ADHD

Summary

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that can affect the way someone experiences and manages attention, activity levels, motivation, impulses and emotions. ADHD can look very different from person to person, and people may experience some difficulties more strongly than others. ADHD is not all about difficulties. People with ADHD may also have strengths such as creativity, enthusiasm, curiosity, energy, spontaneity, problem-solving skills and the ability to become deeply focused on things that interest them.

There are three presentations of ADHD:

1. Predominantly inattentive presentation
2. Predominantly hyperactive-impulsive presentation
3. Combined presentation

Inattentive ADHD

Someone with predominantly inattentive ADHD may:

• Miss details or make careless mistakes, particularly when a task feels repetitive or uninteresting.
• Find their attention easily pulled towards other things.
• Find that their attention moves quickly between different thoughts, ideas or topics.
• Find it difficult to organise tasks, thoughts or belongings.
• Lose or misplace things they need.
• Forget appointments, instructions or everyday tasks.
• Find it difficult to follow through with tasks, particularly when they involve several steps.
• Need more time or repetition to take in information.
• Appear to be daydreaming or “somewhere else”.
• Become overwhelmed when there are lots of things to think about or organise.

Someone with inattentive ADHD may not always appear to be struggling. They may be quiet, appear to be listening or seem very focused, while experiencing lots of thoughts or distractions internally.

Hyperactive-impulsive ADHD

Someone with predominantly hyperactive-impulsive ADHD may:

• Fidget, squirm or feel physically restless.
• Find it difficult to sit still for long periods.
• Feel like they need to move around or keep busy.
• Talk a lot, particularly when they are excited or interested in something.
• Interrupt conversations or speak before someone has finished.
• Say things as soon as they come into their head.
• Find it difficult to wait their turn.
• Act quickly or make decisions before having time to think through what might happen next.
• Seek out activities that involve movement, excitement or lots of stimulation.
• Fidget, touch things or play with objects to help them concentrate or feel comfortable.

Hyperactivity does not always mean physically running around or being unable to sit still. For some people, particularly as they get older, it may feel more like having a busy mind, feeling internally restless or needing to keep themselves occupied.

Combined type ADHD

Someone with combined ADHD experiences a significant combination of both inattentive and hyperactive-impulsive symptoms.

ADHD and gender

ADHD can be experienced by people of any gender. Differences in how ADHD presents can mean that some people are less likely to be recognised or diagnosed. Girls and women may be more likely to experience predominantly inattentive symptoms, although ADHD can present differently for everyone. Some people may also become very good at hiding or compensating for their difficulties, which can make their ADHD less obvious to other people.

Rejection sensitivity

Some people with ADHD describe experiencing intense emotional responses to perceived or actual rejection, criticism, disapproval or failure. This is sometimes referred to as “rejection sensitivity” or “rejection sensitive dysphoria” (RSD). RSD is not a formal diagnosis or recognised symptom of ADHD. However, rejection sensitivity can be an important experience for some people with ADHD and can also occur alongside other experiences, including anxiety, depression, trauma and autism. Someone experiencing rejection sensitivity might:

• Feel extremely upset after receiving criticism or feedback.
• Worry a lot about being disliked or rejected.
• Avoid situations where they might make a mistake or be judged.
• Replay conversations and wonder whether they have done something wrong.
• Feel embarrassed or ashamed after making a mistake.
• Experience a strong emotional reaction to situations that other people might consider minor.

Executive functioning

Executive functions are a group of mental skills that help us manage everyday life. They help us start and complete tasks, organise information, manage our time, remember things, control impulses and adapt when plans change. People with ADHD may find some executive functioning skills more difficult, particularly when they are tired, stressed, overwhelmed or not interested in the task. Some of the executive functioning skills we use every day include:

• Task initiation: Being able to get started on a task, even when it feels boring, difficult or overwhelming.
• Flexible thinking: Being able to adapt when plans change, or something unexpected happens.
• Self-control: Managing impulses, attention and emotions before responding or acting.
• Working memory: Holding information in your mind for a short period of time so that you can use it. For example, remembering the steps involved in completing a task.
• Time management: Keeping track of how much time has passed, estimating how long something will take and managing your time between different activities.
• Planning and organisation: Working out what needs to be done, deciding what order to do things in and keeping track of belongings, tasks and deadlines.
• Prioritising: Working out which tasks are most important or need to be completed first.

These skills can vary from day to day. Someone with ADHD may be able to manage a task very well in one situation but find the same task extremely difficult at another time. Factors such as interest, motivation, stress, tiredness and the environment can all affect how easy it is to use these skills.

How to help myself

There are lots of different ways to make everyday life with ADHD more manageable, and what works for one person may not work for another. It can be helpful to try different strategies and notice what makes things easier for you.

