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Attention-deficit/hyperactivity disorder (ADHD) in children

Medically reviewed by Drugs.com. Last updated on Jun 15, 2023.

Overview

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.

Children with ADHD may also struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.

While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.

Symptoms

The primary features of ADHD include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they're noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.

ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.

There are three subtypes of ADHD:

Inattention

A child who shows a pattern of inattention may often:

Hyperactivity and impulsivity

A child who shows a pattern of hyperactive and impulsive symptoms may often:

Typical developmental behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It's typical for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.

The same is true of hyperactivity. Young children are naturally energetic — they often are still full of energy long after they've worn their parents out. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

When to see a doctor

If you're concerned that your child shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it's important to have a medical evaluation first to check for other possible causes of your child's difficulties.

Causes

While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include genetics, the environment or problems with the central nervous system at key moments in development.

Risk factors

Risk factors for ADHD may include:

Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this. Many issues in childhood can lead to difficulty sustaining attention, but that's not the same as ADHD.

Complications

ADHD can make life difficult for children. Children with ADHD:

Coexisting conditions

ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than others to also have conditions such as:

Prevention

To help reduce your child's risk of ADHD:

Diagnosis

In general, a child shouldn't receive a diagnosis of attention-deficit/hyperactivity disorder unless the core symptoms of ADHD start early in life — before age 12 — and create significant problems at home and at school on an ongoing basis.

There's no specific test for ADHD, but making a diagnosis will likely include:

Diagnosing ADHD in young children

Although signs of ADHD can sometimes appear in preschoolers or even younger children, diagnosing the disorder in very young children is difficult. That's because developmental problems such as language delays can be mistaken for ADHD.

So children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental pediatrician.

Other conditions that resemble ADHD

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

Treatment

Standard treatments for ADHD in children include medications, behavior therapy, counseling and education services. These treatments can relieve many of the symptoms of ADHD, but they don't cure it. It may take some time to determine what works best for your child.

Stimulant medications

Currently, stimulant drugs (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity — sometimes effectively in a short period of time.

Examples include:

Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch of methylphenidate (Daytrana) is available that can be worn on the hip.

The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Ask your doctor about possible side effects of stimulants.

Stimulant medications and certain health risks

Some research indicates that using ADHD stimulant medications with certain heart problems may be a concern, and the risk of certain psychiatric symptoms may be increased when using stimulant medications.

Other medications

Other medications that may be effective in treating ADHD include:

Atomoxetine and antidepressants work slower than stimulants do and may take several weeks before they take full effect. These may be good options if your child can't take stimulants because of health problems or if stimulants cause severe side effects.

Suicide risk

Although it remains unproved, concerns have been raised that there may be a slightly increased risk of suicidal thinking in children and teenagers taking nonstimulant ADHD medication or antidepressants. Contact your child's doctor if you notice any signs of suicidal thinking or other signs of depression.

Giving medications safely

It's very important to make sure your child takes the right amount of the prescribed medication. Parents may be concerned about stimulants and the risk of abuse and addiction. Stimulant medications are considered safe when your child takes the medication as prescribed by the doctor. Your child should see the doctor regularly to determine if the medication needs to be adjusted.

On the other hand, there's concern that other people might misuse or abuse stimulant medication prescribed for children and teenagers with ADHD. To keep your child's medications safe and to make sure your child is getting the right dose at the right time:

ADHD behavior therapy

Children with ADHD often benefit from behavior therapy, social skills training, parent skills training and counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health professional. Some children with ADHD may also have other conditions such as an anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.

Examples of therapy include:

The best results occur when a team approach is used, with teachers, parents, therapists and physicians working together. Educate yourself about ADHD and available services. Work with your child's teachers and refer them to reliable sources of information to support their efforts in the classroom.

New medical device

The U.S. Food and Drug Administration approved a new medical device to treat children with ADHD who are 7 to 12 years old and not taking ADHD prescription medicine. Only available by prescription, it's called the Monarch external Trigeminal Nerve Stimulation (eTNS) System.

About the size of a cell phone, the eTNS device can be used at home under parental supervision, when the child is sleeping. The device generates low-level electrical stimulation which moves through a wire to a small patch placed on the child's forehead, sending signals to areas of the brain related to attention, emotion and behavior.

If eTNS is being considered, it's important to discuss precautions, expectations and possible side effects. Get complete information and instructions from your health care professional.

Ongoing treatment

If your child is being treated for ADHD, he or she should see the doctor regularly until symptoms have largely improved, and then typically every three to six months if symptoms are stable.

Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability, or if your child's ADHD symptoms have not shown much improvement with initial treatment.

Lifestyle and home remedies

Because ADHD is complex and each person with ADHD is unique, it's hard to make recommendations that work for every child. But some of the following suggestions may help create an environment in which your child can succeed.

Children at home

Children in school

Learn all you can about ADHD and opportunities that are available to help your child be successful. You are your child's best advocate.

Alternative medicine

There's little research that indicates that alternative medicine treatments can reduce ADHD symptoms. Before considering any alternative interventions, talk with your doctor to determine if the therapy is safe. Some alternative medicine treatments that have been tried, but are not yet fully proved scientifically, include:

Coping and support

Caring for a child with ADHD can be challenging for the whole family. Parents may be hurt by their child's behavior, as well as by the way other people respond to it. The stress of dealing with ADHD can lead to marital conflict. These problems may be compounded by the financial burden that ADHD can place on families.

Siblings of a child with ADHD also may have special difficulties. They can be affected by a brother or sister who is demanding or aggressive, and they may also receive less attention because the child with ADHD requires so much of a parent's time.

Resources

Many resources are available, such as social services or support groups. Support groups often can provide helpful information about coping with ADHD. Ask your child's doctor if he or she knows of any support groups in your area.

There also are excellent books and guides for both parents and teachers, and internet sites dealing exclusively with ADHD. But be careful of websites or other resources that focus on risky or unproved remedies or those that conflict with your health care team's recommendations.

Strategies for coping

Many parents notice patterns in their child's behavior as well as in their own responses to that behavior. Both you and your child may need to change behavior. But substituting new habits for old ones takes a lot of hard work.

Be realistic in your expectations for improvement — both your own and your child's. And keep your child's developmental stage in mind. Set small goals for both yourself and your child and don't try to make a lot of changes all at once.

Preparing for an appointment

You're likely to start by taking your child to a family doctor or pediatrician. Depending on the results of the initial evaluation, your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist.

What you can do

To prepare for your child's appointment:

Questions to ask your child's doctor may include:

If you do not understand something, don’t hesitate to ask questions.

What to expect from your doctor

Your doctor will ask questions which you should be ready to answer such as:

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

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