ADHD and Your Child: Signs and Treatment Options
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Nov 29, 2021.
ADHD: Could My Child Be at Risk?
Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder diagnosed in roughly 9% to 10% percent of school-aged children and adolescents.
- Children may have difficulty paying attention and completing tasks, and can show excessive signs of hyperactivity, impulsiveness, or some combination of these behaviors.
- ADHD can lead to difficulties in school, work and home life.
- For parents, ADHD can be a significant challenge at home and at school.
ADHD medications such as stimulants, coupled with behavioral therapy, can be very effective in the control of ADHD. Working with the child's pediatrician and early identification of ADHD is advised. The pediatrician knows the child and family well and can make recommendations for treatment.
Follow along to learn about ADHD causes, diagnosis, treatments and myths surrounding this condition.
All Kids Seem Hyperactive: How Can You Tell the Difference?
Anyone who has parented a small child will tell you -- short attention spans and high levels of activity are part of a normal childhood. In children with ADHD these behaviors can be excessive, not appropriate based on their age, and cause disruption, both at school and at home.
Over time, adolescents and teens with ADHD may become less hyperactive, but may still suffer from distraction, poor organization, and low impulse control (acting without thinking). These behaviors, especially in adolescents and young adults, can be risky.
Young adults with uncontrolled ADHD may be at a greater risk for:
- alcohol and drug misuse and abuse
- driving violations
- dropping out of school
- job loss.
As noted in the ADHD guidelines by the American Academy of Pediatrics (AAP), fewer problem behaviors are required as ADHD diagnostic criteria in patients age 17 and older.
Signs and Symptoms of ADHD
The signs and symptoms of ADHD, which must have been present for at least 6 months before diagnosis and occur before age 12, may include:
- Difficulty with paying attention
- Can't follow instructions
- Interrupts or talks excessively
- Can be disorganized or careless
- Has trouble playing quietly in a group
- Restless or jittery
- Has trouble focusing on a task at school or home
- Difficulty forming or keeping friendships
These symptoms must be present in more than one setting, for example, school and home, and lead to an impairment of function in school, grades, social activities, or work-related function.
Is ADHD Inherited?
The causes for ADHD are not fully known, but research is actively ongoing. There does appear to be a link between a family history of ADHD (genetics) and influences from the environment.
Some factors have been identified that may contribute to the development of ADHD and include:
- low birth weight
- fetal exposure to cigarette smoke
- exposure to toxic lead paint after birth.
Additional research is needed to define the exact role of these environmental factors.
Most experts do not believe that diet plays a significant role in the onset of ADHD. For example, food additives, food allergies, or sugar do not seem to cause ADHD.
Is ADHD Overdiagnosed?
ADHD is a real disorder that affects up to 10% of children. ADHD, which can continue into adulthood, can have serious end results if left untreated.
However, some critics claim that there has been overdiagnosis of children with ADHD coupled with excess prescribing of stimulants. There are many reason why this is not true.
- As more has been learned about ADHD and how to recognize it, greater rates of diagnosis may have taken place.
- In addition, legal mandates in the school to increase special services for children may have led some to believe that there are now excessive numbers of children with this diagnosis. In fact, these children are now recognized when previously they may have been ignored.
- More adults are now being diagnosed, too, probably due to greater ADHD awareness.
ADHD Diagnosis and Your Child
Unlike strep throat, ADHD has no special laboratory test that a physician uses to make a specific diagnosis. Your first step is to contact your child's pediatrician. They can make recommendations for a diagnosis or refer you to a child psychiatrist, if needed.
A diagnosis can be made based on interviews with you, your child, and possibly the teachers at school.
Questions may focus on:
- home and school relationships
- ability to control emotions.
A physical exam will help to rule out other causes of symptoms. A family history of ADHD, and other physical or emotional symptoms will be reviewed.
Most cases of ADHD are diagnosed at age 7 or 8, but symptoms may begin sooner. It is estimated that boys with ADHD outnumber girls two-to-one, but some experts feel that girls may not be diagnosed as often due to less disruptive behaviors.
Consequences of Untreated ADHD
Don't ignore ADHD symptoms in your child if they are disruptful to their daily routine, schoolwork, or friendships. See your doctor as soon as possible for an assessment. If ADHD is diagnosed, early treatment can prevent longer-term consequences.
The importance of early and adequate treatment for ADHD is important to lower these risks:
- Increased risk for school failure in both high school and college
- Behavioral problems
- Social problems with peers and family
- Elevated risk due to accidents, alcohol or drug abuse
- Increased chances of depression or anxiety
- Obstacles at work possibly leading to job loss
Education, Training, and Behavioral Management
Behavioral education for the child and their parents or caregivers should always be considered as a treatment for any case of ADHD. This may also be highly recommended as a first-line option if the child is 4 to 6 years of age, has mild symptoms, or the family prefers this option over drug therapy.
