ADHD in Children
- Are in constant motion
- Squirm and fidget
- Do not seem to listen
- Have trouble playing quietly
- Often talk excessively
- Interrupt or intrude on others
- Are easily distracted
- Do not finish tasks
How Is ADHD Diagnosed?
Though your child may have some symptoms that seem like ADHD, it might be something else. That’s why you need a doctor to check it out.
There is no specific or definitive test for ADHD. Instead, diagnosing is a process that takes 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. A doctor will also ask what symptoms your child has, how long ago those symptoms started, and how the behavior affects your child and the rest of your family. Doctors diagnose ADHD in children after a child has shown six or more specific symptoms of inattention or hyperactivity on a regular basis for more than 6 months in at least two settings. The doctor will consider how a child’s behavior compares with that of other children the same age.
Your child’s primary care doctor can determine whether your child has ADHD using standard guidelines developed by the American Academy of Pediatrics, which says the condition may be diagnosed in children ages 4 to 18. Symptoms, though, must begin by age 12.
It is very difficult to diagnose ADHD in children younger than 5. That’s because many preschool children have some of the symptoms seen in ADHD in various situations. Also, children change very rapidly during the preschool years.
In some cases, behavior that looks like ADHD might be caused instead by:
- A sudden life change (such as divorce, a death in the family, or moving)
- Undetected seizures
- Medical disorders affecting brain function
- Bipolar disorder
3 Types of ADHD in Children
Doctors may classify symptoms as the following types of ADHD:
- Hyperactive/impulsive type. Children show both hyperactive and impulsive behavior, but for the most part, they are able to pay attention.
- Inattentive type. Formerly called attention deficit disorder (ADD). These children are not overly active. They do not disrupt the classroom or other activities, so their symptoms might not be noticed.
- Combined type (inattentive and hyperactive/impulsive). Children with this type of ADHD show both categories of symptoms. This is the most common form of ADHD.
ADHD Treatment Overview
Treatment plans may include special education programs, psychological intervention, and drug treatment. Learn as much as you can about the options and talk them over with your child’s health care provider so you can make the best plan for your child.
Studies show that long-term treatment with a combination of medications and behavioral therapy is much better than just medication treatment, or no specific treatments in managing hyperactivity, impulsivity, inattention, and symptoms of anxiety and depression. Those kids treated with both ADHD drugs and therapy also had better social skills.
Drugs for Childhood ADHD
A class of drugs called psychostimulants (or sometimes just stimulants) is a highly effective treatment for childhood ADHD. These medicines, including Adderall, Adzenys XR-ODT, Vyvanse, Concerta, Focalin, Daytrana, Ritalin, and Quillivant XR, help children focus their thoughts and ignore distractions.
Another treatment used to treat ADHD in kids is nonstimulant medication. These medications include Intuniv,Kapvay, and Strattera.
ADHD medicines are available in short-acting (immediate-release), intermediate-acting, and long-acting forms. It may take some time for a doctor to find the best medication, dosage, and schedule for someone with ADHD. ADHD drugs sometimes have side effects, but these tend to happen early in treatment. Usually, side effects are mild and don’t last long.
Behavioral Treatments for Children With ADHD
Behavioral treatment for children with ADHD includes creating more structure, encouraging routines, and clearly stating expectations of the child.
- Social skills training. This can help a child with ADHD learn behaviors that will help them develop and maintain social relationships.
- Support groups and parenting skills training. This includes support for the parents and helping them learn more about ADHD and how to parent a child who has ADHD.
What Treatment Is Best for My Child?
No single treatment is the answer for every child with ADHD. Each child’s needs and personal history must be carefully considered.
For example, a child may have undesirable side effects to a medication, making a particular treatment unacceptable. If a child with ADHD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best.
It’s important to work with a doctor to find the best solution for your child.
The ADHD Coach
Coaching is a relatively new field in the treatment of ADHD in children. ADHD coaches are meant to help children achieve better results in different areas of their lives by setting goals and helping the child find ways to reach them. A child, however, must be mature and motivated enough to work with a coach.
Symptoms of ADHD
There are three groups of symptoms:
Symptoms of ADHD usually show up when kids are young: around age 12 on average. But they can show up much earlier. Some kids have been diagnosed by age 3.
You might not notice it until a child goes to school. In adults, it may be easier to notice at work or in social situations.
The person might procrastinate, not complete tasks like homework or chores, or frequently move from one uncompleted activity to another.
They might also:
- Be disorganized
- Lack focus
- Have a hard time paying attention to details and a tendency to make careless mistakes. Their work might be messy and seem careless.
- Have trouble staying on topic while talking, not listening to others, and not following social rules
- Be forgetful about daily activities (for example, missing appointments, forgetting to bring lunch)
- Be easily distracted by things like trivial noises or events that are usually ignored by others.
