children who do not require special education) under the Rehabilitation Act of 1973. Children with ADHD can benefit from study skills instruction, changes to the classroom setup, alternative teaching techniques and a modified curriculum.

ADHD and Adults

Many children diagnosed with ADHD will continue to meet criteria for the disorder later in life and may show impairments requiring ongoing treatment (Pliszka, 2007). However, sometimes a diagnosis of ADHD is missed during childhood. Many adults with ADHD do not realize they have the disorder. A comprehensive evaluation typically includes a review of past and current symptoms, a medical exam and history, and use of adult rating scales or checklists. Adults with ADHD are treated with medication, psychotherapy or a combination. Behavior management strategies, such as ways to minimize distractions and increase structure and organization, and support from immediate family members can also be helpful.

ADHD is a protected disability under the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA). This means that institutions receiving federal funding cannot discriminate against those with disabilities. Individuals whose symptoms of ADHD cause impairment in the work setting may qualify for reasonable work accommodations under ADA.

Related Conditions

• Autism spectrum disorder
• Disruptive, impulse control and conduct disorders
• Social communication disorder
• Specific learning disorder

  References

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) . 2013.
• Austerman J. ADHD and behavioral disorders: Assessment, management, a nd an update from DSM-5 . Cleve Clin J Med. 2015 Nov;82(11 Suppl 1):S2-7.
• Beaton, D. M., Sirois, F., & Milne, E. (2022). Experiences of criticism in adults with ADHD: A qualitative study . PloS one, e0263366.
• Danielson, M.L., et al. Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, Volume 47, 2018 - Issue 2.
• Harpin VA. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Arch Dis Child. 90 Suppl 1(Suppl 1):i2-7.
• Harpin V, Mazzone L, Raynaud JP, Kahle J, Hodgkins P. (2013). Long-Term Outcomes of ADHD: A Systematic Review of Self-Esteem and Social Function . J Atten Disord. 20(4):295-305.
• Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder . J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):894-921.
• Simon, V. , Czobor, P. , Bálint, S. , et al: : Prevalence and correlates of adult attention-deficit hyperactivity disorder: a meta-analysis. Br J Psychiatry194(3):204–211, 2009
• Tripp, G., Wickens, J.R. Neurobiology of ADHD . Neuropharmacology. 2009 Dec;57(7-8):579-89.
• Wolraich, M.L., Hagan, J.F.J., Allan, C., et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4).

Physician Review

Rana Elmaghraby, M.D.

Stephanie Garayalde, M.D.

More on ADHD

• Children and Adults with ADHD (CHADD): Online ADHD Training for Parents
• Parent's Medication Guide: ADHD – from APA and AACAP (.pdf)  
• National Institutes on Mental Health (NIMH) - ADHD
• Attention Deficit Disorder Association (ADDA)
• ADDitude Magazine - Directory of parent support
• American Academy of Child and Adolescent Psychiatry (AACAP)

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162 ADHD Essay Topics & Examples

Looking for ADHD topics to write about? ADHD (attention deficit hyperactivity disorder) is a very common condition nowadays. It is definitely worth analyzing.

🔝 Top 10 ADHD Research Topics

🏆 best adhd essay examples, 💡 most interesting adhd topics to write about, 🎓 exciting adhd essay topics, 🔥 hot adhd topics to write about, 👍 adhd research paper topics, ❓ research questions about adhd.

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

• ADHD and its subtypes
• The most common symptoms of ADHD
• The causes of ADHD: genetics, environment, or both?
• ADHD and the changes in brain structures
• ADHD and motivation
• Treating ADHD: the new trends
• Behavioral therapy as ADHD treatment
• Natural remedies for ADHD
• ADD vs. ADHD: is there a difference?
• Living with ADHD: the main challenges
• Everything You Need to Know About ADHD The frontal hemisphere of the brain is concerned with coordination and a delay in development in this part of the brain can lead to such kind of disorder.
• Learning Disabilities: Differentiating ADHD and EBD As for the most appropriate setting, it is possible to seat the child near the teacher. It is possible to provide instructions with the help of visual aids.
• Bright Not Broken: Gifted Kids, ADHD, and Autism It is possible to state that the book provides rather a high-quality review of the issues about the identification, education, and upbringing of the 2e children.
• Attention Deficit Hyperactivity Disorder (ADD / ADHD) Some critics maintain that the condition is a work of fiction by the psychiatric and pharmacists who have taken advantage of distraught families’ attempts to comprehend the behaviour of their children to dramatise the condition.
• Psychology: Attention Deficit and Hyperactivity Disorder It is important to pay attention to the development of proper self-esteem in children as it can negatively affect their development and performance in the future.
• ADHD and Its Effects on the Development of a Child In particular, this research study’s focus is the investigation of the impact of household chaos on the development and behavior of children with ADHD.
• The History of ADHD Treatment: Drug Addiction Disorders Therefore, the gathered data would be classified by year, treatment type, and gender to better comprehend the statistical distribution of the prevalence of drug addiction.
• Attention Deficit Hyperactivity Disorder and Recommended Therapy The condition affects the motivational functioning and abnormal cognitive and behavioural components of the brain. Dysfunction of the prefrontal cortex contributed to a lack of alertness and shortened attention in the brain’s short-term memory.
• Rhetorical Modes Anthology on Attention Deficit Disorder It clearly outlines the origin and early symptoms of the disorder and the scientist who discovered attention deficit hyperactivity disorder. Summary & Validity: This article describes the causes of hyperactivity disorder and the potential factors […]
• Attention-Deficit Hyperactivity Disorder in a Young Girl The particular objective was to assist Katie in becoming more focused and capable of finishing her chores. The patient received the same amount of IR Ritalin and was required to continue taking it for an […]
• Similarities and Differences: SPD, ADHD, and ASD The three disorders, Sensory Processing Disorder, Attention Deficit Hyperactivity Disorder, and Autism Spectrum Disorder, are often confused with each other due to the connections and similarities that exist.
• Attention Deficit Hyperactivity Disorder Awareness According to Sayal et al, ADHD is common in young boys as it is easier to identify the problem. The disorder is well-known, and there is no struggle to identify the problem.
• Assessing the Personality Profile With ADHD Characteristics On the contrary, the study was able to understand significant changes in the emotional states and mood of the children when the observations and the tests ended.
• Aspects of ADHD Patients Well-Being This goal can be achieved through the help of mental health and behavioral counselors to enhance behavioral modification and the ability to cope with challenges calmly and healthily.
• ADHD and Problems With Sleep This is because of the activity of a person in the middle of the day and the condition around them. The downside of the study is that the study group included 52 adults with ADHD […]
• The Attention Deficit Hyperactivity Disorder Treatment It has been estimated that when medicine and therapy are applied as treatment together, the outcomes for children with ADHD are excellent.
• Attention Deficit Hyperactivity Disorder Organization’s Mission Children and Adults with Attention-Deficit/Hyperactivity Disorder is an organization that is determined to handle individuals affected by ADHD. The organization was founded in 1987 following the rampant frustration and isolation that parents experienced due to […]
• Case Conceptualization: Abuse-Mediated ADHD Patient The case provides insight into the underlying causes of James’s educational problems and the drug abuse of his parents. The case makes it evident that the assumption from the first case conceptualization about James’s ADHD […]
• Change: Dealing With Patients With ADHD In the current workplace, the most appropriate change would be the increase in the awareness of nurses regarding the methods of dealing with patients with ADHD.
• Dealing With Attention Deficit Hyperactivity Disorder Although my experience is not dramatic, it clearly shows how untreated ADHD leads to isolation and almost depression. However, the question arises of what is the norm, how to define and measure it.
• Parents’ Perception of Attending an ADHD Clinic The main principles of the clinic’s specialists should be an objective diagnosis of the neurological status of the child and the characteristics of his/her behavior, the selection of drug treatment only on the basis of […]
• ADHD: Mental Disorder Based on Symptoms The DSM-5 raised the age limit from 6 to 12 for qualifying the disorder in children and now requires five instead of six inattentive or hyperactive-impulsive symptoms.
• Understanding Attention-Deficit/Hyperactivity Disorder Thus, the smaller sizes of the reviewed brain structures associated with ADHD result in problems with attention, memory, and controlling movement and emotional responses.
• Effective Therapies for Attention Deficit Hyperactivity Disorder The problem at hand is that there is a need to determine which of the therapies administered is effective in the management of ADHD.
• Participants of “ADHD Outside the Laboratory” Study The participants in the testing group and those in the control group were matched for age within 6 months, for IQ within 15 points and finally for performance on the tasks of the study.
• Variables in “ADHD Outside the Laboratory” Study The other variables are the videogames, matching exercise and the zoo navigation exercise used to test the performance of the boys.
• Different Types of Diets and Children’s ADHD Treatment The last factor is a trigger that can lead to the development of a child’s genes’ reaction. Thus, diet is one of the factors that can help prevent the development of ADHD.
• Attention Deficit Hyperactivity Disorder in Children The consistent utilization of effective praises and social rewards indeed results in the behavioral orientation of the child following the treatment goals.
• Vyvanse – ADD and ADHD Medicine Company Analysis It is produced by Shire and New River Pharmaceuticals in its inactive form which has to undergo digestion in the stomach and through the first-pass metabolic effect in the liver into L-lysine, an amino acid […]
• Dealing With the Disruptive Behaviors of ADHD and Asperger Syndrome Students While teaching in a class that has students with ADHD and Asperger syndrome, the teacher should ensure that they give instructions that are simple and easy to follow.
• Current Issues in Psychopharmacology: Attention-Deficit Hyperactivity Disorder This is the area that is charged with the responsibility for vision control as well as a regulation of one’s brain’s ability to go to aresynchronize’ and go to rest.
• Cognitive Psychology and Attention Deficit Disorder On top of the difficulties in regulating alertness and attention, many individuals with ADD complain of inabilities to sustain effort for duties.
• Adult and Paediatric Psychology: Attention Deficit Hyperactivity Disorder To allow children to exercise their full life potential, and not have any depression-caused impairment in the social, academic, behavioral, and emotional field, it is vital to reveal this disorder as early in life, as […]
• Attention-Deficit Hyperactivity Disorder: Biological Testing The research, leading to the discovery of the Biological testing for ADHD was conducted in Thessaloniki, Greece with 65 children volunteering for the research. There is a large difference in the eye movement of a […]
• Issues in the Diagnosis of Attention-Deficit Hyperactivity Disorder in Children Concept theories concerning the nature of attention-deficit/hyperactivity disorder influence treatment, the approach to the education of children with ADHD, and the social perception of this disease.
• Attention Deficit Hyperactivity Disorder Care Controversy The objective of this study was to assess the efficacy, in terms of symptoms and function, and safety of “once-daily dose-optimized GXR compared with placebo in the treatment of children and adolescents aged 6 17 […]
• Attention Deficit Hyperactivity Interventions The authors examine a wide range of past studies that reported on the effects of peer inclusion interventions and present the overall results, showing why further research on peer inclusion interventions for children with ADHD […]
• Attention Deficit Hyperactivity Disorder (ADHD) in a Child A child counselor works with children to help them become mentally and emotionally stable. The case that is examined in this essay is a child with attention deficit hyperactivity disorder.
• Attention Deficit Hyperactivity Disorder: Drug-Free Therapy The proposed study aims to create awareness of the importance of interventions with ADHD among parents refusing to use medication. The misperceptions about ADHD diagnosis and limited use of behavioral modification strategies may be due […]
• Attention Deficit Hyperactivity Disorder: Psychosocial Interventions The mentioned components and specifically the effects of the condition on a child and his family would be the biggest challenge in the case of Derrick.
• Attention Deficit Hyperactivity Disorder: Comorbidities Due to the effects that ADHD has on patients’ relationships with their family members and friends, the development of comorbid health problems becomes highly possible.
• Medicating Kids to Treat ADHD The traditional view is that the drugs for the disorder are some of the safest in the psychiatric practice, while the dangers posed by untreated ADHD include failure in studies, inability to construct social connections, […]
• Attention Deficit Hyperactivity Disorder: Signs and Strategies Determining the presence of Attention Deficit Hyperactivity Disorder in a child and addressing the disorder is often a rather intricate process because of the vagueness that surrounds the issue.
• Cognitive Therapy for Attention Deficit Disorder The counselor is thus expected to assist the self-reflection and guide it in the direction that promises the most favorable outcome as well as raise the client’s awareness of the effect and, by extension, enhance […]
• “Stress” Video and “A Natural Fix for ADHD” Article There certainly are some deeper reasons for people to get stressed, and the video documentary “Stress: Portrait of a Killer” and the article “A Natural Fix for A.D.H.D”.by Dr.
• Attention Deficit Disorder: Diagnosis and Treatment The patient lives with her parents and 12-year-old brother in a middle-class neighborhood. Her father has a small business, and her mother works part-time in a daycare center.
• Treatment of Children With ADHD Because of the lack of sufficient evidence concerning the effects of various treatment methods for ADHD, as well as the recent Ritalin scandal, the idea of treating children with ADHD with the help of stimulant […]
• Attention Deficit Hyperactivity Disorder Medicalization This paper discusses the phenomenon of medicalization of ADHD, along with the medicalization of other aspects perceived as deviant or atypical, it will also review the clash of scientific ideas and cultural assumptions where medicalization […]
• Medication and Its Role in the ADHD Treatment Similar inferences can be inferred from the findings of the research conducted by Reid, Trout and Schartz that revealed that medication is the most appropriate treatment of the symptoms associated with ADHD.
• Children With Attention-Deficit Hyperactivity Disorder The purpose of the present research is to understand the correlation between the self-esteem of children with ADHD and the use of medication and the disorder’s characteristics.
• Natural Remedies for ADHD The key peculiarity of ADHD is that a patient displays several of these symptoms, and they are observed quite regularly. Thus, one can say that proper diet can be effective for the treatment of attention […]
• Cognitive Behavior Therapy in Children With ADHD The study revealed that the skills acquired by the children in the sessions were relevant in the long term since the children’s behaviors were modeled entirely.
• Is Attention Deficit Hyperactivity Disorder Real? In fact, the existence of the condition, its treatment and diagnosis, have been considered controversial topics since the condition was first suggested in the medical, psychology and education.
• Is Attention Deficit Disorder a Real Disorder? When Medicine Faces Controversial Issues In addition, it is necessary to mention that some of the symptoms which the children in the case study displayed could to be considered as the ones of ADHD.
• Foods That Effect Children With ADHD/ ADD Therefore, it is the duty of parents to identify specific foods and food additives that lead to hyperactivity in their children.
• Toby Diagnosed: Attention Deficit Hyperactivity Disorder The symptoms of the disorder are usually similar to those of other disorder and this increases the risks of misdiagnosing it or missing it all together.
• Identifying, Assessing and Treating Attention Deficit Hyperactivity Disorder For these criteria to be effective in diagnosing a child with ADHD, the following symptoms have to be present so that the child can be labelled as having ADHD; the child has to have had […]
• ADHD Should Be Viewed as a Cognitive Disorder The manifestation of the disorder and the difficulties that they cause, as posited by the American Psychiatric Association, are typically more pronounced when a person is involved in some piece of work such as studying […]
• Attention Deficit Hyperactivity Disorder Influence on the Adolescents’ Behavior That is why the investigation was developed to prove or disprove such hypotheses as the dependence of higher rates of anxiety of adolescents with ADHD on their diagnosis, the dependence of ODD and CD in […]
• Stroop Reaction Time on Adults With ADHD The model was used to investigate the effectiveness of processes used in testing interference control and task-set management in adults with ADHD disorder.
• Attention Deficit Hyperactivity Disorder Causes Family studies, relationship studies of adopted children, twin studies and molecular research have all confirmed that, ADHD is a genetic disorder.
• Diagnosis and Treatment of ADHD The diagnosis of ADHD has drawn a lot of attention from scientific and academic circles as some scholars argue that there are high levels of over diagnosis of the disorder.
• Attention-Deficit Hyperactivity Disorder As it would be observed, some of the symptoms associated with the disorder for children would differ from those of adults suffering from the same condition in a number of ways.
• Working Memory in Attention Deficit and Hyperactivity Disorder (ADHD) Whereas many studies have indicated the possibility of the beneficial effects of WM training on people with ADHD, critics have dismissed them on the basis of flawed research design and interpretation.
• Attention-Deficit Hyperactivity Disorder: The Basic Information in a Nutshell In the case with adults, however, the definition of the disorder will be quite different from the one which is provided for a child ADHD.
• How ADHD Develops Into Adult ADD The development of dominance is vital in processing sensations and information, storage and the subsequent use of the information. As they become teenagers, there is a change in the symptoms of ADHD.
• Medical Condition of Attention Deficit Hyperactivity Disorder A combination of impulsive and inattentive types is referred to as a full blown ADHD condition. To manage this condition, an array of medical, behavioral, counseling, and lifestyle modification is the best combination.
• Effects of Medication on Education as Related to ADHD In addition, as Rabiner argues, because of the hyperactivity and impulsivity reducing effect of ADHD drugs, most ADHD suffers are nowadays able to learn in an indistinguishable class setting, because of the reduced instances of […]
• Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment Generally the results indicate that children with ADHD had a difficult time in evaluating time concepts and they seemed to be impaired in orientation of time.
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You have now completed your study of the free course Understanding ADHD . Hopefully as you have studied this material you have both challenged and consolidated some of your previously held beliefs about this common neurodevelopmental disorder. You have learnt how ADHD is experienced, diagnosed and managed, but you should also now recognise that there is much still to be understood about the condition. For example, the exact cause is unknown. It is also not yet clear exactly how child and adult forms of ADHD relate to one another, or indeed if they are distinct from each other at all. The exact mechanism of action of current drug treatments to reduce symptoms of ADHD is also not fully understood.

