Let's Talk About ADHD in Children
We've got the doctor-approved scoop on ADHD in children, including causes, symptoms, treatments, and a jillion other facts and tips that can make life with this mental health condition easier.
A recent study in JAMA reports that roughly 10% of all kids have ADHD. That means about one in 10 children in the U.S. is dealing with this challenging condition, making it one of the most common neurodevelopmental disorders children and teens face today. But at the same time, about 70% of Americans also believe that ADHD is overdiagnosed, according to a 2019 Harris Poll survey. That perception creates a whole lot of uncertainty for parents who are scratching their heads wondering if their child does, in fact, have a clinical condition or whether their behavior is just part of being a kid. Here, a bit of clarity.
Our Pro Panel
We went to some of the top experts in ADHD to bring you the most up-to-date information possible.
Rosemarie Manfredi, Psy.D.
Licensed Psychologist and Certified School Psychologist
Neurodevelopmental Assessment and Consulting, LLC
Lindsay Elton, M.D.
Child Neurology Consultants
Sharon Saline, Psy.D.
Licensed Clinical Psychologist and Author
What Your ADHD Child Wishes You Knew
There’s no difference, really. Back in In 1994, ADD officially became ADHD no matter if symptoms of hyperactivity were present or not. That said, quite a few professionals and regular folks still use the term ADD.
Not all kids with ADHD qualify for an Individual Education Plan (IEP), which includes special education services and accommodations. However, your child may still qualify for services with what’s called a 504 plan, which offers accommodations without special education.
Theoretically any disorder can coexist with ADHD, but the most common include anxiety, learning disabilities, disruptive behavior disorders, mood and sleep disorders, and Tourette Syndrome. In fact, more than two-thirds of those ADHD have at least one other coinciding condition.
ADHD is considered a chronic condition, with roughly 60% of kids diagnosed with ADHD will go on to experience symptoms as adults, too. However, symptoms do often change with age. For example, while hyperactivity is often a telltale in childhood ADHD cases, that generally shifts to restlessness in adults.
What Is ADHD, Again?
Simply put, ADHD, or attention-deficit hyperactivity disorder, is one of the most prevalent childhood conditions that can continue through adolescence and into adulthood.
According to a recent report from the Centers for Disease Control and Prevention (CDC), 6.1 million children have been diagnosed with ADHD. Boys are more likely to be diagnosed (12.9%) than girls (5.6%). And it’s incredibly common among adults: Roughly 11 million have ADHD, or 5% of the adult population.
There are three main behaviors associated with ADHD, according to the National Institute of Mental Health (NIMH):
Of course, every kid (and adult) is inattentive or impulsive at times. Who among us hasn’t felt like jumping out of their skin while having to stay in place during, say, a pandemic? But ADHD is different: It’s not being inattentive sometimes, or hyperactive now and then. In children with ADHD, these behaviors:
are more severe
happen more often
interfere with quality of life
What Causes ADHD in Children?
ADHD is a chronic neurobiological condition and its cause is not entirely known. Right now, there’s zero evidence to show that allergies, immunizations, parenting styles, or too much sugar or food additives have anything to do with your child’s diagnosis.
And even though 58% of Americans surveyed believe an uptick in technology and video game play has led to a greater occurrence of ADHD in children, there’s no clear evidence that this is accurate either.
Instead, kids between 8 and 10 who already have multiple ADHD symptoms do seem to game more than others, notes a 2020 report in the journal European Child & Adolescent Psychiatry. The probable reason? Fast-moving video games are pretty effective at holding the attention of kids who find concentrating challenging.
Based on current research, here are some things that may cause ADHD:
Differing brain anatomy: It’s thought there may be less activity in some parts of the brain that handle attention and activity in kids with ADHD. (This in no way relates to intelligence.)
Heredity: A child with ADHD has a 25% chance of having a parent with ADHD, too.
Head injuries: In some cases, a significant injury to the head may increase risk for developing ADHD.
Premature birth / low birth weight: Babies born very preterm (less than 32 weeks) or at a very low birth weight (under 3.3 pounds) are three times as likely to have ADHD than those born at term and at a healthy weight.