- Have a hard time getting along with others because they can’t read people’s feelings and moods
- Daydream a lot
- Be too wrapped up in their own thoughts to hear you
It may vary with age. You might be able to notice it in preschoolers. ADHD symptoms nearly always show up before middle school.
Kids with hyperactivity may:
- Fidget and squirm when seated
- Get up frequently to walk or run around
- Run or climb a lot when it’s not appropriate. (In teens, this may seem like restlessness.)
- Have trouble playing quietly or doing quiet hobbies
- Always be “on the go”
- Talk excessively
Toddlers and preschoolers with ADHD tend to be constantly in motion, jumping on furniture and having trouble participating in group activities that call for them to sit still. For instance, they may have a hard time listening to a story.
School-age children have similar habits, but you may notice those less often. They are unable to stay seated, squirm a lot, fidget, or talk a lot.
Hyperactivity can show up as feelings of restlessness in teens and adults. They may also have a hard time doing quiet activities where you sit still.
Symptoms of this include:
- Having a hard time waiting to talk or react
The person might:
- Have a hard time waiting for their turn.
- Blurt out answers before someone finishes asking them a question.
- Frequently interrupt or intrude on others. This often happens so much that it causes problems in social or work settings. Friends might get mad at them or get their feelings hurt because they may act without thinking.
- Start conversations at inappropriate times.
Impulsivity can lead to accidents, like knocking over objects or banging into people. Children with ADHD may also do risky things without stopping to think about the consequences. For instance, they may climb and put themselves in danger.
Many of these symptoms happen from time to time in all youngsters. But in children with the disorder they happen a lot — at home and school, or when visiting with friends. They also mess with the child’s ability to function like other children who are the same age or developmental level. Does My Child Have Symptoms of ADHD?
There’s no single test for ADHD.
Your child’s doctor will want to know their symptoms and when they started. They may want to do some tests to rule out other health problems that could change the way your child acts. They might also want to send your child to a children’s mental health specialist, like a child psychologist or psychiatrist, for a more detailed checkup. These doctors may ask to speak to other adults in your child’s life, like coaches or teachers. Only then — if your child meets the criteria for ADHD — will they be diagnosed.
Doctors check for behavior that:
- Is not typical for the person’s age. (Most children can behave in those ways at some point or another, though.)
- Has a negative impact on the person’s ability to function at home, in social environments, or at work.
They also have to consistently display at least six of the above symptoms:
- For at least 6 months
- And in at least two settings, such as at home and in school
Overall, hyperactivity tends to diminish with age. But inattention tends to last into adulthood.
Treatment can help. And a great many children with ADHD ultimately adjust. Some — about 20% to 30% — have learning problems that ADHD treatment may not help, though.
As they grow older, some teens who’ve had the disorder since childhood may have periods of anxiety or depression. When there are more demands at school or home, symptoms of ADHD may get worse.
A child with hyperactive behavior may get symptoms of other disruptive disorders, like oppositional-defiant disorder.
These children are especially at risk to be more likely to drop out of school. If you’re concerned, talk to your or your child’s doctor about your treatment options. Medications, behavioral therapy, and other tactics can help.
Types of ADHD
A person with this type must have at least six of these nine symptoms, and very few of the symptoms of hyperactive-impulsive type:
- Not paying attention to detail
- Making careless mistakes
- Failing to pay attention and keep on task
- Not listening
- Being unable to follow or understand instructions
- Avoiding tasks that involve effort
- Being distracted
- Being forgetful
- Losing things that are needed to complete tasks
To have this type, a person has to have at least six of these nine symptoms, and very few of the symptoms of inattentive type:
- Getting up often when seated
- Running or climbing at inappropriate times
- Having trouble playing quietly
- Talking too much
- Talking out of turn or blurting out
- Often “on the go” as if “driven by a motor”
This is the most common type of ADHD. People with it have symptoms of both inattentive and hyperactive-impulsive types.
Attention Deficit Hyperactivity Disorder: Diagnosing ADHD
Diagnosing ADHD in Children
Health care professionals such as pediatricians, psychiatrists, and child psychologists can diagnose ADHD with the help of standard guidelines from the American Academy of Pediatrics or the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).
You can also find a professional who specializes in ADHD diagnosis through your health plan, your child’s teacher or school counselor, other parents of children with ADHD, or nonprofit organizations such as Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
The diagnosis involves gathering information from several sources, including schools, caregivers, and parents. The health care professional will consider how a child’s behavior compares with that of other children the same age, and they may use standardized rating scales to document these behaviors.