A summary of key learning points from this course:

• ADHD is a common neurodevelopmental condition which affects around 6 in 100 children and adolescents, and around 3 in 100 adults. The condition has three core symptoms: inattention, impulsivity and hyperactivity. It is also associated with difficulties in social interactions and a range of comorbid conditions.
• Diagnosis of ADHD can be made using DSM-5, in which three different presentation types are possible based on the type of core symptoms an individual displays. Symptoms must be present from childhood and found in more than one setting for a minimum of 6 months. It is expected that similar criteria will be found in ICD-11 which will be the first time this diagnostic system has recognised ADHD.
• The search for risk factors for ADHD has been extensive. The condition is known to be highly heritable but genetic studies have yet to reveal a clear genetic basis. Studies indicate multiple genes are likely to be involved. Environmental risk factors also exist, with several prenatal events identified as increasing risk of ADHD.
• The brain basis of ADHD is likely to revolve around the brain circuitry involved in selective attention, including structures such as the prefrontal cortex and a range of neurotransmitters, but most notably dopamine.
• Management of ADHD varies with the age of the individual. Psychosocial and biological treatments are available at all ages, but in younger individuals medication is used with caution because the precise long-term effects on the developing brain are unknown.

This OpenLearn course is an adapted extract from the Open University course SK298 Brain, mind and mental health [ Tip: hold Ctrl and click a link to open it in a new tab. ( Hide tip ) ] .

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3 Tech Tools to Help Your Child Conquer Essays

For students with adhd and/or learning challenges like dysgraphia, writing a research paper might as well be free climbing el capitan — a long, daunting, totally exhausting climb to an end point that’s sometimes impossible to see. chart an easier route for your child by introducing these assistive technology tools for planning and writing essays..

Oh, the terror of staring onto a blank page.

It’s just so much space to fill! I can’t write that much! Where do I even start?!

As an educational therapist, I see many middle- and high-school students with attention deficit disorder ( ADHD or ADD ) totally overwhelmed when tackling essays and papers. So many executive functions are needed for extensive writing. And when dysgraphia factors in, an essay can seem insurmountable.

To these students, writing a term paper may feel like building a house all by themselves! So how about some tools to ease the construction task? For those with access to technology, here are three digital tools I’ve used with students facing a writing project that have alleviated stress and helped them start building their essays.

[ Free Download: Learning Tools That Improve Productivity, Reading and Writing Skills ]

Digital Outlines and Graphic Organizers

There are now web sites and downloadable apps that help guide kids through the brainstorming and outlining processes through clear and user-friendly interfaces. Readwritethink.org , for example, has an “essay map” interface where students chart out their opening statement, introduction, supporting details/paragraphs and conclusion. I once observed a student with ADHD and spectrum disorder using this site and watched him brainstorm into the map with much less stress than usual; it allowed his mind to jump around but also to keep inputting different idea fragments into various map sections.

Inspiration software has apps that allow students to create bubble maps and mind maps with totally customizable color, size, and shape options for the text boxes. They also automatically generate a standard outline for users once they’ve completed a brainstorm map.

Some students prefer to use PowerPoint or Google Slides to make their own organizers and outlines.

[ Free Webinar Replay: Apps, Extensions, and Tech Tools for ADHD Brains: A Learning Guide ]

Speech-to-Text Tools

Many students today are writing their essays on the computer rather than by free-hand, and though typing can be extremely helpful, the writing challenge may still loom large. Thankfully, I’ve seen how game changing speech-to-text (a.k.a. voice recognition) technology can be. I personally use it daily to compose texts, make reminder lists on my phone, or even sometimes while writing on Google Docs.

For our students with ADHD and/or dysgraphia, speech-to-text removes the graphomotor and visual-motor burdens of handwriting by allowing them to speak out their ideas and sentences. I’ve seen this function allow typically stifled students to generate ideas more easily, without worrying about grammar and spelling or how their handwriting looks on paper. I’ve also seen how speech-to-text can prompt them to consider word choice and punctuation more than they ever have, as punctuation must be spoken out by saying “comma” and “period” where appropriate.

Digital Calendar to Plan Out Steps

For better or worse, many teenagers manage their lives on their phones. One positive about this is their access to a digital calendar . I now add all of my projects and appointments on to my phone’s calendar, which alerts me they’re about to come up. But just setting a due date for an essay isn’t going to alleviate anxiety for a student struggling with the assignment.

When my students are overwhelmed with a paper, I help them break down the task into small steps. Step 1 is brainstorming ideas into a list or graphic organizer. Step 2 is considering the ideas they’ve brainstormed to generate a thesis. Step 3 is making an outline of supporting details. Step 4 is writing an introduction. And so on.

And here’s the key component: Students should chart out their steps on their phone’s calendar before starting so that they aim for and reach these incremental goals toward meeting the final deadline. Meeting these smaller goals can give students confidence and propel them toward completion. Ideally, a teacher, parent or tutor would also check in with them along the way to make sure they’re following the steps.