Prenatal exposures: It’s believed that prenatal exposure to alcohol, nicotine and/or lead may also up one’s chance of developing ADHD.
ADHD Symptoms in Children
There are two main buckets of ADHD symptoms in children: There are inattentive symptoms, like daydreaming, getting easily side-tracked, and making careless mistakes with classwork. And there are the hyperactive-impulsive symptoms, such as being fidgety, disruptive in class, and running around like a wind-up toy. There is also ADHD-Combined Type, where the individual has characteristics of both types: inattentive and hyperactive-impulsive.
Regardless of which symptoms fit your child, with ADHD, the clues surface before age 12, and for some, they’re noticeable as early as age 3. Like most any chronic condition, ADHD signs and symptoms can be mild, moderate, or severe. And symptoms can often be confused for emotional or disciplinary problems—or completely missed if your child is generally well-behaved and quiet. While not every kid experiences every symptom, here are the basics:
Predominantly Inattentive Presentation
Here, kids up to 16 might experience six or more of the following symptoms for at least six months. (For older kids, its five or more symptoms over the same time period):
Makes careless mistakes in schoolwork
Lacks attention to detail
Has a hard time staying focused on tasks or even during play activities
Thought of as a daydreamer who’s not listening when you speak
Forgetful when it comes to everyday tasks
Trouble organizing tasks
Avoids or expresses dislike for tasks that require mental effort over a long stretch of time
Loses important things like homework, books, glasses, or cell phone
Predominantly Hyperactive-Impulsive Presentation
Here, your child might experience six or more of the following symptoms for at least 6 months. (For kids who are 17 and 18, however, only 5 symptoms are needed to fit the ADHD criteria.):
Fidgets a lot
Squirms in his or her seat
Appears to be “driven by a motor”
Has a hard time sitting still for things like meals or homework
Runs, jumps or climbs constantly
Interrupts frequently, speaks at inappropriate times and/or blurts out an answer before a question has been finished
Has trouble waiting their turn or listening to directions
Experiences more accidents and injuries than others thanks to impulsiveness
If there are enough telltales of both criteria, then your kiddo would be diagnosed with Combined Presentation. Most children have this type of ADHD. That said, for the preschool set, the most common ADHD symptom is hyperactivity and girls are more likely to present with inattentive symptoms.
Diagnosing ADHD in Children
While a child (or an adult, for that matter) can be flagged for ADHD at almost any age, the average age of diagnosis is 6 years old. And for more severe cases, that age drops to 4.
If you suspect your child has ADHD, it’s not a bad idea to turn to your child’s pediatrician for guidance. While not all pediatricians will be willing and able to make a diagnosis, he or she should be able to point you in the right direction to find a local licensed mental health professional, like a clinical psychologist, neuropsychologist, psychiatrist or clinical social worker who specializes in diagnosing ADHD in children. (Also, your child’s school may be able evaluate your child free-of-charge, based on their ADHD-like symptoms, and offer in-school treatment options. But they cannot offer an ADHD diagnosis. More on that, below.)
Meanwhile, your child’s pediatrician can perform a thorough physical exam, including a vision and hearing test, to rule out other possible medically-related causes of ADHD-like symptoms.
Next, your child’s doctor—or a specialist you were referred to—will likely do the following in order to administer a comprehensive ADHD evaluation:
Conduct a thorough interview (a.k.a. diagnostic interview) with you relating to your child’s symptoms
Have you and your child’s teachers (or childcare providers) fill out standardized questionnaires regarding symptom presentation
Review school and medical records
Talk to and observe your child
Screen for learning disabilities and other mental health issues
According to the American Academy of Pediatrics (AAP), the majority of children diagnosed with ADHD also meet the diagnostic criteria for another mental health issue. Because of this, it’s important to speak to your child’s healthcare provider about screeners for things like developmental delays; autism; learning disabilities; anxiety; depression; trauma; bipolar; and obsessive-compulsive disorder.