- Are in constant motion
- Squirm and fidget
- Make careless mistakes
- Often lose things (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile phones)
- Do not seem to listen
- Are easily distracted
- Do not finish tasks
- Often leave their seat in situations when remaining seated is expected
- Often run about or climb in situations where it isn’t appropriate (adolescents or adults may be limited to feeling restless)
- Can’t play or take part in leisure activities quietly
- Talk excessively
- Blurt out an answer before a question has been completed
- Have trouble waiting for their turn
- Interrupt or intrude on others (e.g., butting into conversations or games)
- Have trouble organizing tasks and activities
- Forget daily activities
To diagnose ADHD, your child should have a full physical exam, including vision and hearing tests. Also, the FDA has approved the use of the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a noninvasive scan that measures theta and beta brain waves. The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it. The scan, approved for use in those aged 6 to 17 years, is meant to be used as a part of a complete medical and psychological exam.
The health care professional should take a complete medical history to check for other conditions that may affect a child’s behavior. Certain conditions that could mimic ADHD or cause the ADHD-like behaviors are:
- Recent major life changes (such as divorce, a death in the family, or a recent move)
- Undetected seizures
- Thyroid problems
- Sleep problems
- Lead toxicity
Though many children show some of the behaviors for ADHD, they do not necessarily have the disorder. An ADHD diagnosis requires that these behaviors have been persistent for at least 6 months, that some symptoms began before age 12, that symptoms are present in two or more settings (such as school and home), and that they significantly affect the child in at least two places (social life, school, etc.).
Diagnosing ADHD in Adults
It is not easy for a health care professional to diagnose ADHD in an adult. Sometimes, an adult will recognize the symptoms of ADHD in themselves when their child is diagnosed. Other times, they will seek professional help for themselves and find that their depression, anxiety, or other symptoms are related to ADHD.
In addition to symptoms of inattention and impulsiveness, adults with ADHD may have other problems, including:
- Chronic lateness and forgetfulness
- Poor organizational skills
- Low self-esteem
- Employment problems
- Short temper
- Hard time finishing a task
- Unthinking and immediate response; hard time controlling behavior
If these difficulties are not managed appropriately, they can cause emotional, social, occupational and academic problems in adults.
In order to be diagnosed with ADHD, an adult must have persistent, current symptoms that date to childhood. ADHD symptoms continue as problems into adulthood for up to half of children with ADHD. For an accurate diagnosis, the following are recommended:
- A history of the adult’s behavior as a child
- An interview with the adult’s life partner, parent, close friend, or other close associate
- A thorough physical exam that may include neurological testing
- Psychological testing
ADHD Treatment in Children
These treatment options have been evaluated for safety, but no two children are alike, and what works for some kids may not work as well for yours.
Together with the doctor, you’ll develop a plan that meets your child’s specific needs. It may take time to figure out what works best. The plan may include medications, behavioral therapy, or both.
The main medications used to treat ADHD are stimulants and nonstimulants. Sometimes antidepressants are also used.
Stimulants are the most common treatment in children and teens. This is usually the type of medication a doctor may try first. Stimulants have been used for a long time and are well-tested. They help the brain control impulses and control behavior and attention.
- Amphetamine (Adzenys XR-ODT)
- Amphetamine/dextroamphetamine (Adderall, Adderall XR)
- Dexmethylphenidate (Focalin, Focalin XR)
- Dextroamphetamine (Dexedrine)
- Lisdexamfetamine (Vyvanse)
- Methylphenidate (Concerta, Daytrana, Metadate, Methylin, Ritalin, Quillivant XR)
Serdexmethylphenidate and dexmethylphenidate (Azstarys)
If the first medicine the doctor prescribes doesn’t seem to help, they may raise the dosage, suggest a different medication, or suggest your child take another medicine along with the stimulant.
Nonstimulants aren’t as well tested. They work in different ways than stimulants, but they can help with concentration and impulse control. For some kids, they may be a better option than stimulants, but they’re often used along with stimulants.
These non-stimulants are FDA-approved for ADHD in children and teens:
- Atomoxetine (Strattera)
- Clonidine ER (Kapvay)
- Guanfacine ER (Intuniv)
- Viloxazine (Qelbree)
Antidepressants aren’t approved to treat ADHD, but they can help with inattention, impulsivity, and hyperactivity. They’re an option for children who haven’t done well on a stimulant alone. Taking an antidepressant along with a stimulant seems to work well for children who have ADHD along with a mood disorder such as depression or anxiety.
Tricyclic antidepressants. These affect chemicals in the brain.
Examples of tricyclic antidepressants include:
- Desipramine (Norpramin, Pertofrane)
- Imipramine (Tofranil)
- Nortriptyline (Aventyl, Pamelor)
Bupropion (Wellbutrin). The doctor may prescribe this if your child doesn’t benefit from stimulants.
Selective serotonin reuptake inhibitors (SSRIs). These are the most commonly prescribed antidepressants for people with depression. These have been tried for ADHD:
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
Venlafaxine (Effexor). This drug also affects chemicals in the brain. It helps improve mood and concentration in children and teens.