Your student can’t build a house with his bare hands. He needs tools to make the job — namely, writing challenges — manageable. And, in my experience, these digital tools really get the job done.

[ Writing Made Easy: Tech Tools to the Rescue ]

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ADHD: Reviewing the Causes and Evaluating Solutions

Luis núñez-jaramillo.

1 División de Ciencias de la Salud, Universidad de Quintana Roo, Chetumal 77039, Quintana Roo, Mexico; xm.ude.oorqu@zenunl

Andrea Herrera-Solís

2 Laboratorio Efectos Terapéuticos de los Canabinoides, Subdirección de Investigación Biomédica, Hospital General Dr. Manuel Gea González, Calz. de Tlalpan 4800, Belisario Domínguez Secc 16, Tlalpan 14080, Ciudad de México, Mexico; moc.liamg@shaerdnaard

Wendy Verónica Herrera-Morales

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in which patients present inattention, hyperactivity, and impulsivity. The etiology of this condition is diverse, including environmental factors and the presence of variants of some genes. However, a great diversity exists among patients regarding the presence of these ADHD-associated factors. Moreover, there are variations in the reported neurophysiological correlates of ADHD. ADHD is often treated pharmacologically, producing an improvement in symptomatology, albeit there are patients who are refractory to the main pharmacological treatments or present side effects to these drugs, highlighting the importance of developing other therapeutic options. Different non-pharmacological treatments are in this review addressed, finding diverse results regarding efficacy. Altogether, ADHD is associated with different etiologies, all of them producing changes in brain development, leading to the characteristic symptomatology of this condition. Given the heterogeneous etiology of ADHD, discussion is presented about the convenience of personalizing ADHD treatment, whether pharmacological or non-pharmacological, to reach an optimum effect in the majority of patients. Approaches to personalizing both pharmacological therapy and neurofeedback are presented.

1. Introduction

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder (NDD) presenting with inattention, hyperactivity, and impulsivity. It can be classified in three subtypes, depending on the intensity of the symptoms: predominantly inattentive, predominantly hyperactive–impulsive, and combined [ 1 , 2 ]. ADHD has a global prevalence of 5.9% to 7.1% in children and 1.2% to 7.3% in adults [ 3 ].

While most studies address ADHD in children from 7 to 17 years old, it is important to outline that this condition is also present in adults. It has been proposed that the number of adults with ADHD has increased over the last 20 years. A part of this increase is due to the permanence of ADHD symptoms in the adult age in 76% of diagnosed patients. ADHD implies important challenges for academic, personal, and job performance [ 4 ].

As for any other condition affecting brain function, in order to find an adequate treatment for ADHD, it is important to first understand its physiological basis. As with other NDDs, the causes of ADHD are aberrant neural development, affecting neurogenesis, synaptogenesis, myelination, and neuronal and glial proliferation and migration. Even though symptoms begin to appear in childhood, neuronal development is affected from early embryogenesis [ 5 ].

The etiology of ADHD is diverse—gestational, perinatal, and genetic factors have been associated with ADHD incidence. However, each patient presents only a few of them.

2. Environmental Factors Associated with ADHD

The incidence of ADHD is associated with a number of environmental factors during different stages of central nervous system (CNS) development, such as gestational and perinatal periods. In this section, we will address some of the environmental factors that have been associated with ADHD.

2.1. Preconceptional, Gestational, and Perinatal Conditions

Premature birth is an important risk factor for ADHD, since it has been reported that it occurs 2.6 to 4 times more frequently in babies born with low weight or very low weight. Premature birth is associated with alterations in neurogenesis and cell death [ 6 ], and these are in turn associated with reduced cortical expansion, as reported in ADHD patients [ 7 ]. One possible reason for increased risk of developing ADHD in preterm children is inflammation; an increase in inflammation-related molecules is associated with increased risk of developing ADHD symptoms [ 8 ].

Perinatal hypoxia is an environmental factor that increases the risk of developing AHDH, probably due to its effects on dopaminergic transmission and neurotropic signaling [ 9 ].

The intake of nutrients during gestation is very important for proper brain development. An important element during neural development is the polyunsaturated fatty acid docosahexaenoic acid (DHA), promoting proliferation and neural differentiation of neural progenitor cells. Decreased levels of DHA during brain development have been associated with ADHD and other neurodevelopmental disorders [ 10 ], and decreased levels of serum DHA levels have been reported in adult ADHD patients [ 11 ]. Additionally, malnutrition or immune activation in the pregnant mother is a risk factor for ADHD and other neurodevelopmental disorders [ 12 ]. High sucrose consumption during pregnancy is possibly related with ADHD incidence. A study performed on rats reported that high sucrose intake in pregnant rats led to the appearance of ADHD-like symptoms in the offspring, who showed increased locomotor activity, decreased attention, and increased impulsivity. Furthermore, the offspring also presented increased dopamine transporter (DAT) and a decrease in dopamine receptors and mRNA expression in the striatum [ 13 ].

Interestingly, there is evidence in a rat model of the influence of preconceptional conditions on ADHD incidence. Offspring of Female rats administered with ethanol for 8 weeks before mating presented ADHD-like symptoms such as hyperlocomotive activity, impulsivity, and attention deficit. These rats also presented low levels of striatal DAT and increased presence of norepinephrine transporter (NET) in the frontal cortex [ 14 ]. A later work by this group revealed that paternal preconceptional alcohol exposure also produced ADHD-like symptoms in the offspring, presenting decreased expression of DAT mRNA and DAT protein in the cortex and striatum. Furthermore, authors report epigenetic changes in both the sperm of these alcohol-exposed male rats and in the frontal cortex and striatum of the offspring, presenting increased methylation in a CpG region of DAT gene promoter, which is in agreement with the reduced expression of DAT in the offspring [ 15 ].

Another environmental factor associated with ADHD is pesticide exposure during development. A study addressing the issue, both at experimental and epidemiological levels, reported that exposure to the pesticide deltamethrin during gestation and lactation in rats led to ADHD-like symptoms, such as working memory and attention deficits, hyperactivity, and impulsive-like behavior. It also produced increased presence of DAT and D1 receptor in the striatum, as well as increased dopamine release and increased presence of D1 dopamine receptor in the nucleus accumbens. Interestingly, the authors also performed an epidemiological study in humans, revealing that children (6 to 15 years old) with detectable levels of pyrethroid metabolites in urine had more than twice the probability of being diagnosed with ADHD [ 16 ].

2.2. Heavy Metal Exposure

One of the most reported environmental factors associated with ADHD is exposure to neurotoxic heavy metals. A study performed on school children revealed that children (6–7 years old) with ADHD presented higher levels of salivary mercury. However, when including all age groups studied (12–13 years and 15–16 years), no significant correlation was found between increased salivary mercury and ADHD, although a mild tendency was observed [ 17 ].

In the case of manganese, both too high and too low blood levels are associated with cognitive deficits. High concentration of manganese in blood is associated with deficits in thinking, reading, and calculations, as well as with lower learning quotient (indicative of learning disability) and more errors in the continuous performance test (measuring attention and response inhibition). Conversely, low blood level of manganese is associated with a poorer performance in the Stroop test, which is used to assess cognitive inhibition [ 18 ]. Similarly, a study addressing the relationship between manganese in drinking water and ADHD found a higher risk of developing this condition (inattentive but not combined subtype) as exposure to manganese in drinking water increased [ 19 ]. However, a study on manganese in children’s deciduous teeth failed to find an association between this metal and cognitive deficits [ 20 ].

The presence of lead in children’s deciduous teeth is positively associated with hyperactivity or impulsivity, as well as inattention and oppositional or defiant disorder [ 20 ]. A study on children from a lead-contaminated region reported that blood levels of cadmium, lead, and manganese correlated with conduct problems and antisocial behavior [ 21 ]. Another work found a higher concentration of blood lead in ADHD children, which was correlated with hyperactivity–impulsivity symptoms but not with inattention [ 22 , 23 ]. Both genetic [ 24 ] and epigenetic [ 25 ] factors have been reported to contribute to lead-related pathogenesis of ADHD. Moreover, a study carried out in Argentina found that children with high blood concentrations of lead are more likely to develop ADHD [ 26 ].

A review on the effects of prenatal and childhood metal exposure on cognition found suggestive evidence of a relation between cadmium exposure and impaired cognitive ability in children. They did not find evidence of a relationship between cadmium exposure and ADHD [ 27 ]. A more recent study addressing cadmium exposure during pregnancy revealed that a higher blood cadmium concentration during pregnancy is associated with higher scores in ADHD diagnostic tests in female children at 6 years of age, but not in the case of male children [ 28 ].

A recently published work reported that ADHD children present higher urine concentrations of chromium, manganese, cobalt, nickel, copper, molybdenum, tin, barium, and lead [ 29 ]. A recent study analyzing serum concentrations of different metals in ADHD children reported low levels of chromium, manganese, and zinc, as well as increased copper/zinc ratios in these children [ 30 ]. A meta-analysis on the relation between blood and hair zinc and ADHD found no statistical difference between ADHD and control children [ 31 ].

Thus, there are a number of environmental factors associated with ADHD incidence. While environmental factors are not found in all ADHD cases, the data reviewed herein highlight the importance of environment in different developmental stages—and even before conception—in regard to the risk of developing ADHD.

3. Sleep Disorders and ADHD

Sleep deprivation, either acute or chronic, produces decreased cognitive functioning (one of the main traits of ADHD). Interestingly, it also produces the externalizing symptoms observed in ADHD patients. For example, a very tired child might become hyperactive, while in a sleepy adult in a condition where it is not possible to sleep (for example, while driving), the externalizing behavior will help them to remain awake. Thus, both of the core ADHD symptoms can be produced by sleep deprivation. Conversely, hyperactivity in children or high internal activity in adults in the evening might lead to sleep disruption [ 32 ].

Among the sleep disorders found in ADHD patients are delayed sleep phase disorders, insomnia, sleep-disordered breathing, increased motor activity during the night, sleep anxiety, clenching teeth, periodic limb movement, restless legs, increased sleep onset latency and shorter sleep time, night awakenings, narcolepsy, and parasomnias [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Among them, delayed sleep phase disorder is one of the most frequently found, being present in 73–78% of both ADHD children and adults. This condition consists of a delay between the sleep propensity cycle and the circadian cycle, leading to increased daytime sleepiness and decreased cognitive functioning [ 32 ].

Sleep disturbance have an impact on daytime vigilance, producing excessive sleepiness [ 32 , 37 , 39 ], and can exacerbate inattention, impulsivity, and hyperactivity as means to remain awake [ 32 , 37 ]. Additionally, stimulant medication might also cause sleep disturbances, although OROS methylphenidate produces less adverse effects on sleep [ 34 , 36 ]. LDX, a stimulant prodrug that undergoes hydrolysis in the bloodstream releasing d-amphetamine, and atomoxetine, a non-stimulant pharmacological treatment for ADHD, do not produce adverse effects on sleep [ 36 ].

Sleep disturbances in ADHD patients can produce significant impairments in attention, mood, and behavior [ 32 , 35 ]. Physiologically, there is evidence supporting an overlap between brain centers regulating sleep and those regulating attention and arousal, so it is possible that affectation of one of these systems also affects the other. Similarly, affectation of noradrenergic and dopaminergic pathways is found in both ADHD and sleep disturbances [ 40 ].

