ADHD in Children: Essentials Parents Should Know

Many parents today have heard of or may know someone with ADHD — but clearly recognizing the early symptoms in your own child can be challenging. Knowing the signs, diagnostic process, and available treatments will help you understand ADHD and advocate effectively for your child.

Attention Deficit Hyperactivity Disorder (ADHD)

If you’ve wondered whether your child’s lack of focus is a sign of ADHD, read on to learn how to get her the supports to succeed academically and intellectually .

Description

Picture a child — we’ll call him Jason — who is in a typical third-grade math class. The teacher hands out worksheets with two columns of multiplication and division questions and announces that students only need to do the even questions. Jason begins to work on the first few questions, but does multiplication for each one (not noticing the division symbols). Shortly thereafter, his friend leaves the room to go to the bathroom, and Jason loses his place in the math problem he’d been working on. Suddenly — or so it seems — class is over, and Jason has left his worksheet on his desk. After calling his friend to get a copy, he then works through every problem until he is completely exhausted. School may no longer seem fun or fair to him.

For children with ADHD, this scenario — or others like it — is probably all too familiar. Here are factors that may indicate a need for intervention with your child.

Symptoms

In order to diagnose ADHD, a psychiatrist looks for symptoms of inattention, impulsivity, or hyperactivity, such as two or more of the following examples:

  • Difficulty holding attention to play or tasks
  • Forgetfulness in daily activities
  • Trouble organizing tasks and activities
  • Tendency to fidget or tap feet
  • Trouble waiting his/her turn
  • Tendency to blurt out an answer before a question is complete

These symptoms (or a history of them) must be present before the age of 12, and they must be exhibited in multiple settings, such as at home and school and extracurriculars. Most importantly, to be indicative of ADHD, the set of symptoms needs to interfere with a child’s daily functioning.

Characteristics

The above symptoms tend to be reflected in these characteristics:

  • Difficulty staying on task
  • Forgetfulness (of materials, schedule, or tasks)
  • Difficulty sitting or standing still
  • Difficulty sustaining attention for the same length of time as peers
  • Careless errors or mistakes, especially in detail-oriented work such as math, writing mechanics, and spelling
  • Difficulty with time management (and a lack of awareness about how long something takes)

Diagnosis

It is important to note that all attention-based disorders are now grouped under the umbrella term of Attention Deficit Hyperactivity Disorder. In particular, there are three types of ADHD:

  • Attention Deficit Hyperactivity Disorder – Hyperactive/Impulsive Type
  • Attention Deficit Hyperactivity Disorder – Inattentive Type (formerly “ADD”)
  • Attention Deficit Hyperactivity Disorder – Combined Type

The diagnostic process is the same for all, though the treatments may vary according to the child’s symptoms, the parents’ preferences, and the evaluator’s recommendations.

Diagnostician and Testing

ADHD can only be diagnosed by a psychiatrist, psychologist, or neuropsychologist. An evaluation includes information about family history, developmental milestones, academic history, tests of intelligence and academic achievement, and assessments of inhibition and other executive function skills. Diagnosticians will also ask parents and teachers to complete questionnaires about the child’s behavior and possible symptoms.

You can see examples of these surveys here.

See Noodle’s comprehensive guide to learning disabilities in children for a more detailed description of the diagnostic process.

Age of Diagnosis

As of 2011, the American Academy of Pediatrics reported that a diagnosis of ADHD can be made when a child is between the ages of four and 18. There are specific diagnostic criteria for children at different ages. These range from issues involving focus and direction-following for preschool-aged children to those involving academic and organizational skills for older children.

Prevalence

According to the American Psychiatric Association, approximately five percent of the U.S. population has ADHD. Other estimates, though, suggest that its prevalence may be higher in some communities. In 2011, for example, the Centers for Disease Control and Prevention reported the national prevalence at 11 percent in the school-aged population, based on surveys asking parents if their child had “ever received an ADHD diagnosis from a health care provider.” Diagnosis rates also vary significantly across the country, with rates below nine percent in states like Idaho and Nevada and above 18 percent in Kentucky. One possible explanation for these differences is that states with higher rates of ADHD have more robust diagnostic processes and tools, as opposed to higher actual rates of students with the disorder.