These conditions can go hand-in-hand with ADHD, but they can also mimic ADHD symptoms. Also, know that when it comes to ADHD evaluations, it’s not a one-and-done situation. It’s typically recommended that children and adolescents get re-evaluated every 2 to 3 years, or sooner if symptoms change or your child isn’t making the progress you expected.
Treating ADHD in Children
There are no quick, Band-Aid-style fixes for ADHD. Don’t assume your child who struggles with sitting still or prioritizing homework will suddenly be a desk-bound master organizer thanks to a pill. That just doesn’t happen.
Think about it like this: Rather than ADHD medication teaching your child to keep schoolwork organized or to refrain from interpreting the teacher, it helps kids’ brains to be more available to learning, absorbing, and recalling tools that they have learned to assist them in organization, planning, time management, and more.
So even though 30% of Americans surveyed believe that prescription medication is the only way to manage ADHD in children, know that a truly successful ADHD treatment plan requires a 360° approach—and a long-term commitment from parents, kids, and teachers alike. With that, here’s an age-by-age guide to treatment strategies.
Preschoolers With ADHD
The A-1 treatment for children under 6 years old is behavioral parent therapy from a child and adolescent therapist who specializes in attention-deficit hyperactivity disorder. This type of therapy involves both the grownups in a child's life and the child and it generally takes anywhere from 8 to 16 sessions.
Here, parents learn how to show—and reinforce—positive behaviors and skills. Unfortunately, half of all preschoolers with ADHD never receive this recommended behavioral treatment. And 25% get medication alone, which should be the last resort for this age group. Still, in some cases, meds may help.
If you go this route, talk to your child’s healthcare provider about stopping after 6 months to reassess symptoms and to consider whether meds should be continued.
School-age Children With ADHD
For children with ADHD who are between the ages of 6 and 12, the preferred approach is a combination of behavioral parent therapy (again, spanning about 8 to 16 sessions), medication (with regular monitoring), and school-based modifications and/or supports, which can include things like in-class movement breaks; having a seat near the teacher and away from distractions like doors and windows; and allowing kids to tape-record assignments.
Once the proper medication and dose is determined, roughly 80% of kids treated with stimulant ADHD meds, such as Adderall (dextroamphetamine-amphetamine) or Ritalin (methylphenidate), experience great improvement, research shows. (Stimulants work by boosting neurotransmitters in the brain that help process information.)
If, however, stimulants prove ineffective, non-stimulant options, like Strattera (atomoxetine), may be prescribed. By the time your kiddo is about 8 to 10 years old, he or she is likely mature enough to attend individual or group behavior therapy, which can continue to help your child with peer relations, organizational skills, and more.
Tweens and Adolescents with ADHD
FDA-approved medications, parent behavioral training, and/or classroom interventions are all still in play for kids up to age 18. Tweens and teens continue to benefit from peer or one-on-one behavior therapy with a mental health pro as well.
Meanwhile, older teens may want to try ADHD coaching. Here, a coach (who’s not necessarily a therapist) can help adolescents tweak behaviors related to ADHD, like time management, organization, and goal-setting. (There are no certification requirements to be an ADHD coach, so due diligence is necessary. Try to zero in on a licensed mental health professional who also offers coaching and/or refer to the ADHD Coaches Organization, which vets coaches before putting them on its “List of Professional ADHD Coaches.”)
Finally, if a teen has been on short-acting ADHD meds (taken every 4 hours, as needed) prior, they might start to consider tweaking their regime to long-acting medications, which are taken once in the morning. This can prove helpful for older kids when extracurriculars, after school jobs, and sports stretch into the evening hours.
(PS: Kids need to be able to swallow extended-release capsules or tablets, since chewing or crushing these types of meds is a no-no. If your tween is taking extended-release capsules that are made up of beads, however, you may be able to open the capsule and sprinkle its contents into food.)
ADHD Medication Side Effects in Kids
Stimulant medications that are commonly prescribed to treat ADHD in children are considered very safe. That said, the FDA does not recommend stimulant meds or the non-stimulant Strattera (atomoxetine) for kids with serious heart problems, as those medications might increase blood pressure or heart rate to a problematic level.