Conversely, during wake time, sleep disturbances produces symptoms resembling those observed in ADHD patients [ 35 , 41 , 42 ]. It is, thus, recommended to assess sleep disorders in patients with ADHD symptoms in order to avoid misdiagnosis [ 41 , 42 ].

The relationship between sleep disorders and ADHD is complex. While ADHD might produce sleep disorders, they could also be coincident conditions [ 36 ]. Moreover, sleep disorders have been proposed to be not only one of the intrinsic features of ADHD, but also might be one of its causes [ 32 , 36 ]. Another possible explanation for this interaction would be an underlying common neurological disease leading to both sleep disorders ad ADHD [ 36 ]. A recent review on the subject proposed that chronic sleep disorders are some of the main causes of ADHD symptoms [ 32 ]. The authors suggested that patients presenting ADHD symptoms should undergo quantification of sleep and sleep problems in order to rule them out as the sole cause of ADHD symptoms. Thus, ADHD treatment should address both the symptoms (with classic ADHD treatment) and the sleep problem [ 32 , 34 , 35 , 36 ], although the effect of this combined treatment still requires further research [ 32 ].

4. Genetic Factors Associated with ADHD

Different studies have revealed an important genetic influence in the etiology of ADHD [ 43 ]. It is a polygenic condition with an important number of genes involved, as confirmed by a genome-wide association study on ADHD reporting 12 significant loci associated with this condition [ 44 ]. Many of the genes reported to be associated with ADHD participate in processes such as neurotransmission, neuritogenesis, synaptogenesis, or receptor location in synapses [ 45 ]. In this review, we will focus on two genes, a neurotrophin (brain-derived neurotrophic factor –BDNF-) and a molecule involved in dopaminergic signaling (DAT).

Brain-derived neurotrophic factor (BDNF) is a neurotrophin with high expression in the brain that is highly concentrated in the hippocampus and cortex. It has an important role in neuronal development, being important for neuronal proliferation, migration, differentiation, and maturation, as well as for synaptogenesis [ 46 ].

BDNF has been implied in ADHD pathophysiology. It has been proposed that low levels of this neurotrophin may explain the reduction in brain volume observed in ADHD patients, and it has also been implied in dopaminergic system homeostasis. Some pharmacological treatments for ADHD promote the regulation of plasma BDNF levels [ 47 ].

4.1.1. Circulating BDNF

Since BDNF is able to cross the blood–brain barrier and plasma concentrations of BDNF are highly correlated with its levels on cerebrospinal fluid, a number of studies have searched for a difference in plasma concentrations of BDNF in ADHD patients when compared against controls. There are reports indicating a lower concentration of BDNF in plasma of ADHD patients, both in children [ 48 ] and adults [ 49 ]. In another study involving children, an increase in plasma BDNF was observed after 6 weeks of treatment with an effective dose of methylphenidate [ 50 ]. In accordance, a recent study revealed that methylphenidate treatment produces an increase in serum BDNF in boys with ADHD [ 51 ]. However, this has not always been replicated, since there are also articles reporting no difference in serum BDNF between children with ADHD and controls [ 52 , 53 , 54 ].

A recently published meta-analysis encompassing studies comparing BDNF levels in ADHD patients without any other comorbidity found no overall difference between ADHD patients and controls. However, when analyzing males and females separately, they found significantly higher levels of plasma BDNF in males with AHDH than in control males, while no difference was found between females with and without ADHD [ 55 ].

Thus, different and even contrary results have been obtained regarding BDNF concentrations in plasma or sera of ADHD patients. While this suggests that the link between BDNF and ADHD is not completely clear, other alternatives should be considered. For example, fluctuations in serum BDNF concentrations in morning and evening samples have been reported [ 56 ], meaning the lack of relation between peripheral BDNF concentration and ADHD might be due to the time of the day when the sample was obtained.

4.1.2. Genetics of BDNF

There are a number single nucleotide polymorphisms (SNP) of the BDNF gene that have been associated with ADHD. Among the most studied variations in the BDNF gene, there is a polymorphism called Val66Met (also known as rs6265), in which a change in codon 66 produces a substitution of the original amino acid (valine) by methionine. The anatomical effects of this variation are more apparent in the hippocampus and cortex [ 46 ]. While some studies have assessed the presence of this SNP in ADHD patients [ 57 , 58 , 59 ], other studies failed to find an association between this polymorphism and ADHD [ 46 , 60 , 61 , 62 , 63 ].

Another SNP of the BDNF gene whose association with ADHD is not conclusive is rs2030324, since some studies report an association between this polymorphism and ADHD [ 57 , 58 , 59 , 64 ], while other reports fail to find this association [ 46 , 60 , 61 , 62 , 63 ].

There are other SNPs of the BDNF gene that have been studied so far, with positive correlations being shown between ADHD and the presence of C270T (rs27656701) [ 58 , 61 ], rs11030101 [ 62 , 64 , 65 ], and rs10835210 [ 62 , 63 ]. There are also reports addressing SNPs of the BDNF gene for which no association with ADHD has been found, including rs12291186, rs7103411 [ 63 ], and rs7103873 [ 62 , 63 ].

Moreover, rare single nucleotide variants of BDNF gen have also been associated with a higher risk of developing ADHD [ 66 ]. However, this is an area that requires further research.

As observed with peripheral BDNF concentrations, genetic variants of the BDNF gene have been associated with ADHD in numerous cases, although in some cases there are contradictory results in different articles (see Table 1 ). Moreover, some of the genetic variants of the BDNF gene associated with ADHD have also been studied in association with other neurological conditions and treatments. For example, C270T is reported to be associated with intellectual disabilities [ 58 ]. Moreover, rs11030101 is associated with a better response to electroconvulsive shock therapy for treatment-resistant depression [ 67 ], with body weight gain in schizophrenic patients treated with atypical antipsychotics [ 68 ], as well as with the presence of major depressive disorder [ 69 ], schizophrenia, and bipolar disorder [ 70 ], although there is another publication in which no evidence of association between this SNP and bipolar disorder was found [ 71 ]. Additionally, rs10835210 has been associated with bipolar disorder, schizophrenia [ 70 ], and phobic disorders [ 72 ].

Polymorphisms of the BDNF gene studied in relation with ADHD incidence. * Polymorphisms for which contradictory results have been reported. rs, reference SNP ID number.

For rs6265 (Val66Met), there are many articles addressing the association of this SNP with different conditions, and in some of them it has been found. For example, some articles report an association of this SNP with major depressive disorder [ 69 , 73 ], while other studies fail to find this association [ 74 , 75 ]. An association has also been reported between rs6265 and amnestic mild cognitive impairment, as well as with the transition from this condition to Alzheimer’s disease [ 76 ]. However, in patients with early-stage breast cancer, this SNP is associated with a lower probability of presenting cognitive impairment after chemotherapy [ 77 ].

4.1.3. Other Neurotrophines

While BDNF has been widely studied in association with ADHD, it is not the only neurotrophin studied in relation with this condition, given the important role of neurotrophines in central nervous system development and synaptic plasticity. In this regard, there are studies addressing the participation of fibroblast growth factor (FGF), vascular endothelial growth factor, insulin-like growth factor (IGF2) [ 47 ], glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF), and neurotrophin-3 (NTF-3) [ 47 , 53 ] in ADHD pathophysiology.

BDNF is a molecule highly involved in synaptic plasticity and has an undisputed role in central nervous system development. Therefore, it is not surprising to find a number of studies associating alterations in the presence of this neurotrophin in serum, or different SNPs of its gene, with ADHD. However, its role in ADHD development is not a constant for every sample of ADHD patients studied so far, and for many of the aspects of this molecule (serum levels, SNPs) there are reports indicating associations, with others finding no association at all. This does not mean that the alterations associated with this molecule are not important for ADHD, but rather highlight the variable etiology of this condition.

4.2. Dopaminergic System

The dopaminergic system emerges in early stages of CNS embryonic development, and an imbalance in this system might affect brain development. It is related with cell proliferation, neuronal differentiation and migration, synaptogenesis, and neurogenesis. Thus, it is not surprising that a role of this neurotransmitter system has been reported in different neurological diseases, including ADHD [ 78 ].

One of the most studied molecules of the dopaminergic system in relation to ADHD is DAT, a molecule responsible for dopamine reuptake, and the main target of two commonly used pharmacological treatments for ADHD, methylphenidate and amphetamines [ 78 ]. Genetic studies support the importance of this neurotransmission system for ADHD. Mice heterozygous for the DAT gene (+/− heterozygotes) are reported to present altered attentional function [ 79 , 80 ] and hyperactivity [ 80 ], while rat models with this heterozygous genotype do not present major affectations [ 81 , 82 ]. However, DAT knockout rats present hyperactivity [ 81 , 82 ], as well as a dysregulation in frontostriatal BDNF function [ 82 ]. Hyperactivity in these rats can be counteracted by amphetamine, haloperidol, and methylphenidate [ 82 ].

In humans, ADHD patients present lower DAT availability in the basal ganglia, caudate nucleus, and putamen [ 83 ]. The DAT gene presents a variable tandem repeat region (VNTR) at the untranslated 3′region, and there are different alleles for this VNTR, with the 9-repeat and 10-repeat alleles being the most frequently encountered. The reported effects of this VNTR on DAT expression vary in different articles, however the most recent results indicate that the 9-repeat allele is associated with a higher DAT expression than the 10-repeat allele. [ 84 ]. The possible association between this VNTR and ADHD has been addressed in various studies. For example, an analysis of both patients and the literature found an association of the 10-repeat/10-repeat genotype with ADHD only in adolescents [ 85 ], studies performed in children reported an association between the 10-repeat/10-repeat genotype and ADHD [ 86 , 87 ], while a recently published meta-analysis reported an association of the 10-repeat allele with ADHD in children and adolescents, specifically in European population [ 88 ]. However, there are also reports indicating no association at all between ADHD and the VNTR of DAT gene (9-repeat/10-repeat, 10-repeat/10-repeat, and 10-repeat/11-repeat genotypes) [ 89 ], no association between the 10-repeat/10-repeat allele with ADHD [ 90 ], and no association between ADHD and the 9-repeat or the 10-repeat alleles for this polymorphism [ 91 ]. The last three studies were performed in children.

Additionally, the relevance of this VNTR has been studied in relation to cognitive function in healthy subjects. Again, mixed results were found. A meta-analysis published in 2016 addressing studies performed in healthy subjects did not find any association between DAT VNTR and different cognitive functions, such as executive functions, inhibition, attention, and long-term declarative memory [ 92 ]. A study performed in children aged 3 to 5 years old addressing the presence of the 9-repeats and 10-repeats alleles revealed that the presence of the 10-repeat allele of the DAT gene is associated with diminished ability to voluntarily regulate reactivity in healthy children [ 93 ]. A recent study on both ADHD and healthy children reported an effect of the specific genotype in the performance of children on attentional switching when studying the whole research sample, in which children carrying the 9-repeat allele performed worse than those carrying the 10-reapet homozygous or the 10-repeat/11-repeat heterozygous allele [ 91 ]

The participation of the dopaminergic system in the pathophysiology of ADHD has been widely reported [ 78 ]. Herein, we study a particular variation of the DAT gene, a VNTR in the 3′ region of the gene, finding articles supporting a role of this polymorphism in ADHD, as well as works failing to find an association between this VNTR and ADHD. This does not imply a lack of importance of this variation, but rather highlights the variability in the genetic etiology of this condition. Moreover, while the dopaminergic system is highly involved in the pathophysiology of ADHD, given its role in CNS development, it is also strongly related with other neuropsychiatric conditions, such as autism [ 78 , 94 , 95 ] and schizophrenia [ 78 , 94 , 96 , 97 ].