If you find it difficult to concentrate or feel restless, try including movement or something for your hands to do. This could be using a fidget toy, doodling, tapping your foot, stretching, walking, dancing, cycling or playing sport. Some people find that movement helps them focus and manage their energy, although some fidget toys can become distracting, so use whatever helps you rather than what you think you should be using.

When tasks feel overwhelming, or you are struggling to get started, break them down into smaller, manageable steps. Instead of thinking about everything you need to do, focus on the first small task. You could also use a timer for 10 or 15 minutes and focus only on the task until the timer finishes. Visual timers can be useful if you find it difficult to judge how much time has passed. Once the timer finishes, you can decide whether to continue or take a break.

Use reminders and visual prompts to support your memory and organisation. Phone alarms, calendars, to-do lists, sticky notes and visual schedules can help you remember appointments, deadlines and everyday tasks. Putting information somewhere you will regularly see it can make it easier to remember without having to rely on your memory alone.

Make time for hobbies, creativity and activities that you enjoy. Doing things that interest you can allow you to relax, recharge and use your strengths. Your hobbies do not need to be productive or linked to school, work or other responsibilities to be worthwhile.

If your thoughts feel busy or you notice yourself becoming overwhelmed, try slowing down and focusing on your breathing. You could try box breathing by breathing in for four counts, holding for four, breathing out for four and holding for four. You can also use other calming activities that work for you, such as listening to music, going outside or taking a short break.

Try to notice and value your strengths rather than focusing only on the things you find difficult. You might be creative, funny, caring, loyal, determined, adventurous, good at sport or someone who looks after the people around you. ADHD can make some everyday tasks more difficult, but struggling with something does not mean that you are lazy, careless or incapable. If something does not go to plan, try to think about what could make it easier next time rather than being overly critical of yourself.

You do not have to manage everything on your own. If ADHD is making school, work, relationships or everyday life difficult, talk to someone you trust or ask a professional about what support may be available.

How to help a loved one

Supporting someone with ADHD can involve helping them understand what works for them and making everyday tasks feel more manageable. It can be helpful to involve the whole family in this, including siblings and wider family members, so that everyone understands that people’s brains work differently and may need different things to feel comfortable, supported and able to do their best.

Work with your loved one to build a routine that includes regular sleep, meals, physical activity, hobbies and opportunities to spend time with other people. Rest, nutrition, exercise and social connection can support concentration, energy and emotional wellbeing. If they are struggling with one of these areas, talk together about small changes that might make things easier rather than trying to change everything at once.

Help your loved one recognise when they are becoming frustrated, overwhelmed or overstimulated. You could work together to identify early signs that they are becoming overwhelmed and agree on strategies that help them regulate, such as taking a break, moving somewhere quieter, using a fidget, going for a walk or spending some time alone. It can also be useful to agree these strategies as a family so everyone knows what support is helpful.

When giving instructions or setting expectations, keep them clear and manageable. Breaking larger tasks into smaller steps can make them feel less overwhelming, particularly when your loved one is struggling to know where to start. Avoid giving lots of instructions at once where possible, and check that they have understood what needs to be done.

You can also help your loved one find organisational strategies that work for them. This might include phone or calendar reminders, alarms, visual timetables, checklists, written instructions or post-it notes in places where they are easy to see. The aim is not to expect them to remember everything, but to create reminders and routines that reduce the amount they need to keep in their head.

Body doubling can also be useful for some people with ADHD. This involves completing a task alongside another person, either in the same room or through a video or phone call. The other person does not necessarily need to do the same task. Having someone nearby can provide company, encouragement and accountability, which may make it easier to start or continue a task. You could use body doubling for things such as tidying, studying, completing paperwork or getting ready to leave the house.

Myth Buster

Myth: “ADHD is not a real medical disorder.”
Truth: ADHD is a recognised neurodevelopmental condition. There is a substantial body of research into ADHD, including research using brain imaging, genetics and behavioural studies. ADHD can affect attention, activity levels, impulse control, motivation and executive functioning.

Myth: “Children just grow out of ADHD.”
Truth: ADHD can continue into adulthood, although the way symptoms are experienced can change over time. For example, outward hyperactivity may become less noticeable as someone gets older, while difficulties with attention, organisation, time management or impulse control may continue. People may also develop strategies, receive support or take medication that changes how they experience and manage their symptoms.

Myth: “ADHD is caused by bad parenting.”
Truth: ADHD has strong genetic influences and often runs in families. Parenting style does not cause ADHD, and no parenting approach can cure it. However, supportive and understanding parenting can help a young person manage their symptoms and feel safe, understood and able to cope.

Myth: “Only boys have ADHD.”
Truth: ADHD can affect people of all genders. Differences in how ADHD presents and is recognised can contribute to some girls and women being diagnosed later or being missed. Girls may be more likely to present with predominantly inattentive symptoms, which can be less noticeable than hyperactive or impulsive behaviours. This does not mean that ADHD affects one gender more or that boys and girls always experience ADHD differently.