Regardless, all children on ADHD medications should be periodically monitored for changes in heart rate or blood pressure. Beyond that, here are some side effects that may impact children taking stimulant ADHD meds:
Temporary decreased appetite
Less common side effects include:
Minor growth delay
Rebound effect, which means a child's activity increases or develops a bad mood once the meds wears off
Visual or tactile hallucinations
Non-stimulant ADHD medication may also produce similar side effects, like stomach ache, decreased appetite, and weight loss, in addition to nausea and fatigue. While these may sound worrisome, adjusting your child’s dosage and/or schedule can often relieve these side effects. Trying a different stimulant or switching to a non-stimulant medication can work, too.
School and ADHD
Chances are, your child spends most of his or her day at school. So it comes as no surprise that many parents’ first heads up about their child’s concentration and focus challenges comes directly from their child’s elementary school teacher.
But red-flagging potential ADHD is only the start of what a child’s school can and should do. School is a crucial factor in the overall treatment protocol. In fact, the American Academy of Pediatrics notes that adjusting a child’s school environment is a key ingredient to any successful ADHD treatment plan.
It’s essential to note that, while teachers and some school staff are 100% able to identify attention, concentration, and memory concerns, they cannot legally diagnose ADHD. What schools can do, however, is determine whether (and how) a child’s ADHD symptoms may be affecting learning—and they can offer support and mediation.
To get there, you will need to ask your child’s school (in writing) for an evaluation. (This holds true even if you’ve already had an outside professional do an eval.) Here, a certified school psychologist will assess your child’s attention issues and likely conduct psychological testing, and appraise academic skills and progress, too. This wide scope is imperative because anywhere from 30% to 50% of children with ADHD also have a learning disability.
Once that all-important evaluation is squared, and learning and/or attention issues are indicated, you’ll be in a position to work with the school to put in place in-class accommodations or modifications—or both. This means things like incorporating movement breaks into your child’s day, starting a reward system to encourage organization, and longer test-taking times could be implemented to help your child succeed in school.
These are established via an Individualized Education Plan (IEP) or a 504 Plan, named after the Section 504 statute that notes schools cannot discriminate against children with disabilities. (Unlike IEPs, 504s don’t always require a school evaluation; check your local rules.)
ADHD Looks Different in Boys and Girls
It’s true that boys are more likely to be diagnosed with ADHD than girls (12.9% versus 5.6%), but that doesn’t mean girls aren’t impacted. Instead, research shows that ADHD affects more girls than what’s traditionally reported.
One study found that ADHD may simply be missed in girls because their symptoms tend to manifest differently than in boys. Most girls with ADHD exhibit predominantly inattentive symptoms, which means that they have problems focusing; they’re forgetful and distracted.
That also means that typical ADHD symptoms of hyperactivity and impulsiveness aren’t on full display to raise ADHD concerns. And it’s those disruptive signs that often drive diagnosis. To wit: According to surveys, 6% of moms believe a child must display hyperactive-impulsive symptoms in order to be diagnosed with ADHD.
That’s not to say that girls don’t have hyperactive-impulsive presentations of ADHD. It simply means that it often looks different in girls than it does in boys.
For instance, in school, a boy with ADHD might bounce his knee under his desk all day, repeatedly leave his seat without permission, or blurt out answers without being called on. A girl with hyperactive-impulsive presentation ADHD might simply be seen as a chatterbox in class. That hyperactivity disconnect is likely what keeps girls not only from diagnosis, but proper treatment, too.
Do Children Grow Out of ADHD?
While symptoms can easily change with age (like how a preschooler’s hyperactivity can morph into a teen’s restlessness), ADHD is still considered a chronic condition. And about 60% of those who were diagnosed with ADHD as kids continue to experience symptoms into adulthood. Does that mean your child will be on ADHD medications forever? Not necessarily. Some adults still find benefit from continuing ADHD medication, while others don’t. For many, the ultimate goal is not to get off meds, but to successfully manage symptoms with little to no side effects. Either way, your child will likely have years of behavior training and organizational techniques to utilize for success in adult life.