5. Changes in Brain Structure and Function in ADHD Patients

As an NDD, ADHD involves alterations of mechanisms such as neurogenesis and synaptogenesis. There are a number of possible mechanisms through which these alterations take place, both environmental and genetic, some of which have been mentioned in the present review. In the end, all of these altered mechanisms produce an altered brain function affecting attention and impulse control, functions regulated by the central nervous system. Understanding the changes in brain function associated with ADHD might shed some light not only on the functional causes of this condition, but also on possible ways to deal with it.

5.1. Brain Imaging Studies

Children with ADHD present atypical connectivity in reward circuitry when compared with control children. Increased connectivity of the nucleus accumbens with the prefrontal cortex was observed to be associated with greater impulsivity [ 98 ].

Hypofunction and abnormal cortico-striatal pathways of the cortico-striato-thalamo-cortical (CSTC) circuit are associated with ADHD. Five different CSTC circuits have been reported: the sustained attention circuit, emotion circuit, selective attention circuit, hyperactivity circuit, and impulsivity–compulsivity circuit. Four of them (except emotion circuit) have been related with ADHD diagnostic criteria. However, pathogenesis of the emotion circuit is also related with ADHD [ 99 ]

A study on ADHD children reported significantly decreased white matter volume, as well as decreased volume in the cortex and caudate nucleus, although it did not reach statistical significance. Cortical thickness was reduced in ADHD patients bilaterally in the frontal cortex and in the right cingulate cortex, structures related with executive function and attention. Regarding default mode network, functional connectivity was reduced in ADHD children in the anterior and posterior cingulate cortexes, lateral prefrontal cortex, left precuneus, and thalamus. However, connectivity was increased in the bilateral posterior medial frontal cortex [ 100 ].

A study on male adolescents with ADHD and controls reported decreased gray matter volume in the left anterior cingulate cortex and bilateral decreases in the occipital cortex, hippocampus–amygdala complex, and cerebellum in ADHD adolescents [ 101 ]. Such decreases in cerebellar volume have been previously reported in both female and male ADHD patients [ 102 ].

An important issue with many of the imaging studies in ADHD patients has been small sample size. A large-scale study performed on children, adolescents, and adults with ADHD reported decreased surface area in children, mainly in the frontal, cingulate, and temporal regions. This effect was more pronounced in younger children (4–9 years old). Moreover, cortical thickness in ADHD children is also reduced in the fusiform gyrus and temporal lobe, an effect more prominent in children of 10 and 11 years old. No change in surface area or cortical thickness was observed in adolescent or adult ADHD patients [ 103 ].

There are important changes in brain morphology in ADHD patients. An elegant study performed in ADHD patients and controls from 6 to 28 years of age analyzed differences in neurodevelopmental trajectories. This study reported that ADHD patients present overall reduced cortical volume, mainly in frontal lobes, and primarily due to a decrease in surface area and gyrification. Interestingly, although both groups presented maturational changes due to age, they presented different trajectories for these changes, suggesting that ADHD is associated with developmentally persistent changes in the whole cortex, mostly due to decreased surface expansion (reduced surface area and less convolution) [ 7 ].

When comparing children with comorbid epilepsy and ADHD with control children, a widespread decrease in cortical thickness is observed, along with decreased volume in some subcortical structures and the brainstem. These alterations were observed early in the course of epilepsy, thus the authors suggested that neurodevelopmental changes occurred before epilepsy onset [ 104 ]. In children with comorbid autism spectrum disorder and ADHD, when compared with typically developing controls, presented significantly lower volumes in left postcentral gyrus. This was observed through magnetic resonance imaging in both children and preadolescents, but was absent in adolescents. The authors suggested that pathophysiology in these comorbid patients may be related to somatosensory deficits and delayed maturation in this area [ 105 ].

5.2. Quantitative Electroencephalography

All these changes lead to alterations in brain function. A frequently used technique for the study of brain activity is quantitative electroencephalography (qEEG), since it has a low cost, a high temporal resolution, and does not need special facilities to be performed. Furthermore, qEEG has also been used to determine the effects of pharmacological treatments on brain activity in order to assess effectiveness [ 106 , 107 ], to choose the correct pharmacological option for a patient [ 108 ], to study the effects of previous pharmacological treatments on the current one [ 109 , 110 ], as well as to determine a possible cognitive effect of the chosen pharmacological treatment [ 111 ].

During the last decades, several studies have performed qEEG analyses on ADHD patients. A review on the subject published in 2012 addressed the main associations between brain activity and ADHD, including increased frontocentral theta activity. Another frequently reported factor, although not always replicated, is an increased theta/beta ratio. For beta and alpha bands, most of the reports have indicated decreased activity, although there are also reports that have indicated increased activity in these frequency bands in ADHD patients [ 112 ]. One of the most used indicators for ADHD is the theta/beta ratio in the Cz region. It has been reported that ADHD children (inattentive and combined subtypes) present increased theta/beta ratios [ 1 ]. Another study found that children with ADHD presented more delta and theta activity [ 113 ]. However, some authors have mentioned that this measure is not necessarily useful for diagnosis, since among other issues, it presents variations according to age [ 114 ].

Another example of the influence of age on brain electrical activity associated with ADHD is a study comparing children with and without ADHD, as well as adults with and without ADHD. Interestingly, children with ADHD presented higher delta and theta activity than control children, while in adults no difference was found between ADHD group and controls in the frequency bands analyzed [ 115 ]. Among the few differences in qEEG activity found in adults with ADHD is a higher gamma activity (39.25–48 Hz), suggesting a functional alteration in dorsal attention network [ 116 ].

ADHD patients often present comorbidities [ 117 ], which might influence qEEG in a different way to the findings in ADHD only patients. For example, children with ADHD and problematic Internet use present differences in qEEG when compared to ADHD only patients. However, no differences were found between ADHD only patients and ADHD patients with depression [ 118 ]. Another study found that adolescents with ADHD and Internet gaming disorder presented lower relative delta power and greater relative beta power than adolescents with ADHD only [ 119 ].

It is noteworthy that although a number of studies have been published regarding neurophysiological correlates of ADHD through qEEG, there are still some differences in the results reported by different authors. Beyond possible methodological differences, there are a number of factors reported to influence qEEG activity in ADHD patients, which might be responsible—at least in part—for the differences reported so far, and which might be of importance when using qEEG information to choose or design a therapeutic approach. These factors include comorbidities [ 4 , 120 ] and the ages of the patients [ 114 , 116 , 121 ]. Other factors reported to affect qEEG activity in other populations and conditions are ethnicity [ 122 , 123 , 124 , 125 , 126 ], sociocultural environment during development [ 127 , 128 ], and the degree of advancement of a psychiatric condition, as reported for alcohol dependence [ 129 , 130 , 131 ].

6. Therapeutic Approaches

6.1. pharmacological treatment.

Both stimulant and non-stimulant pharmacological treatments have proven to be effective in diminishing ADHD symptoms in children and adolescents [ 132 , 133 ], although stimulant medication seems to have greater effectiveness [ 133 , 134 ]. Herein, we will address one frequently used stimulant (methylphenidate) and one frequently used non-stimulant (atomoxetine)

6.1.1. Methylphenidate

Methylphenidate is one of the most used drugs for ADHD treatment. It has been present in the market for 50 years and it reduces excessive hyperactivity, impulsivity, and inattention in children and adolescents with ADHD. In the United States, it is prescribed to 8% of children and adolescents under 15 years of age and to around 3% to 5% of the same population in Europe [ 135 ].

Methylphenidate blocks DAT and NET, reducing reuptake and producing an increase in available dopamine and norepinephrine in the synaptic cleft [ 135 , 136 , 137 ], leading to increased dopamine and norepinephrine transmission in the prefrontal cortex [ 132 ]. A meta-analysis on the effects of methylphenidate treatment on ADHD in adults found it effective in improving neurocognitive performance, accomplishing better results than placebo groups in terms of working memory, reaction time variability, vigilance, driving, and response inhibition [ 136 ].

6.1.2. Atomoxetine

Atomoxetine has been reported to be effective for ADHD treatment [ 138 ], being more effective in adults than in children [ 134 ].

Atomoxetine blocks norepinephrine reuptake, producing increased presence of norepinephrine and dopamine in prefrontal cortex [ 132 ]. Since atomoxetine does not produce an increase of dopamine or norepinephrine in the nucleus accumbens, it lacks abuse potential [ 132 , 139 ]. This drug is associated with improvements in quality of life in children adolescents and adults, although this parameter is not further increased with long-term use [ 139 ].

6.1.3. Adverse Effects

Both stimulant and non-stimulant pharmacological treatments for ADHD produce adverse effects in a percentage of treated patients. The main adverse effects found for these drugs (% of patients treated with stimulants/% of patients treated with non-stimulants) are decreased appetite (28.6%/14.2%), nausea (7.9%/10.3%), headache (14.5%/20.8%), insomnia (12.3%/8.6%), nasopharyngitis (6.0%/7.1%), dizziness (5.1%/10.0%), abdominal pain (7.8%/11.5%), irritability (9.3%/6.9%), and somnolence (4.4%/34.1%) [ 133 ].

A systematic review on the adverse effects of methylphenidate in children and adolescents revealed that about 1 in 100 patients present serious adverse events after methylphenidate treatment (including death, cardiac problems and psychiatric disorders), while more than half of the patients treated with methylphenidate suffer one or more adverse events. The authors concluded that it is important to identify subgroups of patients who might be harmed by methylphenidate treatment and highlight the importance of remaining alert to possible adverse events in patients with this treatment [ 135 ]. There might also be uncommon adverse effects. For example, there is a report of 3 cases of systemic sclerosis associated with methylphenidate treatment [ 140 ]. The authors of the last study suggested that patients with signs of autoimmune or vasospastic conditions should be briefed about this possible side effect before commencing methylphenidate treatment.

A systematic review on possible adverse effects of atomoxetine, including decreased growth rate, cardiovascular and hepatic effects, aggression, psychosis, seizures, and suicidal ideation, determined that evidence indicates it is safe to use in ADHD patients [ 141 ]. Furthermore, the presence of comorbidities does not interfere with treatment efficacy, nor does treatment exacerbate comorbid symptoms [ 142 , 143 ]. However, it is important to be alert to other possible adverse effects. A case report and review indicated that the appearance of tics is a common side effect of atomoxetine treatment [ 144 ].

Methylphenidate and atomoxetine are known to increase heart rate and blood pressure, raising concern regarding possible cardiovascular effects of these drugs in ADHD patients. A review on the cardiovascular effects of these drugs in healthy subjects found the drug to be safe to use. Most of these studies were performed in children and adolescents, although there have also been some studies performed on adults, with no serious risk being reported in these subjects either. However, patient blood pressure and heart rate should be monitored on a regular basis. Moreover, careful follow-up should be performed for patients presenting certain cardiovascular conditions [ 145 ].

