ADHD In Children: Symptoms, Diagnosis, And Treatment Options

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. ADHD is often first diagnosed in childhood, and symptoms can persist into adulthood. For children with ADHD, symptoms can present daily challenges and affect various aspects of life, including their school performance, peer relationships, and functioning at home. However, early diagnosis and treatment of ADHD can make a significant difference in a child’s mental health, quality of life, and daily functioning. 

Attention-deficit/hyperactivity disorder (ADHD) in children

Recent data suggest that an estimated 7 million children in the U.S. aged 3-17 have ever been diagnosed with ADHD. In children, ADHD is more commonly diagnosed among boys than girls; however, this does not mean that boys are more likely to have ADHD. Rather, this difference may be due to the different ways in which ADHD symptoms present. While boys tend to have symptoms of hyperactivity that are easier to notice, girls often have inattentive symptoms that may be less obvious.

In both children and adults, there are thought to be three types of ADHD:

• Predominantly inattentive ADHD: Someone with this type of ADHD often has trouble focusing, makes careless mistakes, and is easily distracted.
• Predominantly hyperactive/impulsive ADHD: Someone with this type of ADHD has both hyperactive and impulsive symptoms, such as feeling a need to be in constant motion, having trouble sitting still, and having trouble waiting their turn.
• Combined ADHD: Someone with this type of ADHD has a mix of inattentive and hyperactive-impulsive symptoms. Combined ADHD is diagnosed when a person meets criteria for both inattentive and hyperactive/impulsive types. 

Common symptoms of ADHD in children

Given the three different types of ADHD, children with ADHD will typically present with either mostly inattentive symptoms, mostly hyperactive and impulsive symptoms, or a combination of both types of symptoms. 

Inattentive symptoms

Common symptoms of inattention can include: 

• Difficulty paying attention to details
• Trouble concentrating on tasks that required prolonged, focused mental effort 
• Getting easily distracted 
• Frequently losing things, such as books or backpacks 
• Forgetting about daily tasks, such as chores, homework assignments, or events

Hyperactive and impulsive symptoms

Common examples of hyperactivity and impulsivity include: 

• Talking excessively 
• Fidgeting or squirming 
• Moving around when they are expected to stay seated
• Difficulty playing quietly 
• Interrupting others
• Feeling restless and like they have too much energy

How symptoms can affect daily life

A child’s symptoms can have a significant impact on multiple aspects of their life, including the child’s school performance, social relationships, and daily functioning. For instance, a child with ADHD may have difficulty completing schoolwork, find it hard to stay focused on important tasks, and frequently interrupt others when they are speaking. As noted by the American Psychiatric Association, ADHD can lead to low self-esteem and “impaired academic and social function in children when not appropriately managed.”

When to consider an ADHD evaluation

ADHD may be a very legitimate concern for some children and adolescents. It is a disorder, and that means that there is a persistent pattern of behavior or symptoms that may interfere with the child’s or adolescent’s ability to function in their daily lives. If a child displays this pattern, it may be time to seek clinical support, such as from the child’s healthcare provider.

How ADHD is diagnosed

To receive a diagnosis of ADHD, children up to 16 years of age must show at least six symptoms of inattention, hyperactivity and impulsivity, or both. In addition, these symptoms must also: 

• Occur for at least six months 
• Be present in two or more settings, such as at home and at school
• Interfere with functioning at school, work, and/or in social situations

What the diagnostic process includes

There is no single test to diagnose ADHD; rather, the diagnostic process entails a comprehensive evaluation that typically includes various components, such as: 

• A physical exam
• A thorough medical history and family history 
• Tests to rule out other conditions
• Standardized ADHD symptom checklists, questionnaires, and/or interview questions

In some cases, a primary care provider may be able to diagnose ADHD, or they may refer the child to a mental health professional. 

Ruling out other conditions

When diagnosing ADHD in children, healthcare providers also try to rule out other mental health conditions that may exhibit similar symptoms to ADHD. Conditions that may share some symptoms with ADHD include anxiety, sleep disorders, depression, substance use disorders, learning disorders, and certain physical conditions. ADHD may also often exist alongside another mental health condition, such as oppositional defiant disorder or conduct disorder. To properly assess, diagnose, and treat a child’s condition, a healthcare provider will need to conduct a thorough evaluation.

What causes ADHD?

The exact cause of ADHD is not known; however, researchers have identified a number of possible risk factors that may play a role. These include genetic factors, differences in brain development, and environmental factors such as exposure to toxins during pregnancy, low birth weight, and high levels of family stress. 

Treatment options for ADHD in children

It is important for parents, caregivers, teachers, social workers, and other practitioners to recognize that a child is more than a diagnosis, and there are a number of effective strategies available to help treat ADHD. 

Medication 

While pharmacological treatments may be recommended for ADHD in some cases, nonpharmacological approaches are also being studied and practiced. Although medications can be an effective treatment for ADHD and may work quickly, the long-term side effects are not well known. Medication also doesn’t necessarily address issues children may have with managing academic performance or personal relationships. If you feel your child or adolescent may be living with ADHD or has recently been diagnosed, there are many effective treatments you can try before resorting to prescribing medications.

Behavioral intervention

As noted by the CDC, the American Academy of Pediatrics (AAP) recommends behavior therapy, and specifically, parent training in behavior management, as the first line of treatment for ADHD in young children (under 6 years of age). In parent training in behavior management, parents meet with a therapist to learn strategies to help their child. In addition to this parent education and training, behavior therapy for ADHD can include behavior therapy with children and behavioral interventions in the classroom. 

Behavioral interventions in the classroom often focus on giving teachers behavioral strategies to use. These often include giving children simple step-by-step instructions and announcing consequences ahead of time for not paying attention or following instructions. Contingency management is also used in teacher programs where children receive daily report cards outlining goals within the classroom. Children will receive rewards when they’ve met their goals or have contributed to the group.

Lifestyle changes

Certain lifestyle changes and complementary health approaches can also help children and adolescents manage symptoms more effectively. Research shows that physical exercise can have beneficial effects on symptoms of ADHD, including improved attention and reduced impulsivity and hyperactivity. In addition to regular exercise, studies show that adequate sleep is crucial for children living with ADHD symptoms.

Managing ADHD symptoms at home and school

In addition to getting ADHD treated professionally, there are a number of steps that parents, caregivers, family members, and teachers can take to help a child manage their ADHD symptoms. These include: 

• Helping the child create and stick to a consistent structure and routine. 
• Using clear and direct communication. 
• Helping the child stay organized and manage time effectively. 
• Offering positive reinforcement and celebrating the child’s achievements. 

Getting professional support through BetterHelp

Parents should be empowered by school counselors, teachers, and pediatricians to advocate for their children. Providing literature, seminars, webcast information, strategies, and the latest educational resources, as well as medical research, can benefit parents.

If you feel your child may have ADHD, a therapist may be able to help you navigate the process and learn how to best support your child. BetterHelp is an online therapy platform that can provide you and your family with support and advice to get your child on the right track. An online therapist can offer parents help in processing their feelings about their child and a potential ADHD diagnosis. 

Online therapy has shown effectiveness in supporting parents who are caring for children with an ADHD diagnosis. In one virtual clinic for parents of children with ADHD, results demonstrated high parent satisfaction with the intervention and high usability.