A Short Guide to ADHD in Children

Attention-deficit hyperactivity disorder (ADHD) is a behavior disorder typically diagnosed in children between the ages of two and 17, most commonly before age 12.

ADHD generally causes difficulty paying attention, impulsiveness, and in some cases, but not all, hyperactivity. While signs may be apparent in young children, some do not show symptoms until their attention is challenged in grade school.

What causes attention-deficit/hyperactivity disorder and who is at risk?

The exact cause of ADHD has yet to be determined. ADHD is one of the most researched diagnoses in children's mental health. Genetics is likely a large part of the cause. It can appear in:

• Children whose parents and siblings have ADHD are at higher risk of developing ADHD. However, there may be multiple factors involved.
• Environmental, social, and physical factors may also contribute. Due to varying results, it is unclear if these factors are related to ADHD, and studies continue. Some of these factors may or may not be involved. There is a link between exposure to environmental toxins and children with ADHD.
• Children born prematurely may be at risk of developing ADHD.
• Drug use during pregnancy is another known risk factor.
• ADHD occurs in the brain and some studies have found low dopamine levels in children diagnosed with ADHD. Dopamine is a neurotransmitter, a chemical released by nerves and the brain to send messages.
• ADHD is not the result of diet, use of electronics, screen time, or poor parenting. This includes eating too much sugar, which is a common mistake. Studies have shown that diet during pregnancy is also not a cause.
• Attention deficit/hyperactivity disorder is three to five times more common in boys than girls.
• Cultural differences may play a factor in this disease or diagnosis. In the United States, over 9% of children had been diagnosed with ADHD as of 2016. In Great Britain, less than 1% have the diagnosis. Reports of other ethnicities are also lower.

Symptoms of ADHD

Symptoms start in childhood, sometimes as early as three years old, but typically before age 12. However, symptoms may occasionally not be recognized or diagnosed until adulthood, when they become diagnosed as adult ADHD.

The symptoms include inattention, hyperactivity, and impulsivity. Children may have some or all of the symptoms, but all symptoms are not necessary for diagnosis. Symptoms can be mild, moderate, or severe, and include:

Inattention

• Missing details or making mistakes in school that they should not miss.
• Difficulty paying attention during play or projects; short attention span.
• Appear as though they are not listening or have trouble listening.
• Have a difficult time following instructions, completing schoolwork, chores, or tasks because they are easily distracted or lose focus.
• Find it challenging to organize activities and orders, follow time management, or meet deadlines.
• Avoid tasks that require ongoing mental effort like homework or studying.
• Frequently losing things.
• Easily distracted.
• Often forgetful when it comes to daily projects.

Hyperactivity

• Fidgeting frequently, unable to sit still.
• Often get up when they should be sitting.
• Running, climbing, and moving around when not appropriate or with nowhere to go.
• Difficulty playing, focusing, or engaging quietly.
• Constantly on the go or in motion.
• Talking more than a reasonable amount.
• Losing things frequently.
• Difficulty staying on task, often changing tasks without completing them.

Impulsivity

• Interrupting others.
• Difficulty waiting.
• Speaks out of turn.
• Acts without thinking first.

Symptoms can be mistaken for emotional issues or lack of discipline. On occasion, there is a delay due to missed signs. Symptoms may seem to decrease with age, and hyperactive symptoms become more restless than over-energetic.

How is attention-deficit hyperactivity disorder diagnosed?

Your child’s primary healthcare provider may diagnose attention-deficit hyperactivity disorder. The primary provider may refer the child to a mental health professional like a psychiatrist to evaluate, diagnose, and treat them if necessary.

To make a diagnosis, the provider will request detailed reports from the child’s primary caregivers, teachers, and anyone who spend the most time with the child. The reports will look for observations of the child’s behavior. Symptoms must occur at both home and school, not just in one location or for one caregiver.

To properly diagnose ADHD, symptoms must be ongoing or occurring for longer than six months. To qualify, the child must have at least six symptoms of hyperactivity-impulsivity and/or six symptoms of inattention for those six months. Symptoms also cannot be actions that come and go or are related to an alternative cause, such as:

• Stress.
• Anxiety.
• Depression.
• Medical illness.
• Learning problem.
• Hearing, vision, or speech problem.
• Autism Spectrum Disorder.
• Sleep disorder.
• Brain injury.
• Mood disorder.
• Substance abuse.

The assessment will consist of physical, neurological, and psychological evaluations. ADHD overlaps all of these areas, and each needs addressing. The assessment includes standard behavior rating scales to reach diagnostic criteria. The provider will assess the child’s memory and learning ability to rule out other causes. If the child’s symptoms are appropriate for diagnosis, the provider will establish a treatment plan that works best for the child.

Treating and managing ADHD

There is no cure for ADHD. Treatments are available that can help reduce symptoms and improve activity. Treatment options include medication, therapy, or combination treatment. Your child’s provider will determine which treatments should be used based on your child’s age, symptoms, severity, health, and ability to tolerate treatments.

Medications can include:

• Psychostimulants are the most common and improve neurotransmitters and reduce symptoms. Examples include Adderall, Vyvanse, and Ritalin.
• Antidepressants, like bupropion, have been shown to have some benefits.
• Other medications like Strattera, Clonidine, and Guanfacine.

Therapies include:

• Behavior therapy involves therapists who work with the child to improve social and emotional skills that are lacking due to ADHD.
• Psychotherapy allows children to work with a therapist to discuss feelings, behaviors, and issues that bother them and learn how to deal with them effectively.
• Family therapy helps the whole family learn to work through the stress of living with someone with ADHD.
• Parenting coaching helps parents learn ways to understand the child's behaviors and how to deal with them.

The provider should include you in the care plan process. As the caregiver and child’s support, you must understand the disease process and treatments and advocate for your child’s needs. You will also need to understand what treatments work and do not work for your child.

Can I prevent ADHD?

Currently, there are no known methods to prevent ADHD. However, early detection and treatment to reduce symptoms is the goal to help children reduce the struggles that come with ADHD.