Weight loss has also been reported after atomoxetine treatment, occurring during the first two years of treatment. However, evidence suggests this decrease begins to be compensated between 2 and 5 years after the beginning of treatment [ 141 ]. Similarly, methylphenidate has been associated with adverse effects such as anorexia, weight loss, and insomnia [ 146 ].

A comparative study on short-term effects of methylphenidate and atomoxetine on ADHD reported significantly higher weight loss in children treated with atomoxetine [ 147 ]. However, a more recent study reported that children present significantly more weight loss after methylphenidate than after atomoxetine treatment [ 148 ].

A meta-analysis on gastrointestinal adverse effects of methylphenidate reported increased risk of decreased appetite, weight loss, and abdominal pain in children and adolescents under this pharmacological treatment [ 149 ].

A comparison between the presence of adverse effects after methylphenidate and atomoxetine treatments in ADHD children indicated methylphenidate as a safer option, since children under atomoxetine treatment presented higher incidence rates of anorexia, nausea, somnolence, dizziness, and vomiting than children under methylphenidate treatment [ 147 ]. A more recent study reported similar results, since children treated with atomoxetine presented higher incidence rates of mild adverse effects, such as decreased appetite, weight loss, dyspepsia, abdominal pain, stomach ache, irritability, mood disorders, and dizziness. As for severe adverse effects, patients under atomoxetine treatment presented higher incidence rates of gastrointestinal, neuropsychiatric, and cardiovascular effects [ 150 ].

6.1.4. Long-Term Adverse Effects

Long-term adverse effects of methylphenidate are the subject of intense study, given that it is the first-line stimulant drug used for ADHD treatment in children, adolescents, and adults [ 11 , 151 ]. A review on the subject addressed different adverse effects studied in patients after long-term (over one year) administration of methylphenidate, including low mood or depression, anxiety, irritability or emotional reactivity, suicidal behavior or ideation, bipolar disorder, psychotic symptoms, substance use disorders, tics, seizures or EEG abnormalities, and sleep disorders. The authors concluded that existing information indicates that methylphenidate is safe to use, although caution should be taken when prescribing this drug to specific groups, such as preschool children, patients prone to psychosis or tics, and high-risk adolescents [ 152 ]. However, the need for more studies on the long-term effects of treatment with this drug is highlighted, since studies in humans are rather scarce and with a high degree of heterogeneity in terms of methodological approach [ 151 , 152 ].

6.1.5. Long-Term Therapeutic Effect

Given that ADHD is a chronic disorder and that many of the children presenting ADHD will still present symptoms in adulthood, it is particularly important to determine the long-term effectiveness of pharmacological treatments. However, very few studies address this issue, and no conclusion can yet be drawn regarding the long-term effects (years) of pharmacological treatment of ADHD on symptom reduction and quality of life. Thus, the long-term efficacy of drug treatment for ADHD remains under debate [ 153 , 154 , 155 , 156 ]

Current pharmacological treatments for ADHD have proven to be safe and effective. The efficacy of these treatments on ADHD symptoms is clear, and thus pharmacological therapy is often used to treat ADHD patients [ 136 , 138 , 141 , 152 ]. However, there are also some drawbacks to this therapeutic approach, including the time required to reach the effective dose for each patient [ 3 , 157 ]; the lack of response in some patients [ 121 , 158 , 159 , 160 ]; the unresolved issue of long-term effectiveness (of great importance given that in many cases the treatment must go on for years) [ 153 , 154 , 155 , 156 ]; the presence of adverse effects, which although not life threatening in most cases, are nevertheless upsetting [ 133 , 135 , 144 ]; and the existence of specific groups of patients with whom a greater caution must be taken [ 140 , 145 , 152 ]. Altogether, these drawbacks have led to the search of new therapeutic approaches. One of the strategies studied so far is the possibility of using other drugs to treat ADHD, including drugs interacting with serotoninergic (metadoxine, paroxetine, duloxetine, buspirone), glutamatergic (memantine), cholinergic (AZD3480, AZD1446, lobeline, galantamine, mecamylamine), histaminergic (mk-0249), and catecholaminergic neurotransmission systems (modafinil, droxidopa, desipramine, bupropion, nomifensine, reboxetine, venlafaxine, duloxetine, guanfacine, aripiprazol, dasotraline, selegiline), as well as lithium [ 161 ].

6.2. Non-Pharmacological Therapies

Pharmacological therapy is effective although presents some inconveniences, including the existence of adverse effects in some patients and lack of effect in others. Therefore, there are also different non-pharmacological approaches for ADHD treatment.

6.2.1. Behavioral Parent Training

The goal of parent training is to equip parents with techniques that will be useful in managing ADHD-related behavior presented by their children. A systematic review published on 2011 found no reliable effect of ADHD children’s behavior, although it may lead to increased confidence and decreased stress in parents [ 162 ]. Later studies found an effect of behavioral parent training on ADHD symptoms, which is not increased by previous working memory training, although this combination did produce positive effects on working memory storage and processing [ 163 ]. It is noteworthy that cognitive functioning of both parents and children influences the effectiveness of this therapeutic approach on ADHD symptoms. Better working memory in children and higher parental response caution presented an association with improvements in inattention. As for conduct problems, better parental self-regulation was associated with a better result in this area. However, none of the measured cognitive functions in children or parents were associated with improvements in hyperactivity [ 164 ]. Moreover, behavioral parent training improves coexistence at home, since a reduction in the frequency and severity of problematic situations is produced, along with a reduction of stress in parents [ 165 ].

6.2.2. Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) has also been used to treat ADHD. A review performed on the subject found CBT to be effective in reducing ADHD symptoms in adults, however only when improvement was evaluated by the patient and not when evaluated by the clinician [ 166 ], although a more recent meta-analysis on the subject reported a good effect of CBT on ADHD adults [ 167 ]. A Cochrane systematic review concluded that CBT has a positive effect on ADHD symptoms, either alone or in conjunction with other therapies, although considered the evidence to be low-quality in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group approach. [ 168 ]. A meta-analysis found that CBT is one of the most effective non-pharmacological options to treat ADHD, ranking just after physical exercise [ 169 ]. A later systematic review confirmed the effects of CBT on ADHD symptoms [ 170 ]. A recent study reported CBT to be effective in reducing ADHD symptoms in patients, either with or without conjunct medication [ 171 ].

6.2.3. Attention Training Techniques

Attention training techniques are often used to improve life quality and increase well-being. Given the effect of these techniques on brain activity, as well as on attention and self-regulation, their use to reduce ADHD symptoms and improve life quality in these patients is currently under study [ 172 ].

Mindfulness can be defined as paying attention to the present, an activity that implies sustained attention. A systematic review on the effects of mindfulness-based interventions on ADHD found that such approaches were popular among adults with ADHD, finding improvements in attention, although the effects of such approaches in children and adolescents are still unclear [ 173 ]. A recent meta-review reported a large effect size of mindfulness on ADHD [ 174 ]. A review on the effects of mindfulness-based cognitive therapy on ADHD adults reported good effects of this therapeutic approach, especially when used in conjunction with pharmacological therapy [ 175 ], while a systematic review analyzing the effects of meditation-based techniques (either on parents and children or on children only) on ADHD children could not draw a clear conclusion regarding beneficial effects [ 176 ].

Adult ADHD patients that underwent an 8-week mindfulness awareness practice period presented decreased ADHD, depression, and anxiety symptoms [ 177 ]. Similarly, a study performed with children revealed that an 8-week period of mindfulness-oriented meditation produced improvements in the performance of neuropsychological tests, as well as in ADHD symptoms. Although encouraging, the authors stated that the results are still preliminary, given the small number of children participating in the study [ 178 ]. There are also results indicating that this technique produces an improvement in ADHD symptoms in ADHD children with oppositional defiant disorder [ 179 ].

6.2.4. Neurofeedback

Neurofeedback (NFB) is a therapy in which patients learn to modify EEG patterns through operant conditioning. There are articles reporting the induction of plastic changes after NFB training [ 180 , 181 , 182 , 183 ], supporting a theory explaining the effects of NFB on different brain disorders through the induction of synaptic plasticity, leading to an homeostatic set point. Additionally, besides some unusual cases of headache, no collateral effects have been reported with this technique. One of the most interesting aspects of NFB is the induction of plastic changes from within the brain under normal physiological conditions, without the need for an external stimuli such as pharmacological treatments or transcranial stimulation to alter brain activity, thus the probability of adverse effects is minimal [ 181 ].

Specific NFB protocols have been developed over the decades. These protocols were designed based on articles reporting specific qEEG variations in neurological patients or qEEG patterns associated with cognitive function. Some of these standardized protocols have been studied in terms of their ability to treat ADHD [ 184 ].

Several articles have addressed the use of NFB in ADHD patients. The results have been mixed and numerous meta-analyses have been published on the subject. The conclusions of these meta-analyses have also been mixed. There are meta-analyses reporting good effects of NFB on ADHD [ 185 , 186 , 187 ], not finding reliable effects [ 188 ], not reaching a conclusion on the subject of efficacy [ 189 ], finding a minor effect of this therapeutic approach significantly below what is observed with pharmacological treatment [ 190 ], or finding a minor effect only in the presence of pharmacological treatment [ 191 ].

An overview of recent publications gave the same impression. Some reports found effects of NFB theta/beta or theta/alpha protocols on ADHD, measurable at follow-up 8 weeks or 12 months after treatment completion [ 192 , 193 ]. Other reports found no effect [ 194 , 195 , 196 ]. Moreover, there are reports revealing a minor effect of NFB, below the effect levels of other therapeutic approaches [ 197 , 198 , 199 ].

NFB is a therapeutic approach widely studied for ADHD treatment. The results so far have been mixed. However, given the absence of side effects and its ability to induce synaptic plasticity [ 181 ], it is an option worth keeping in mind.

6.2.5. Other Non-Pharmacological Approaches

The use of non-pharmacological supplementations, such as polyunsaturated fatty acids, peptides, amino acids, plat extracts, probiotics, micronutrients, and herbal supplementation, is currently being studied in order to determine their usefulness in treating ADHD. However, further research is still needed in this area [ 200 ].

A study performed in ADHD children under methylphenidate treatment for whom zinc supplementation was added reported no significant effect of zinc supplementation on the total score for a parent’s questionnaire for ADHD or in the hyperactivity and impulsivity subscales. However, zinc-supplemented children present improvements in inattention scores [ 201 ].

A meta-analysis on non-pharmacological interventions for ADHD patients found that physical exercise produced a good effect on ADHD cognitive symptoms, especially aerobic exercise targeting executive functions [ 169 ].

7. Treatment Personalization

In the first sections of this review, we addressed some of the factors associated with ADHD incidence, ranging from a variety of environmental factors to the presence of different genetic polymorphisms. However, these different etiologies are not always present, since patients might present one or another (see Section 2 and Section 3 ). Similarly, while there are some changes in brain activity associated with ADHD, they are not always the same (see Section 4 ). Accordingly, there is also variation in the response of patients to both pharmacological and non-pharmacological treatments (see Section 5 ).