The Brain and ADHD

By the age of three years old, the brains of children with ADHD have developed normally but more slowly than neurotypical brains. The neurological areas that are most affected in those with ADHD are in the frontal lobe and the networks connecting the two hemispheres of the brain; these areas are involved in “thinking, paying attention, and planning,” according to the National Institutes of Health.

Some brain regions, such as the cortex and the corpus callosum, that are integral to helping the brain communicate across its different regions also show irregular development; research suggests that in children with ADHD, these may never fully catch up. Moreover, there is research showing that the brains of people with ADHD behave differently in the “default mode network,” which is thought to be responsible for executive functions and attention to external factors. This neurological difference persists even in adults who no longer show symptoms of ADHD.

Recognition of the Positives

Dr. Ned Hallowell, a psychiatrist who specializes in ADHD and advocates on behalf of children with this learning disorder, urges parents to look for mirror traits. For every potentially non-adaptive, or negative, symptom, there is a corresponding, “mirroring” positive trait. For example, children with ADHD tend to be stubborn, but this same trait corresponds with perseverance, which is a positive characteristic.

Mirror Traits

Mirror traits for those with ADHD include:

  • Impulsivity and distractibility, which may lead to divergent thinking, imagination, and creativity
  • Stubbornness and sometimes obsessiveness, which may lead to hyperfocus (it may sound counterintuitive, but when kids with ADHD are engaged or interested in a topic, they can actually focus for longer periods of time than their neurotypical peers)
  • An inability to be organized and stay on topic, challenges that may result in a greater ability to achieve “flow” and spontaneity, which are helpful for improvisational jazz and rap

Evidence-Based Interventions

There is no cure for ADHD, but with evidence-based treatments, people with this disability can lead happy, successful lives.

Organizational Skills Training (OST)

OST and other behavioral therapies that include explicit instruction about self-regulation and routines can be effective in helping children with ADHD learn organizational skills that many neurotypical individuals take for granted. Though not all children with ADHD have difficulty with organization, most do. “Organization, time management, and planning skills are needed to meet school demands and associated tasks that must be completed at home,” write Gallagher, Abikoff, and Spira, authors of Organizational Skills Training for Children with ADHD. They point to several studies demonstrating that students who lack these skills are more likely to disengage from school and fare poorly academically.

OST has a few key features, notably:

  • A team approach in which skills are reinforced in a variety of settings by the child’s parent(s), teachers, and clinicians
  • A hierarchical approach in which the curriculum continues to build on skills already mastered
  • An externalization of poor habits, i.e., a “glitch” approach
  • Progress tracking via charts and graphs

It is also founded on what is known as the “ABC” approach:

  • An Antecedent, which is the event or environment that leads to an action
  • A Behavior, whether it is successful or maladaptive
  • A Consequence, or a reinforcement of some kind

For example, if each day that a child comes home, she loses track of her belongings, the antecedent is the ritual of arriving home; the behavior might be running to her room without paying attention to where she’s going or placing her backpack in a cubby by the door; and the consequence would be the help of a sign to remind her of these organizational steps.

Medication

Data from this 14-month study showed that stimulant medication is most effective in treating the symptoms of ADHD, as long as it is administered in doses adjusted for each child to give the best response — either alone or in combination with behavioral therapy.

Eighty to 85 percent of people with ADHD benefit from medication that is prescribed and managed by a psychiatrist who specializes in this disorder.

There are two types of medication used to treat children with ADHD: stimulants and non-stimulants.

Stimulants

It may sound counterintuitive to provide someone with attentional difficulties a stimulant, but in fact, these medications stimulate the regions of the brain that help people focus. They have been found to be helpful for 70 to 80 percent of children with ADHD.

