Almost all children have times when their behavior veers out of control. They may speed about in constant motion, make noise nonstop, refuse to wait their turn, and crash into everything around them. At other times they may drift as if in a daydream, unable to pay attention or finish what they start.
However, for some children, these kinds of behaviors are more than an occasional problem. Children with attention-deficit/hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.
These children often have trouble getting along with siblings and other children at school, at home, and in other settings. Those who have trouble paying attention usually have trouble learning. An impulsive nature may put them in actual physical danger. Because children with ADHD have difficulty controlling this behavior, they may be labeled “bad kids” or “space cadets.”
Left untreated, ADHD in some children will continue to cause serious, lifelong problems, such as poor grades in school, run-ins with the law, failed relationships, and the inability to keep a job.
Effective treatment is available. If your child has ADHD, your pediatrician can offer a long-term treatment plan to help your child lead a happy and healthy life. As a parent, you have a very important role in this treatment.
What Is ADHD?
ADHD is a condition of the brain that makes it difficult for children to control their behavior. It is one of the most common chronic conditions of childhood. It affects 4% to 12% of school-aged children. ADHD is diagnosed in about 3 times more boys than girls.
The condition affects behavior in specific ways.
What Are The Symptoms Of ADHD?
ADHD includes 3 groups of behavior symptoms: inattention, hyperactivity, and impulsivity. The table below explains these symptoms.
Symptoms of ADHD
| Symptom | How a child with this symptom may behave |
|---|---|
| Inattention |
Often has a hard time paying attention, daydreams Often does not seem to listen Is easily distracted from work or play Often does not seem to care about details, makes careless mistakes Frequently does not follow through on instruction or finish tasks Is disorganized Frequently loses a lot of important things Often forgets things Frequently avoids doing things that require ongoing mental effort |
| Hyperactivity |
Is in constant motion, as it “driven by a motor” Cannot stay seated Frequently squirms and fidgets Talks too much Often runs, jumps, and climbs when this is not permitted Cannot play quietly |
| Impulsivity |
Frequently acts and speaks without thinking May run into the street without looking for traffic first Frequently has trouble taking turns Cannot wait for things Often calls out answers before the question is complete Frequently interrupts others |
Are There Different Types Of ADHD?
Not all children with ADHD have all the symptoms. They may have one or more of the symptom groups listed in the table above.
The symptoms usually are classified as the following types of ADHD:
- Inattentive only (formerly known as attention-deficit disorder [ADD])—Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is more common.
- Hyperactive/impulsive—Children with this type of ADHD show both hyperactive and impulsive behavior, but they can pay attention. They are the least common group and are frequently younger.
- Combined inattentive/hyperactive/impulsive—Children with this type of ADHD show a number of symptoms in all 3 dimensions. It is the type that most people think of when they think of ADHD.
How Can I Tell If My Child Has ADHD?
Remember, it is normal for all children to show some of these symptoms from time to time. Your child may be reacting to stress at school or home. She may be bored or going through a difficult stage of life. It does not mean she has ADHD.
Sometimes a teacher is the first to notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to the parents’ attention.
Perhaps questions from your pediatrician raised the issue. At routine visits, pediatricians often ask questions such as:
- How is your child doing in school?
- Are there any problems with learning that you or your child’s teachers have seen?
- Is your child happy in school?
- Is your child having problems completing class work or homework?
- Are you concerned with any behavior problems in school, at home, or when your child is playing with friends?
Your answers to these questions may lead to further evaluation for ADHD.
If your child has shown symptoms of ADHD on a regular basis for more than 6 months, discuss this with your pediatrician.
RBK Pediatrics: Diagnosis and Treatment of ADHD
RBK Pediatrics and Adolescent Medicine offer a variety of services, including ADHD evaluations. Performed in conjunction with school based psycho-educational testing, the patients are evaluated for ADHD in a standardized manner in accordance with the AAP and NICHQ guidelines.
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children.
The primary care clinician should initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.
RBK Pediatrics Diagnosis of ADHD
To make a diagnosis of ADHD, the primary care clinician should determine that Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria have been met (including documentation of impairment in more than 1 major setting); information should be obtained primarily from reports from parents or guardians, teachers, and other school and mental health clinicians involved in the child’s care. The primary care clinician should also rule out any alternative cause.
In the evaluation of a child for ADHD, the primary care clinician should include assessment for other conditions that might coexist with ADHD, including emotional or behavioral (eg, anxiety, depressive, oppositional defiant, and conduct disorders), developmental (eg, learning and language disorders or other neuro-developmental disorders), and physical (eg, tics, sleep apnea) conditions.
The primary care clinician should recognize ADHD as a chronic condition and, therefore, consider children and adolescents with ADHD as children and youth with special health care needs. Management of children and youth with special health care needs should follow the principles of the chronic care model and the medical home.
RBK Pediatrics Treatment of ADHD
Recommendations for treatment of children and youth with ADHD vary depending on the patient’s age:
For preschool-aged children (4–5 years of age), the primary care clinician should prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment and may prescribe methylphenidate if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child’s function. In areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment.
For elementary school–aged children (6–11 years of age), the primary care clinician should prescribe US Food and Drug Administration–approved medications for ADHD, and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both. The evidence is particularly strong for stimulant medications and sufficient but less strong for atomoxetine, extended-release guanfacine, and extended-release clonidine (in that order). The school environment, program, or placement is a part of any treatment plan.
For adolescents (12–18 years of age), the primary care clinician should prescribe Food and Drug Administration–approved medications for ADHD with the assent of the adolescent, and may prescribe behavior therapy as treatment for ADHD, preferably both.
The primary care clinician should titrate doses of medication for ADHD to achieve maximum benefit with minimum adverse effects.