Since the etiology of ADHD could be very different from patient to patient, the precise nature of the physiological changes underlying the clinical manifestations of ADHD in each case could be slightly different, affecting the effectiveness of the chosen treatment and possibly explaining the variation in the effect of the same treatment on different patients. This can be observed in the variations in qEEG activity observed in different studies [ 112 , 113 , 114 , 116 , 121 ]. However, the design of personalized treatments based on specific characteristics of each patient could lead to better clinical results. In this regard, strategies to adjust therapeutic approaches based on patients’ characteristics have been used for both pharmacological and non-pharmacological therapies.

Selecting the appropriate pharmacological treatment and the dose to be used takes some time, given the large inter-individual variability regarding treatment efficacy, leading to a delay in reaching a therapeutic effect, and in some cases producing an early termination of treatment due to frustration, either by the provider or the family [ 157 ]. Moreover, there is some variability regarding patient response to methylphenidate, including patients that do not achieve adequate symptom control or experience adverse effects with commonly used doses. Therefore, dose optimization has been proposed as a means to achieve an adequate effect for most of the patients, enhancing both the efficacy and safety of methylphenidate treatment [ 3 ]. This has led to the search for strategies to find adequate treatments for each patient, such as pharmacogenomics, in which a patient’s genotype for a particular gene is used to predict the effects of medication in that patient. However, in spite of the progress that has already been made, no pharmacogenomic test so far has been found to be helpful in treatment selection [ 157 ].

Treatment resistance has been reported for both atomoxetine [ 158 ] and methylphenidate [ 121 , 159 , 160 ]. For this reason, qEEG can be used as a source of information to determine at an earlier point whether methylphenidate [ 121 , 160 , 202 ] or atomoxetine [ 107 , 202 ] is effective or if an alternative treatment is needed for a patient.

Most of the reports on the use of NFB for ADHD use a standardized protocol, either equal for all participants or adapted to each patients after qEEG analysis. However, there is another more personalized approach known as qEEG-informed (or qEEG-guided) NFB. In this variant of NFB, rather than selecting a particular protocol (for example, theta/beta ratio) and applying it to all participants, subjects receive a NFB protocol selected for them after qEEG analysis. This type of NFB has been successfully used in schizophrenia [ 203 ], obsessive compulsive disorder [ 204 ], migraine [ 205 ], dementia [ 206 ], and with learning-disabled children [ 207 , 208 ].

There are so far only two studies applying qEEG-informed NFB in ADHD patients, so it is not yet possible to perform a meta-analysis on the effects of this type of NFB on ADHD. However, a positive effect of NFB has been reported in both published studies [ 209 , 210 ].

8. Discussion

ADHD is an NDD with a complex etiology. While it is clear that its main cause is alterations in neurodevelopmental processes such as synaptogenesis, myelination, and neurogenesis [ 5 ], the causes of these neurodevelopmental alterations are diverse. In some cases they might be associated with environmental factors such as premature birth [ 6 ], perinatal problems [ 9 ], nutrition during pregnancy [ 10 ], or exposure to heavy metals [ 17 , 18 , 19 , 26 , 27 , 29 ]. Additionally, there is strong evidence of genetic influence on ADHD [ 43 , 44 ], and an interaction between environmental and genetic factors cannot be discarded.

The purpose of this review is not to fully describe all factors associated with ADHD appearance, but rather to address some of the main etiologies described so far, in order to clarify the high diversity of factors associated with this NDD. When analyzing the different sections of this review, one thing becomes evident—that ADHD patients are diverse regarding the etiology of their condition and their responses to treatment. This heterogeneity outlines the high variability in patients’ particular conditions regarding ADHD symptom manifestation and treatment, since it is probable that the underlying neurophysiological alterations for each patient are at least slightly different. Thus, standardized treatment (either pharmacological or non-pharmacological) may not be equally efficient in all cases.

Moreover, there could be other factors that are usually disregarded in relation with ADHD incidence, but which might play an important role in this condition. Recently, the gut microbiome has been the subject of intense research as an ADHD-associated factor, and even though further research is needed in order to determine its precise influence on ADHD, there are already reports indicating a possible link between them [ 211 , 212 , 213 , 214 ].

In the end, all of these factors produce changes in brain structure and function [ 1 , 7 , 112 , 113 , 114 , 115 ], leading to the symptomatology observed in ADHD patients. Therapeutic approaches to treat this condition have the objective of compensating such alterations in order to reduce symptoms and improve quality of life. However, as we have observed in this review, not all patients present the same neurophysiological changes. Studies performed on qEEG activity have yielded different results regarding brain electrical activity in ADHD patients [ 4 , 112 , 114 , 120 ]. Additionally, both brain imaging and qEEG techniques have revealed that changes are not consistent throughout the lifespan, being different in children and adults [ 114 , 115 , 116 , 121 ]. Therefore, there is a need for treatment personalization for each ADHD patient in order to achieve greater effect with minimal adverse effects.

Pharmacological treatments, both stimulants and non-stimulants have proven to be effective and safe for ADHD patients [ 132 , 133 ], and thus are widely prescribed to treat this condition. However, the pharmacological approach to ADHD treatment has some drawbacks, mostly regarding difficulties in reaching effectiveness in all patients [ 3 , 121 , 157 , 158 , 159 , 160 ] and the presence of adverse effects [ 133 , 135 , 144 ].

The search for other therapeutic options has led to the assessment of the effects of other drugs on ADHD [ 161 ], as well as the design of non-pharmacological treatments, such as behavioral parent training, CBT, attention-improving techniques, and NFB.

The effects of behavioral parent training on ADHD symptoms in children are not consistent, with some articles finding effects [ 163 ] and others not finding any [ 162 ]. However, behavioral parent training does reduce stress in parents and promotes a better coexistence at home, which is favorable for children [ 162 , 165 ]. In the case of CBT, there is more evidence indicating a good effect in reducing ADHD symptoms [ 167 , 168 , 169 , 170 , 171 ]

Attention training techniques are still under intense study. There is some evidence regarding the effect of this technique on ADHD in adults [ 173 , 175 ], while in children and adolescents the results are not clear so far [ 173 , 176 ].

A number of studies on the effect of NFB on ADHD symptoms have yielded different results, either finding a positive effect [ 185 , 186 , 187 , 192 , 193 ], a mild effect [ 190 , 197 , 198 , 199 ], or no effect at all [ 188 , 194 , 195 , 196 ]. However, NFB has a number of advantages that encourage the search for an adequate protocol to treat ADHD patients. It is targeted directly to change brain activity associated with the condition under treatment, it has virtually no side effects, and the therapeutic effect is due to the induction of plastic changes in the central nervous system, thus it might establish a long-term changes [ 180 , 181 , 182 , 183 ].

9. Conclusions

In the present review, we have gone through some of the factors associated with ADHD, and it is clear that a great heterogeneity exists in the etiology of this condition. Therapeutic approaches, although functional in many cases, also show heterogeneity in their effects in certain groups of patients. The diverse range of effects of the therapeutic approaches used should not be a surprise, given the diversity of etiologies found in ADHD. Even though clinical manifestations of this condition might be similar (diagnosis is based on the presence certain symptoms), the same clinical manifestations could occur with different underlying physiological changes, considering the variations in qEEG activity in different groups of patients [ 112 , 113 , 114 , 116 , 121 ]. Thus, these neurophysiological changes presented by patients may not necessarily respond in equal form to a given therapeutic approach. Given the inter-personal variance in the etiology of ADHD, it is advisable to personalize the therapeutic approach. Regarding pharmacological therapies, dosage optimization [ 3 ], pharmacogenomics [ 157 ], and the use of qEEG to select the adequate drug for a given patient have been proposed [ 107 , 121 , 160 , 202 ].

Regarding non-pharmacological options, the use of qEEG-informed NFB has been proposed for personalized treatment in ADHD patients. The studies carried out to date have shown positive results [ 209 , 210 ], although the number of studies is still too small to draw a conclusion. However, given the advantages of NFB [ 181 ] and the positive effects of this approach reported for other conditions [ 203 , 204 , 205 , 206 , 207 , 208 ], it is worth performing further studies on the effectiveness of this type of NFB on ADHD.

Author Contributions

Conceptualization, L.N.-J. and W.V.H.-M. writing—reviewing and editing, L.N.-J., W.V.H.-M., and A.H.-S. All authors have read and agreed to the published version of the manuscript.

This research received no external funding

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Introduction To Attention Deficit Hyperactivity Disorder (ADHD)
• Introduction to Attention Deficit Hyperactivity Disorder (ADHD)

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What is ADHD?

ADHD is one of the most common childhood disorders. Approximately 3-7% of school-aged children have the disorder. Prevalence rates seem to vary by community, with some research indicating that larger cities may have rates as high as 10-15%.

• Distractibility.
• Hyperactivity.
• Poor impulse control.
• Forgetfulness.

The "attention deficit" component of ADHD refers to inattention , or difficulty focusing for long periods and being easily distractible . The "hyperactivity" portion of ADHD is used to describe behavior that is restless, agitated, and difficult to resist . Hyperactive individuals often appear as if they NEED to move. They are in almost constant motion, and frequently make excessive noise.

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Although impulsivity is not included in the diagnostic label, it is also considered a behavior characteristic of this disorder. When impulsivity is paired with hyperactivity, the person appears to act without prior thought or intention. Impulsive behaviors are often intrusive, rude, and dangerous, sometimes resulting in accidents. For example, children may not think about landing when they jump off a ledge to catch a ball.

Given that all children tend to exhibit some of the behaviors characteristic of ADHD, such as daydreaming, restlessness, or thoughtlessness, it is important to understand the difference between normal behaviors and a true disorder. True ADHD symptoms are long-term and severe enough to impair someone's everyday functioning . Moreover, symptoms must occur in more than one environment . For example, in children, this means that the ADHD symptoms interfere with success in school and relationships with parents, siblings, or peers. For adults, ADHD interferes with both work and family functioning.

Experts consider ADHD to be a chronic condition that has no cure. However, individuals with this disorder should not give up hope. There are many different treatment options that can help people successfully manage ADHD symptoms and move forward in their lives.

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Harvard’s Institute of Politics Announces Fall 2024 Resident Fellows

Introduction

CAMBRIDGE, MA - The Institute of Politics at Harvard Kennedy School today announced the appointment of six Resident Fellows who will join the IOP for the Fall 2024 semester. The fellows bring diverse experience in politics, elected office, polling, journalism, and economic development to address the challenges facing our country and world today.

"We are thrilled to welcome this Fall's cohort of Resident Fellows to Harvard to engage and collaborate with our students and community, and to get their thoughts and insight in the final few months of this year's historic election. Their diverse experiences will no doubt inspire our students to consider careers in public service and prepare them to provide essential political leadership in the months and years ahead," said IOP Director Setti Warren .

"We are excited to have such a remarkable group of Fellows at the IOP this Fall. They bring varied perspectives on how to best approach some of our country's most consequential challenges, and I am confident our students will gain important insight into the fields of politics, civic engagement, journalism, and more," said Michael Nutter , Chair of the Institute of Politics' Senior Advisory Committee, and former Mayor of Philadelphia.