Common stimulants include:

  • Adderall
  • Dexadrine
  • Concerta
  • Daytrana
  • Focalin
  • Metadate
  • Ritalin

Non-stimulants

In turn, non-stimulants, which are slower-acting, increase the amount of norepinephrine in the brain. Among its many jobs, norepinephrine helps regulate attention, learning, and emotion.

Common non-stimulants include:

  • Strattera
  • Intuniv
  • Kapvay

Common Side Effects

The most common side effects of these medications include decreased appetite and trouble sleeping. In such cases, the remedy is to lower the dosage. Still, according to researchers at MIT, about 60 percent of patients respond well to the first drug they receive. That said, there are children who don’t tolerate medications initially (or at all), and for them, it may make sense to consider other treatments.

Exercise

Multiple studies have shown that multiweek physical exercise programs resulted in perceptions of fewer negative ADHD-like symptoms and greater response inhibition.

Further Reading

Noodle’s range of articles on ADHD, including:

The following outside resources are well-established authorities in the field of ADHD. You will find in-depth coverage here:

Sources:

ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. (n.d.). Retrieved March 16, 2015, from Pediatrics.

ADHD: Parents Medication Guide. (2013). American Academy of Child & Adolescent Psychiatry and American Psychiatric Association.

ADHD and Mental and Cognitive Health. (2009, April 15). Retrieved March 11, 2015, from Dr. Hallowell.

Attention Deficit Hyperactivity Disorder. (n.d.). Retrieved March 14, 2015, from National Institute for Mental Health.

Data & Statistics. (2014, December 10). Retrieved March 14, 2015, from Centers for Disease Control and Prevention.

Elliott, Ph.D, G., & Kelly, K. (2006, January 1). ADHD Medications, An Overview. Retrieved March 15, 2015, from CHADD.

Hoza, B., & Smith, A., et al. (2014). A Randomized Trial Examining the Effects of Aerobic Physical Activity on Attention-Deficit/Hyperactivity Disorder Symptoms in Young Children. Journal of Abnormal Child Psychology. Retrieved March 15, 2015, from Springer Link.

Limb, C., & Braun, A. (2008). Neural Substrates of Spontaneous Musical Performance: An fMRI Study of Jazz Improvisation. Retrieved March 17, 2015, from PLOS One.

Liu, S., & Chow, H., et al. (2012). Neural Correlates of Lyrical Improvisation: An fMRI Study of Freestyle Rap. Scientific Reports, 2(834). Retrieved March 9, 2015, from Scientific Reports.

Marching to a Different Beat: ADHD and Circadian Rhythms. (2012, October 3). Retrieved March 15, 2015, from Scicurious.

My Child Has Been Diagnosed with ADHD — Now What? (2014, December 10). Retrieved March 11, 2015, from Centers for Disease Control and Prevention.

Prox-Vagedes, V., & Steinert, S. et al. (2011). Word Recognition Memory in Adults with Attention-Deficit/Hyperactivity Disorder as Reflected by Event-Related Potentials. Frontiers in Human Neuroscience, 5(27). Retrieved March 9, 2015, from NCBI.

Rating Scales and Checklists. (n.d.). Retrieved March 14, 2015, from National Resource Center on ADHD.

Smith, A., & Hoza, B., et al. (n.d.). Pilot Physical Activity Intervention Reduces Severity of ADHD Symptoms in Young Children. Journal of Attention Disorders. Retrieved March 13, 2015, from Sage Journals.

Symptoms and Diagnosis. (2014, September 29). Retrieved March 12, 2015, from Centers for Disease Control and Prevention.

Trafton, A. (2014, June 10). McGovern Institute for Brain Research at MIT. Retrieved March 12, 2015, from McGovern Institute.

White, H., & Shah, P. (2011). Creative style and achievement in adults with attention-deficit/hyperactivity disorder. Personality and Individual Differences, 50(5), 673-677. Retrieved March 12, 2015, from ScienceDirect.

Who Can Diagnose LD and/or ADHD. (n.d.). Retrieved March 16, 2015, from LD Online.