Evidence for diagnosis or treatment in children under 4 years of age is lacking, and "parent training in behavior management" (PTBM) may be the recommended option in this age group, as noted by the AAP Guidelines. This training can help parents learn the range of developments to expect in their child at certain ages, behaviors that help foster a positive parent-child relationship, and defined skills to help manage problem behaviors.
Also include in the education:
- Information about symptoms and course of ADHD
- Medical treatments and expected drug side effects, if used
- Local resources for the family and child.
Communication should also be initiated at the school. Parent-training to learn how to effectively manage ADHD behaviors, and child-focused treatment that fosters social, academic and problem-solving skills are important for success.
Drug Treatment Options for ADHD: Where to Begin?
A healthcare provider with expertise in evaluation, diagnosis and treatment of children with ADHD is the best place to start. For many parents, this will be their child's primary care pediatrician.
ADHD can be a complicated condition. A combination of behavior management and drug treatment are often the optimal choice for positive outcomes in ADHD.
The stimulants, such as methylphenidate, are often the first choice of drug treatment in ADHD.
- Stimulants are effective in up to 80 percent of patients, and they have been used for the treatment of ADHD for many decades.
- Stimulants act quickly in children to curb hyperactivity, impulsiveness and improve attention.
- They may be used in conjunction with patient counseling.
What Are the Choices in Stimulant Medications?
Stimulants are often the first class of drug chosen for ADHD treatment, and include various dose forms such as:
- methylphenidate options: Ritalin, Daytrana, Focalin, Concerta, Jornay PM, Quillivant XR, Cotempla XR ODT, or Adhansia XR
- Azstarys (dexmethylphenidate and serdexmethylphenidate): contains serdexmethylphenidate, a prodrug of dexmethylphenidate; provides an early onset and a longer duration without spikes in dexmethylphenidate concentrations.
- the mixed amphetamine salts: Adderall, Mydayis, Vyvanse
- the oral dissolving amphetamine tablets: Adzenys XR-ODT, Evekeo ODT
- the amphetamine tablets: Evekeo
- the extended-release amphetamine liquid: Dyanavel XR and Adzenys ER
- Dyanavel XR is also available as a once-daily, extended-release tablet
Stimulants are available in many versions of regular-release and sustained-release formulations to allow dosing that can be specific for a child's needs, such as around school and homework times; long-acting forms taken once-a-day are usually preferred. Keep in mind titration with an immediate-release form may be needed before using some extended-release forms. Orally-dissolving tablets are also an option.
Generic versions are available for many of these products, and can lead to major cost-savings in your overall healthcare plan. Talk to your doctor and pharmacist about this option.
Can ADHD Treatment Interfere With Sleep or Appetite?
There is more than a 50 year history of use with stimulants, and their actions and side effects are well-known. In fact, until 2002, stimulants were the only FDA-approved treatment for ADHD.
As proven in a groundbreaking clinical trial called the Multi-Modal Treatment Study of Children with ADHD (MTA study), stimulants are the most effective treatment for ADHD as long as doses are monitored and adjusted specifically for each child.
However, side effects can occur and should be reported to your child's doctor if they interfere with the daily routine. Side effects can include:
- difficulty sleeping
- reduced appetite and weight loss
- stomach upset.
Could My Child Become Addicted to Stimulant Medications?
This is a common question among parents.
- Parents or caregivers may be concerned that stimulant use in ADHD may lead to future addiction or other forms of drug abuse.
- In fact, studies suggest that ADHD stimulant treatment decreases the risk of substance abuse and may delay the onset through adolescence.
- Adolescents with ADHD have also been shown to have fewer car accidents when being treated for ADHD compared to those who are not treated.
Special Topic: Abuse of Stimulants by Others
As children get older, they may become more responsible for handing and administering their own medications. A risk of addiction has not been shown to occur in people with ADHD who use stimulants appropriately.
- However, there is the risk that family members, friends, classmates or others may attempt to gain access to the stimulant medication for abuse.
- A recent study pointed out that most teens who abuse ADHD stimulants get them from someone else.
- However, some teens who were prescribed stimulants were taking higher doses. Researchers also found that teens were smoking or "snorting" these drugs (inhaling through the nose).
To safeguard medications, children's and teenager's ADHD medications should be monitored. Caregivers or school personnel should safeguard and administer these drugs. At home, keep medications locked in a childproof container and deliver stimulant medications first-hand to the school nurse.
Nonstimulants: Atomoxetine (Strattera)
There is no cure for ADHD, but medicines can effectively control many of the symptoms. If stimulants are not an option for your child, your healthcare provider may suggest using a non-stimulant such as atomoxetine (brand name: Strattera).
- Atomoxetine is in a class of medications called norepinephrine reuptake inhibitors. Atomoxetine may take several weeks for the full effect to be seen, but also has a low abuse potential.
