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ADHD: What parents need to know

Teacher is working with a young boy in a classroom and he is not paying attention.

ADHD (Attention Deficit Hyperactivity Disorder) has received a lot of media coverage over the past decade. Sometimes it gives families helpful knowledge and at other times it can cause confusion or fear about this common diagnosis. Here’s what you really need to know about ADHD.

What is ADHD in kids?

ADHD is the feeling when you can't pay attention for a long time, feel overly active, or have trouble controlling your impulses. The official medication definition for ADHD is; the condition in which a person experiences a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with their functioning or development. If your child is diagnosed with ADHD, they could experience 1 of 3 types:

  1. ADHD with mostly inattentive symptoms – trouble staying on task, not listening to directions or trouble keeping their attention.
  2. ADHD with mostly hyperactive or impulsive symptoms – restlessness, always fidgeting, tough time staying still or always needing to move, jump or climb. The impulsiveness may show like they are not able to wait, or being overly emotional to situations.
  3. ADHD with symptoms of both inattention and hyperactivity – this would be a combination of those symptoms.

You may have also heard the term ADD (Attention Deficit Disorder). This is an outdated name for the inattentive type of ADHD. The name changed to reflect the growing knowledge about this condition and to more accurately classify its symptoms.

How common is childhood ADHD?

ADHD is a very common childhood diagnosis. According to a National Health Interview Survey in the years 2011 to 2013, 9.5% of children in the United States would qualify for a diagnosis. Boys are 2 to 3 times more likely than girls to be diagnosed. Because ADHD has a genetic component, it is possible that if 1 or more people in the family have ADHD, your child may be at higher risk of also showing symptoms. Risk factors for developing ADHD could also include developmental medical conditions, drug use during pregnancy or premature birth.

How is childhood ADHD diagnosed?

Typically, your child’s pediatrician can make the diagnosis or they may refer you to a trained psychiatrist or psychologist who evaluates your child. They will assess your child by looking at their behavior, how they act, medical history and health checks.  Information from you, the parents or caregiver, and teachers will also be helpful to monitor you child’s symptoms over time. If you have concerns about your child, it is best to discuss them with their pediatrician and they can refer you to the appropriate specialists.

Each type of ADHD has its own unique standards for diagnosis. In order to qualify, a child needs to show at least 6 of the 9 symptoms associated with the ADHD type for at least 6 months and in at least 2 different settings, like at home, at school or in extracurricular activities.

For ADHD with inattentive symptoms, a child can show at least 6 of these symptoms:

  1. Makes careless mistakes.
  2. Can’t sustain attention on tasks.
  3. Does not listen when spoken to directly.
  4. Does not follow through on instructions.
  5. Difficulty organizing tasks.
  6. Avoids tasks that require sustained mental effort.
  7. Often loses things.
  8. Easily distracted.
  9. Forgetful in daily activities.

For ADHD with hyperactive or impulsive symptoms, a child must show at least 6 of these symptoms;

  1. Fidgets and squirms.
  2. Can’t sit still.
  3. Runs or climbs at inappropriate times.
  4. Can’t stay quiet.
  5. Always “on the go”.
  6. Talks excessively.
  7. Blurts out answers.
  8. Difficulty waiting on their turn.
  9. Often interrupts.

For ADHD of the combined type, a child must exhibit 6 or more symptoms of the inattentive type AND 6 or more symptoms of the hyperactive or impulsive type.

Also, for any of the types, ADHD symptoms must start to show before the age of 12; must interfere with social, academic and daily living activities should be inconsistent with the child’s developmental age and cannot be better explained by another mental disorder such as depression or anxiety. So, there’s quite a high bar when a doctor is looking to make an ADHD diagnosis.

Sometimes, results of an evaluation are unclear about whether a child’s symptoms are due to ADHD or another issue like anxiety, depression, sleep deprivation or excessive screen time. While screen time does not cause ADHD, it can show as similar symptoms in children. In that case, more testing may be needed. Keep in mind it’s common for ADHD to occur with other disorders. For example, 50% of children diagnosed with ADHD are diagnosed with learning disorders, 40% are diagnosed with Oppositional Defiant Disorder - a disorder where a child can be uncooperative and show combative behavior, and 25 to 50% are diagnosed with sleep problems. This is why it is helpful to talk with an expert who can offer recommendations for your child.

What treatments are effective for kids with ADHD?

The right treatment for ADHD depends on the age of the child and the way their symptoms affect them. A combination of medicine and behavioral supports can often be helpful.

Medication treatment for ADHD in kids

Core symptoms of ADHD are best treated with medications known as stimulants. Stimulants work by increasing the natural brain chemicals norepinephrine and dopamine, which help increase focus and decrease impulsive behavior. Stimulants come in different forms such as tablets, capsules and liquid. The effectiveness of a dose can last anywhere from 4 to 16 hours.

When these medications are used as intended for ADHD, it is unlikely that kids are put kids at increased risk for substance abuse. If anything, it could reduce the likelihood children will self-medicate and harm themselves with other substances in an attempt to relieve symptoms. It is worth considering that, while medications come with risks, not treating ADHD is also a risk.

Nonstimulant medications for ADHD also exist and can be helpful for ADHD symptoms on their own or in combination with stimulants.

Behavioral and environmental strategies for kids with ADHD

Adding behavioral therapies to a medication treatment can help with improved behavior, anxiety, improved grades, social skills and parent-child relations. Many children find help through skill development, anger management or special school accommodations like an Individualized Education Plan or 504 plan. If your child has been diagnosed with ADHD, try to speak with teachers, school counselors, coaches and other caring adults about how to set up your child for success.

For children younger than 6 years old, parent training in behavioral management is the first line of treatment before medication because younger children often have more side effects to ADHD medication.

Caregivers can do a few things to help their succeed like;

  • Sticking to a routine.
  • Minimizing distractions such as noises, electronics and bright lights.
  • Offering limited choices to prevent any overwhelming decisions.
  • Communicating clearly and being specific when talking with the child.
  • Helping the child get organized.
  • Offering age-appropriate rewards for positive behavior.
  • Disciplining effectively and with natural consequences.
  • Providing a healthy lifestyle with nourishing food, physical activity and sleep.

What if ADHD is left untreated?

Untreated ADHD can really hurt a child in a few areas; academically, socially and personally, preventing them from reaching their full potential. Untreated symptoms can result in strained relationships, limited life choices and risky behaviors. Kids with ADHD who are untreated are at higher risk for substance abuse.

If you have concerns about treating your child for ADHD, talk with your child’s pediatrician, psychologist, psychiatrist or other health care professionals who have advanced knowledge of ADHD.

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Child & Adolescent Psychiatry

Clinical Associate Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Psychiatry & Behavioral Science, University of Kansas School of Medicine