ADHD in Children

ADHD symptoms in children

Attention-Deficit / Hyperactivity (ADHD) is a condition with symptoms that include excessive restlessness, poor attention, and impulsive acts. There are three major presentations of ADHD: predominantly inattentive, in which children and adolescents have problems concentrating and focusing; predominantly hyperactive-impulsive, in which children and adolescents experience impulsivity and excess activity; and combined type, in which children and adolescents experience symptoms of inattention, hyperactivity, and impulsivity. Symptoms of ADHD often continue into adulthood.

ADHD is typically diagnosed when a child is 7 or 8 years old, although symptoms may be present as early as ages 3 to 5. Girls are often identified later than boys. Bright children may not be diagnosed until later as they may compensate for their difficulties until schoolwork and life demands get more challenging. 

Early diagnosis and intervention are essential for the effective treatment of ADHD. Delayed diagnosis can result in worsening symptoms, co-occurring conditions, and functional impairment. However, accurate diagnosis can be challenging, as ADHD symptoms can overlap with symptoms of other mental health conditions, such as anxiety or depression. A comprehensive evaluation is necessary to ensure an accurate diagnosis and effective treatment plan. The evaluation may include a thorough medical and psychiatric history, physical exam, and assessment of symptoms and functional impairment in multiple settings. Parents and teachers can provide valuable information about a child's behavior and functioning in different settings, such as home and school.

It is normal for children to have moments of inattention, impulsivity, or hyperactivity, but children with ADHD experience these symptoms to such a degree that daily functioning at home, school, and with peers is impacted.

ADHD Facts:

• ADHD is a treatable medical disorder. While the exact cause is not known, it may be caused by the reduction of neurotransmitters in the part of the brain controlling executive functioning and impulse control.
• It is normal for children to have moments of inattention, impulsivity, or hyperactivity, but children with ADHD experience these symptoms to such a degree that daily functioning is impacted at home, school, and with peers.
• As children with ADHD grow into adolescence, hyperactivity lessons yet they continue to have significant problems with disorganization, distraction, and poor impulse control.
• ADHD runs in families and environmental factors may be involved. It is inherited at a rate of nearly 75%. Risk of developing ADHD is increased for children born to mothers who smoked cigarettes, consumed alcohol, or had mental health issues during pregnancy; children born prematurely or with low birth weight; and children suffering a brain injury or seizure disorder.
• About 17 million people in the United States are affected by ADHD. To put that in context, the state population of Arizona is just over 7 million.

Symptoms of inattention

• Often makes careless mistakes and lacks attention to detail. Example: making hasty decisions or not following directions.
• Often has difficulty paying attention to tasks or while playing. Example: daydreaming in class, easily distracted.
• Often seems to not listen when spoken to directly. Example: mind seems somewhere else, even in the absence of obvious distraction.
• Often fails to follow through on instructions, schoolwork, or chores. Example: starts tasks, but quickly loses focus and is easily sidetracked.
• Often has difficulty organizing tasks and activities. Example: messy, disorganized work; poor time management.
• Often avoids, dislikes, or is reluctant to participate in tasks requiring sustained mental effort. Example: avoids homework or chores, i.e. procrastinates.
• Often loses things. Example: loses homework, folders, or backpacks
• Often easily distracted. Example: often goes off on tangents during conversations
• Often forgetful in daily activities. Example: may forget to complete chores

Symptoms of hyperactivity and impulsivity

• Often fidgets with or taps hands and feet or squirms in seat. Example: may also need to hold or fiddle with an object.
• Often leaves the seat when remaining seated is expected. Example: frequent requests to use the restroom to get out of class.
• Often runs or climbs where it is inappropriate or feels restless. Example: gravitates toward risky play activities involving stunts.
• Often unable to play quietly or, if older, participate in leisurely activities. Example: family tension due to constant activity.
• Often acts as if “on the go” or “driven by a motor”. Example: uncomfortable being still for an extended time at restaurants, church, or movies.
• Often talks excessively. Example: wants to “say it” or risk forgetting a thought.
• Often blurts out an answer before a question has been fully asked. Example: completes people’s sentences; cannot wait for turn in the conversation.
• Often has difficulty waiting for his or her turn. Example: trouble waiting in-line; limited patience; easily frustrated.
• Often interrupts or intrudes on others. Examples: intrudes on conversations, games, or activities; may start using other people’s things without asking or getting permission.

How ADHD may appear in different settings

ADHD symptoms may affect children (ages 6-17) in school, at home, and/or in social situations. For a diagnosis of ADHD to be made, symptoms must be present in two or more settings.

Home

• Fails to finish chores or homework
• Loses things like homework, books, pencils, eyeglasses, wallets, and mobile phones
• Difficulty doing leisure activities quietly

School

• Trouble getting organized. For instance, has trouble keeping materials and belongings in order; poor time-management skills
• Trouble sitting still, talking out of turn, or blurting out answers in school
• Fails to pay close attention to details or makes careless mistakes

Social

• Difficulty waiting for his or her turn
• Frequently interrupts or intrudes on others. For instance, he or she may butt into conversations
• Talks excessively

Risks of not treating ADHD

• Increased risk of failing grades and dropping out of high school and college
• Behavior and discipline problems
• Social difficulties and family strife
• Accidental injury
• Alcohol and drug abuse
• Depression, anxiety, and other mental health disorders
• Employment problems
• Driving accidents
• Unplanned pregnancy and sexually transmitted diseases
• Delinquency, criminality, and arrest

Treating ADHD and co-occurring disorders depends on the child’s age and comorbid condition. Treatment may include medication, parent training, behavioral therapy, coaching, and educational support (IEP or 504 plan). Every additional disorder with ADHD adds to the complexity of the treatment. For instance, Oppositional defiant disorder has no FDA-approved medication for treating it, but a mood stabilizer may be indicated if the anger and aggression are at a level where the safety of the child or others is a concern. While stimulant medication is the first-line treatment for ADHD, for a child with a co-occurring mood disorder, it may make temper tantrums and irritability worse. When treating multiple disorders, the order in which they are treated, and the choice of medication used require the expertise of a specialist.

Medications are often used to treat ADHD and comorbidities, but they are not a cure. Stimulant medication is a first-line treatment for ADHD, but it may not be appropriate for children with certain comorbidities. Children with comorbid mood disorders may experience increased irritability and temper tantrums with stimulant medication. Some children with ODD or conduct disorder may benefit from mood stabilizers or atypical antipsychotics. The decision to start medication will be thoroughly discussed and agreed upon by the provider, the parents, and the child. It’s important to weigh the risks and benefits of any medication.

Non-medication treatments, such as behavioral therapy and parent training, can also be effective for managing ADHD and comorbidities. Every additional disorder with ADHD adds to the complexity of the treatment. The order in which comorbidities are treated, and the choice of medication used, requires the expertise of a specialist.