Support

If you have been reading this booklet and thought, “This sounds like something I am experiencing,” or you already have an ADHD diagnosis but feel that you need more support, there are different options available. Support can focus on understanding what your body and mind need to feel comfortable, building confidence in being yourself and asking for help, and learning how to communicate what you need to the people around you.

It can also be helpful to work with your family, school or other people in your life to develop strategies that support you. This might include exploring how you learn and whether adjustments such as extra time, movement breaks, different seating, visual prompts or quieter spaces could make learning easier. Support can also help you understand how you experience emotions in your body and develop coping strategies for managing strong or overwhelming emotions.

You can learn more about ADHD and explore ways of managing difficulties while developing a better understanding of your strengths and what matters to you. Support is not about changing who you are; it can help you find strategies that make everyday life more manageable and allow you to work towards the things that are important to you.

Assessments

If you think you may have ADHD, you can speak to your GP or someone at your school or college about what you are experiencing. Depending on your circumstances, you may be able to access an NHS assessment through your local pathway, the NHS Right to Choose pathway or a private assessment.

NHS Right to Choose can allow eligible people in England to choose an alternative NHS-funded provider for an assessment or treatment when their GP agrees that a referral is appropriate. This can provide an alternative to waiting for an assessment through the local NHS service, although eligibility and available providers can vary.

An ADHD assessment usually involves gathering information about how you experience difficulties across different areas of your life. This may include questionnaires completed by you and, where appropriate, parents, carers or teachers, alongside conversations about your development, school or work, relationships, hobbies, daily life and the things you find difficult. The assessment will consider whether the difficulties are consistent with ADHD and whether there may be other explanations or additional needs that should also be considered.

Therapy interventions

Medication

Some people with ADHD are prescribed medication to help manage symptoms such as difficulties with attention, impulsivity or hyperactivity. ADHD medications work in different ways, including by affecting brain chemicals involved in attention, motivation and impulse control. Your doctor or specialist will work with you to find an appropriate medication and dose, and monitor how you are responding to it.

Therapy and other support

Medication is not the only form of support available. Depending on your individual needs, you may be offered support from professionals such as psychologists, occupational therapists or other members of a mental health or neurodevelopmental team. Your GP or ADHD service can help you explore what support may be appropriate.

• Psychological therapy – may help you understand your ADHD, develop strategies for managing difficulties with attention and organisation, manage emotions and build confidence.
• CBT – may help you identify unhelpful thought patterns and develop practical strategies for managing ADHD-related difficulties.
• Occupational therapy – may help you find practical strategies and adjustments to make everyday activities, routines, sensory needs and organisation more manageable.
• Psychoeducation – may help you understand ADHD and how it can affect attention, emotions, relationships, learning and everyday life, so that you can develop strategies that work for you

Helplines

ADHD Embrace

ADHD Embrace is a community-centred charity supporting children and young people with ADHD, as well as their parents, carers, schools and professionals. They provide information, practical support, workshops, webinars, advice clinics and resources to help families and professionals better understand and support ADHD. They also provide resources for young people themselves.

Phone: 07356 294000
Email: chair@adhdembrace.org
Website: https://adhdembrace.org/

ADHD UK
ADHD UK is a charity supporting people with ADHD, as well as their families, carers, employers and colleagues. They provide information and support about living with ADHD, raise awareness, work to reduce stigma and provide resources to help people understand their rights and access appropriate support and adjustments.

Phone: 020 3984 9679
Email: hello@adhduk.co.uk
Website: https://adhduk.co.uk/

Childline
Childline is a free service for young people to talk to a counsellor about anything. The service is available 24 hours a day, 7 days a week. Childline is available to anybody who is 18 years old or younger.

Phone: 0800 1111
Opening times: Available 24 hours a day, 7 days a week, 365 days a year
You can also find helpful resources, speak to a counsellor online or send a message on their site.
Website: www.childline.org.uk

NSPCC
NSPCC is a children’s charity that works to protect children and prevent abuse and neglect. They provide support and advice for adults about child abuse, neglect, child safety, online safety and children’s mental and emotional wellbeing.

Phone: 0808 800 5000
Opening times: 10 am–4 pm, Monday–Friday
Email: help@nspcc.org.uk

Samaritans

Samaritans is a charity providing emotional support to anyone who is struggling to cope or needs someone to talk to. They are there for people experiencing all sorts of difficulties, including stress, anxiety, loneliness, relationship or family problems, bereavement, feeling overwhelmed and concerns about mental health or suicide.

Phone: 116 123
Opening times: 24 hours a day, 7 days a week, 365 days a year
Website: http://www.samaritans.org