"We are thrilled to welcome the incredibly accomplished members of the 2024 Fall Fellows Cohort as we begin the fall semester prior to the incredibly important U.S. election. As we close out the 'biggest election year in history,' our world remains in the throes of a major period of democratic backsliding. American voters, including many Harvard students, will once again face the possibility of reactionary backsliding and threats to fundamental rights. Closer to home, we are keenly aware of the threats to free speech on campus. While this semester will bring renewed challenges to and debates concerning those fundamental rights, we are hopeful that study groups will remain a source of vibrant, productive, and gratifying discussions on Harvard's campus. In that spirit, this semester's cohort of Fellows will bring in critical perspectives from the varied worlds of governing, policymaking, polling, reporting, and campaigning to equip students with the tools necessary to create a better tomorrow. We are confident that this cohort of Fellows will help this program to remain a bastion of freedom of speech and civil discourse on Harvard's campus," said Éamon ÓCearúil ‘25 and Summer Tan ‘26 , Co-Chairs of the Fellows and Study Groups Program at the Institute of Politics.

IOP Resident Fellows are fully engaged with the Harvard community. They reside on campus, mentor a cohort of undergraduate students, hold weekly office hours, and lead an eight-week, not-for-credit study group based on their experience and expertise.

Fall 2024 Resident Fellows:

• Betsy Ankney: Former Campaign Manager, Nikki Haley for President
• John Anzalone: One of the nation's top pollsters and strategists, and founder of Impact Research, a public opinion research and consulting firm
• Alejandra Y. Castillo: Former U.S. Assistant Secretary of Commerce for Economic Development
• Asa Hutchinson: Former Governor of Arkansas and 2024 Presidential Candidate
• Brett Rosenberg: Former Director for Strategic Planning, National Security Council and Deputy Special Coordinator for the Partnership for Global Infrastructure and Investment, Department of State
• Eugene Scott: Host at Axios Live, and former reporter who has spent two decades covering politics at the local, national and international level, including at the Washington Post and CNN

Brief bios and quotes can be found below. Headshots are available upon request.

Betsy Ankney Ankney is a political strategist with over 15 years of experience on tough campaigns. She has been involved in campaigns and Super PACs at the national and state level and played a role in some of the biggest upsets in Republican politics. She has been an advisor to Ambassador Nikki Haley since 2021, serving as Executive Director for Stand for America PAC and most recently as Campaign Manager for Nikki Haley for President. After starting with zero dollars in the bank and 2% in the polls, the campaign defied the odds, raised $80 million, and Nikki Haley emerged as the strongest challenger to Donald Trump. Ankney served as the Political Director of the National Republican Senatorial Committee for the 2020 cycle. She advised senate campaigns across the country, working directly with candidates and their campaigns on budgets, messaging, and fundraising. Prior to her work at the NRSC, Ankney managed multiple statewide campaigns, including Bruce Rauner for Governor in Illinois and Ron Johnson for Senate in Wisconsin. For her work on Ron Johnson’s race, she was named “Campaign Manager of the Year” by the American Association of Political Consultants for 2016. Ankney got her start in politics at the 2008 Republican National Convention and served in various roles at the Republican National Committee as well as on multiple campaigns and outside efforts. She serves on the boards of The Campaign School at Yale and The American Association of Political Consultants. She is from Toledo, Ohio and attended Vanderbilt University.

"I am honored to be a part of the fantastic program at the Harvard Institute of Politics. As we enter the final stretch of one of the wildest and most unpredictable election cycles in modern history, I look forward to having conversations in real time about our political process, what to look for, and why it matters." – Betsy Ankney

John Anzalone Anzalone is one of the nation’s top pollsters and messaging strategists. He has spent decades working on some of the toughest political campaigns in modern history and helping private-sector clients navigate complex challenges. He has polled for the past four presidential races, most recently serving as chief pollster for President Joe Biden’s 2020 campaign. In that role, he helped develop the messaging and strategy that drove paid communications, major policy rollouts, speeches, and convention thematics. He has also polled for the campaigns of President Obama and Hillary Clinton, and has helped elect U.S. senators, governors, and dozens of members of Congress. Anzalone works with governors across the country, including current Governors Gretchen Whitmer (MI) and Roy Cooper (NC). He polls regularly for the Democratic National Committee, the Democratic Senatorial Campaign Committee, the Democratic Congressional Campaign Committee, Senate Majority PAC, and AARP. With more than 30 years of experience in message development and strategic execution, he has been called on by key decision-makers, executives, and CEOs to provide counsel in a changing world and marketplace. He has extensive experience using research and data to break down complex subjects into digestible messages that resonate with target audiences. He grew up in St. Joseph, Michigan, and graduated from Kalamazoo College in Kalamazoo, Michigan. He is married and has four children, two dogs, and lives in Watercolor, Florida.

"After a 40-year career in politics I am so excited to give back by sharing and mentoring politically active and curious students, but also to have an opportunity to learn from them myself. During the next three months we will be living the 2024 elections together in real time. There is nothing more exciting than that regardless of your political identity." – John Anzalone

Alejandra Y. Castillo The Honorable Alejandra Y. Castillo was nominated by President Biden and sworn in as U.S. Assistant Secretary of Commerce for Economic Development on August 13, 2021, becoming the first women of color to hold this position. Ms. Castillo led the Economic Development Administration (EDA) between August 2021-2024 through an unprecedented moment of growth and opportunity. As the only federal agency focused exclusively on economic development, she guided EDA’s the implementation of over $6.8 billion dollars in federal funding, powering EDA and its mission to make transformational placed-based investments to support inclusive and equitable economic growth across America. Spanning over two decades of public service and non-profit work, she has served in three Presidential administrations --Biden, Obama and Clinton. Her career has also included a drive to shattering glass ceilings and providing inspiration to multiple generations of diverse leaders. Castillo is an active member in various civic and professional organizations, including the Hispanic National Bar Association, the American Constitution Society, as well as the Council on Foreign Relations. Castillo holds a B.A. in Economics and Political Science from the State University of New York at Stony Brook; a M.A. in Public Policy from the Lyndon B. Johnson School of Public Affairs, University of Texas at Austin; and a J.D. from American University, Washington College of Law. A native of Queens, NY., the daughter of immigrants from the Dominican Republic.

"I am excited to join this Fall semester IOP Fellowship class and have the opportunity to engage with students and faculty members across the University. The IOP fellowship presents a great forum to discuss and evaluate the future of U.S. industrial strategy and economic growth in light of the historic federal investments in place-based economic development during the last three years. I am honored to join my colleagues in making this an exciting and informative semester for students." – Alejandra Y. Castillo

Asa Hutchinson Governor Asa Hutchinson is a former Republican candidate for President of the United States. He served as the 46th Governor of the State of Arkansas and in his last election, he was re-elected with 65 percent of the vote, having received more votes than any other Republican candidate for governor in the State’s history. As a candidate for President, Hutchinson distinguished himself as an advocate for balancing the federal budget, energy production and enhanced border security. He also was a clear voice for the GOP to move away from the leadership of Donald Trump. Hutchinson’s time as governor is distinguished by his success in securing over $700 million per year in tax cuts, safeguarding the retirement pay of veterans from state income tax, shrinking the size of state government, creating over 100,000 new jobs and leading a national initiative to increase computer science education. The Governor’s career in public service began when President Ronald Reagan appointed him as the youngest U.S. Attorney in the nation for the Western District of Arkansas. In 1996, he won the first of three consecutive terms in the U.S. House of Representatives. During his third term in Congress, President George W. Bush appointed Governor Hutchinson to serve as Administrator of the Drug Enforcement Administration and later as the nation’s first Undersecretary of Homeland Security for Border Protection. He is a former Chairman of the National Governors. He grew up on a small farm near Gravette. He and his wife, Susan, have four children and seven grandchildren. Governor Hutchinson is currently CEO of Hutchinson Group LLC, a security consulting firm.

"After 8 years as Governor it is time to teach and mentor. I am honored to have the opportunity this fall to share my experiences and perspective but to also learn from the students and my colleagues who will also be resident fellows at the IOP. The timing is historic with our democracy facing a critical choice this fall as to the direction of our country." – Asa Hutchinson

Brett Rosenberg Rosenberg is a foreign policy expert who has served in the White House, Department of State, and Senate. During the Biden Administration, Rosenberg was the inaugural Deputy Special Coordinator for the Partnership for Global Infrastructure and Investment, President Biden’s and the G7’s flagship program designed to meet infrastructure needs in low- and middle-income countries. At the White House, Rosenberg served on the National Security Council as Director for Strategic Planning, working on shaping and realizing approaches to issues spanning from international economics to Western Hemisphere engagement, as well as helping to write the National Security Strategy. Prior to her service in the Biden administration, Rosenberg was Associate Director of Policy for National Security Action, where she remains a senior advisor. Rosenberg began her career in Washington as a legislative aide to then-Senator Kamala Harris, where she advised the senator on a range of domestic and economic policy issues. Rosenberg is a Nonresident Scholar at the Carnegie Endowment for International Peace, and her writing has appeared in outlets including Foreign Affairs, Foreign Policy, The New Republic, and McSweeneys. She received her A.B. in History from Harvard College and her PhD (DPhil) in International Relations from the University of Oxford, where she was a Rhodes Scholar.

"What a privilege it is to be part of this incredible community in this incredible moment. I can't wait to learn from the students, faculty, and other fellows as we dive in together to discuss some of the most pressing issues facing the United States and the world." – Brett Rosenberg

Eugene Scott Eugene Scott is a host at Axios Live, where he travels the country interviewing political and policy leaders. He was previously a senior political reporter for Axios covering 2024 swing voters and voting rights. An award-winning journalist, Scott has spent two decades covering politics at the local, national and international levels. He was recently a national political reporter at The Washington Post focused on identity politics and the 2022 midterm election. Following the 2020 presidential election, he hosted “The Next Four Years,” then Amazon’s top original podcast. He also contributed to “FOUR HUNDRED SOULS: A Community History of African America, 1619-2019,” which topped the New York Times’ bestseller list. In addition to writing, Scott has regularly provided political analysis on MSNBC, CBS and NPR. Scott was a Washington Correspondent for CNN Politics during the 2016 election. And he began his newspaper career at the Cape Argus in Cape Town, South Africa not long after beginning his journalism career with BET News’ “Teen Summit.” Scott received his master’s degree from Harvard University’s Kennedy School of Government and his bachelor’s from the University of North Carolina Hussman School of Journalism and Media. He is a D.C. native and continues to live in the Nation’s Capital.

"Learning from and with the professionals that visited the IOP during my time on campus was one of the highlights of my time at the Kennedy School. I am eager to help lead students in understanding the press and this country as we navigate the final weeks of arguably the most consequential election of our time." – Eugene Scott

Additional information can be found here .

About the Institute of Politics Fellows Program The Institute of Politics at Harvard Kennedy School was established in 1966 as a living memorial to President John F. Kennedy. The Institute’s mission is to unite and engage students, particularly undergraduates, with academics, politicians, activists, and policymakers on a non-partisan basis to inspire them to pursue pathways in politics and public service. The Institute blends the academic with practical politics and offers students the opportunity to engage in current events and to acquire skills and perspectives that will assist in their postgraduate pathways.

The Fellows Program has stood as the cornerstone of the IOP, encouraging student interest in public service and increasing the interaction between the academic and political communities. Through the Fellows Program, the Institute aims to provide students with the opportunity to learn from experienced public servants, the space to engage in civil discourse, and the chance to acquire a more holistic and pragmatic view of our political world.

For more information on the fellowship program, including a full list of former fellows, visit: iop.harvard.edu  

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