- ADHD and Kids Stats: Centers for Disease Control and Prevention. (2020). “Data and Statistics About ADHD.” cdc.gov/ncbddd/adhd/data.html
- How Many Kids Have ADHD: JAMA Network Open. (2018). “Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016.” jamanetwork.com/journals/jamanetworkopen/fullarticle/2698633
- Overdiagnosed: PRNewswire. (2019). “Merck Manuals Survey Reveals 70% of Americans Think ADHD is Overdiagnosed in Today's Culture.” prnewswire.com/news-releases/merck-manuals-survey-reveals-70-of-americans-think-adhd-is-over-diagnosed-in-todays-culture-300910615.html
- ADHD Fact Sheet: Centers for Disease Control and Prevention. (2020). “What is ADHD?” cdc.gov/ncbddd/adhd/facts.html
- Gaming and ADHD: European Child & Adolescent Psychiatry. (2020). “Time spent gaming and psychiatric symptoms in childhood: cross-sectional associations and longitudinal effects.” link.springer.com/article/10.1007%2Fs00787-019-01398-2
- What Else May Cause ADHD: HealthyChildren.org, from the American Academy of Pediatrics. (2019). “Causes of ADHD: What We Know Today.” healthychildren.org/English/health-issues/conditions/adhd/Pages/Causes-of-ADHD.aspx
- When ADHD Symptoms Surface: Mayo Clinic. (2019). “Attention-deficit/hyperactivity disorder (ADHD) in children.” mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889
- Stealth Symptoms of ADHD: National Institute of Mental Health. (2019). “Overview: Attention-Deficit/Hyperactivity Disorder.” nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
- Diagnosis by Age: National Institute of Mental Health. (2019). “Attention-Deficit/Hyperactivity Disorder: Age of Onset.” nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd.shtml
- Guidelines for Diagnosing and Treating Children: Pediatrics. (2019). “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” pediatrics.aappublications.org/content/144/4/e20192528
- Preschoolers and ADHD: Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (2015). “Preschoolers and ADHD.” chadd.org/for-parents/preschoolers-and-adhd
- Success With Meds: Frontiers in Neuroscience. (2013). “Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers.” ncbi.nlm.nih.gov/pmc/articles/PMC3666055/
- Teens and ADHD: CHADD. (n.d.). “Treatment of Teens with ADHD.” chadd.org/for-parents/treatment-of-teens-with-adhd
- ADHD medications: HealthyChildren.org. (2019). “Common ADHD Medications & Treatments for Children.” healthychildren.org/English/health-issues/conditions/adhd/Pages/Determining-ADHD-Medication-Treatments.aspx
- ADHD Meds and Kids’ Hearts: The U.S. Food and Drug Administration. (2018). “FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children and young adults.” fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-safety-review-update-medications-used-treat-attention
- Med Side Effects: Understood. (n.d.). “ADHD Medication Side Effects.” understood.org/en/learning-thinking-differences/treatments-approaches/medications/adhd-medication-side-effects
- Learning Disabilities and ADHD: Learning Disabilities Association of America. (2003). “ADHD.” ldaamerica.org/disabilities/adhd/
- IEPs and 504s for ADHD: ADDitude. (2019). “Is an IEP or 504 Plan Best for Your Child? How to Decide.” additudemag.com/iep-step-5-evaluate-your-options
- Girls and ADHD (1): European Child & Adolescent Psychiatry. (2019). “Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment.” link.springer.com/article/10.1007%2Fs00787-018-1211-3
- Girls and ADHD (2): ADDitude. (2019). “ADHD in Girls: Why It’s Ignored, Why That’s Dangerous.” additudemag.com/adhd-in-girls-women/
- ADHD Through Adulthood: The Journal of Child Psychology and Psychiatry. (2017). “Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity.” acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12620
- ADHD Misconceptions: HealthyChildren.org. (2018). “8 ADHD Myths & Misconceptions.” healthychildren.org/English/health-issues/conditions/adhd/Pages/Myths-and-Misconceptions.aspx