All these medicines can cause side effects. They usually happen when a child first starts taking them. They’re usually mild and go away fairly soon. Before your child starts any new medication, talk to their doctor about what to expect.
If you become concerned about side effects while your child is on a medication, call the doctor. Don’t make changes in the treatment without talking to them.
Meds Not for Everyone
Medications don’t always work for kids with ADHD. In fact, they don’t seem to work at all in 20% to 30% of cases. In others, the improvement is only slight or the side effects are too serious. Your health care team can help you put together a combination of medication and behavioral therapy or therapy alone that works best for your child.
To know what’s working, it can help to first talk to your doctor about the goals of treatment. Another idea is to monitor and keep track of the timing and intensity of your child’s symptoms in an ADHD symptom log. Then you and your health care team can look back at the log to identify patterns that might help shape more effective treatment.
This type of therapy uses positive reinforcement for good behavior and negative reinforcement for unwanted behaviors. A mental health professional — a psychologist, social worker, or family therapist — works with you and your child’s teachers to set up a program to improve your child’s behaviors.
Behavioral therapy is often used along with ADHD medications, but it can also be used alone.
The FDA has two technology based therapies as nondrug treatment for children.
The first is a device is called the Monarch eTNS System and is approved for children 7 to 12. It is about the size of a cell phone and works by delivering mild stimulation to electrodes attached to the forehead. Those mild electrical pulses interact with the part of the brain believed to be responsible for ADHD.
Also approved is game-based digital therapeutic device called EndeavorRx for pediatric ADHD patients ages 8 to 12 years old. Using a video game-based approach, the device used both sensory stimuli and motor skill challenges to target areas of the brain and help improve focus and cognitive function.
In addition, some studies have shown that omega-3 supplements may help some children with ADHD.
Some kids with ADHD may benefit from changes in diet, such as going gluten-free or avoiding certain food dyes and additives. Talk to your child’s doctor about the best options for them.
Risks of Untreated ADHD
Untreated ADHD can cause problems throughout life. People with ADHD tend to be impulsive and have short attention spans, which can make it harder to succeed in school, at work, in relationships, and in other aspects of life.
Children with untreated ADHD may face problems at home and at school.
Because ADHD can make it hard for children to pay attention in class, a student with untreated ADHD may not learn everything they’re taught. They may fall behind or get poor grades.
Children with ADHD may struggle to control their emotions. This can cause social problems. They may not know how to share toys, take turns, play well with others, or react the right way in certain situations. Without treatment and guidance, they may have trouble making or keeping friends. This can be hard for them to deal with, because many children with untreated ADHD also have low self-esteem or depression.
Kids with untreated ADHD can be more impulsive, so they may get hurt a lot. Some research shows that young people with untreated ADHD make more visits to the emergency room with injuries.
If ADHD hasn’t been addressed, teens who have already done poorly at school for years aren’t likely to catch up, so poor grades may keep coming. Even students with untreated ADHD who coasted through elementary school may have problems keeping up in high school, where the workload is more intense.
Teens with untreated ADHD may struggle with relationships. They may not have many friends, and they may not fare well in the dating world. They’re also likely to have problems getting along with their parents.
ADHD that’s left alone could raise the chance of dangerous behaviors, including:
- Doing drugs
- Risky sexual choices
Among girls with untreated ADHD, eating disorders are more common. Some of these problems may be linked with depression or low self-esteem.
Once they’re old enough to get their driver’s license, teens with untreated ADHD are more likely to have trouble behind the wheel. They may be involved in more car accidents than their peers.
Although certain symptoms may fade with age, ADHD can be a lifelong problem. And some people aren’t diagnosed with ADHD until they’re adults.
It’s important for all grownups with ADHD to have treatment for it.
If not, they’re more likely to have employment problems. Even if they can get a job, they may not be able to keep it. They’re also more likely to have trouble:
- Getting to work on time
- Completing work by set deadlines
- Staying organized
- Getting along with co-workers
- Accepting criticism calmly
If you have untreated ADHD, you’re more likely to have relationship problems. You may be too emotional. You may have arguments with others more often than your peers. And your partner or friends might have trouble getting you to listen.
People with untreated ADHD have higher rates of divorce. You’re also more likely to be depressed or have low self-esteem.
The same risky behaviors that can harm teens with untreated ADHD can also impact adults in the same situation. For example:
- Drug abuse
- Risky sex
They’re also more likely to have
- Car accidents
- Gambling problems
- Trouble with the law
Some research says between 25% and 40% of people in prison have ADHD — many of whom are undiagnosed or untreated. The same research suggests that if those people had treatment for their ADHD, the action that led to their jail time may not have happened.