- Atomoxetine is approved for use in children with a diagnosis of ADHD and is dosed based on weight. A generic option for Strattera is available. It is also approved for use in adults.
- A Boxed Warning for atomoxetine states an increased risk of suicidal ideation was seen in short-term clinical trials in children and adolescents with ADHD. Helathcare providers should balance the risk of suicidality against the clinical need for the drug. A Boxed Warning is the highest level of warning issued for a drug by the FDA.
- It is important to monitor your child for changes in mood or signs of depression or suicide, and discuss these issues immediately with your doctor if you notice them.
Nonstimulants: Viloxazine ER capsules (Qelbree)
In April, 2021, Qelbree (viloxazine extended-release capsules) from Supernus Pharmaceuticals was approved for the treatment of ADHD in pediatric patients 6 to 17 years of age. Qelbree is also being studied in adults with ADHD.
- Viloxazine is classified as a selective norepinephrine reuptake inhibitor (SNRI) and is given as an extended-release capsule once a day.
- The capsules may be swallowed whole or opened and the contents sprinkled onto applesauce. Qelbree comes as a 100 mg, 20 mg or 400 mg capsule. It is not a controlled substance.
- The most common side effects (≥5%) were sleepiness, decreased appetite, fatigue nausea, vomiting, trouble sleeping and irritability. Qelbree may increase suicidal thoughts and actions in some children with ADHD, especially within the first few months of treatment or when the dose is changed.
Alpha-2 Agonists: An Added Option
Even though stimulants are very effective, about 10 to 20 percent of children may not have an optimal effect or may have side effects that require a dose or medicine change.
For these children, a class of medications called alpha-2 agonists can be used alone or added to stimulants or nonstimulants like atomoxetine (Strattera). Alpha-2 agonists include newer extended-release versions of clonidine (Kapvay) and guanfacine (Intuniv).
Alpha-2 agonists may cause low blood pressure, slow heart rate, and drowsiness as side effects, but may be useful in children with trouble sleeping, aggression, or stimulant-induced tics.
ADHD Myth: All Children Will Eventually Outgrow ADHD
Some children, at their doctors direction, may have a trial reduction or elimination of their medications if their symptoms are improved over a year, dosages have remain stable, or missed doses do not result in symptoms. However, over one-half of adolescents who have ADHD continue to need ADHD treatment into adulthood.
Many adults with ADHD remain undiagnosed and are not able to address their illness; in fact, only 25 percent of adults with ADHD symptoms even seek treatment.
- Untreated ADHD can leave adults at risk for depression, anxiety, or alcohol and drug abuse.
- In addition, problems may arise within the workplace, with personal relationships, or with financial or legal issues.
ADHD Myth: People with ADHD are Lazy
Actually, the minds of children and adults with ADHD are working very hard -- far from being lazy.
However, organizing information in their brains takes extra steps. Adequately completing a task in a timely fashion, and staying focused while doing it, is not as easy for people with ADHD. Some experts suggest that a part of the brain in those with ADHD works harder -- but less efficiently -- than those without ADHD.
Options need to be created for people with ADHD to work "differently", not "harder", so that they can focus, for example:
- external tools such as alarms
- creating lists with timelines
- developing written charts for decision-making.
My Child Can't Swallow Pills - Are There Other Options?
Swallowing tablets can be a challenge for some children. Easier-to-use forms of ADHD medicines are available, for example:
- Skin patches: Daytrana
- Liquids: Methylin Solution, Quillivant XR, Dyanavel XR, Adzenys ER
- Chewable pills: Methylin Chewables, Quillichew ER, Vyvanse
- Capsule contents that can be sprinkled on applesauce and swallowed (but don't chew the beads): Metadate CD, Ritalin LA, Focalin XR, Adderall XR, Mydayis, Jornay PM, Adhansia XR, Qelbree, Azstarys
- Capsule contents that may be sprinkled in water and taken immediately: Vyvanse, Azstarys
- Orally-dissolving dose forms (tablet dissolves on tongue without chewing or crushing): Cotempla XR-ODT, Adzenys XR-ODT, Evekeo ODT
In 2019, the FDA approved the first medical device to treat ADHD. The Monarch external Trigeminal Nerve Stimulation (eTNS) System is available by prescription only for patients aged 7 to 12 years old who are not currently taking prescription medication for ADHD.
The device generates a low-level electrical pulse to a small patch placed above the patient's eyebrows. Clinical trials have shown success when used nightly for four weeks compared to a placebo device. An average ADHD Rating Scale score decreased from 34.1 to 23.4 points compared with a decrease from 33.7 to 27.5 points.
Side effects include drowsiness, increased appetite, trouble sleeping, teeth clenching, headache, and fatigue. The device cannot be used in children under 7 years and it may take up to four weeks to see results.
Finished: ADHD and Your Child: Signs and Treatment Options
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