I think my child has ADHD: Now what?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that causes inattention, impulsivity and hyperactivity at levels that aren’t appropriate for the age of the child.

ADHD has been diagnosed in millions of children in the US, including in children as young as 4 years of age. It’s estimated that about 10 percent of children in the US have been diagnosed with ADHD, with boys being more likely to receive a diagnosis than girls (12.9 vs 5.6 percent).

The exact cause of ADHD is not clear, but it is known to run in families.

It’s not uncommon for parents to be concerned that their child might have ADHD. Read on to find out more about what to do if you think your child has ADHD.

Signs your child may have ADHD

ADHD presents itself in three different ways, so not all children will have the exact same symptoms. Symptoms can also present differently in boys than girls, with girls tending to have more subtle or inattentive-type symptoms.

The three different types of ADHD are:

1. Predominantly inattentive ADHD
2. Predominantly hyperactive-impulsive ADHD
3. Combined-type ADHD

Healthcare providers refer to a handbook called the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5) when diagnosing ADHD. It sets out the criteria, including the symptoms to look for (listed below), when diagnosing ADHD.

ADHD symptoms vary depending on the type of ADHD a child has

Combined-type ADHD, as the name suggests, includes symptoms from both of the lists above.

What to do if you think your child has ADHD

If you think your child has ADHD then a good first-step is to talk with their teacher or another adult who cares for them frequently. Ask them about your child’s behavior and whether they have noticed any ADHD symptoms.

The next step is to make an appointment with a healthcare professional. A wide range of healthcare professionals can diagnose ADHD including, psychiatrists, pediatricians, psychologists, clinical social workers, nurse practitioners, licensed therapists and others.

CHADD, an organization focused on helping Children and Adults with Attention Deficit Hyperactivity Disorder, recommends doing your research before booking an appointment for your child. Look for someone who has had training in diagnosing and treating ADHD.

ADHD can also coexist with and mimic other conditions, so it’s also important to select someone with the right experience who is able to investigate all the possible causes for your child’s symptoms.

One last thing to consider is that only some healthcare professionals are able to prescribe medications to treat ADHD. These include physicians (DO and MD), nurse practitioners and supervised physician assistants. If ongoing care with the same person is important to you, select a healthcare professional who can diagnose and treat the condition.

Healthcare professionals use a variety of tools to help diagnose ADHD

The American Academy of Pediatrics (AAP) has published guidelines providing recommendations for healthcare professionals to follow when diagnosing children with ADHD. The DSM-5 also sets out the criteria that must be met for a diagnosis of ADHD to be made.

ADHD isn’t diagnosed by a scan or blood test - instead information is gathered from a variety of sources to get a picture of your child’s symptoms. Questionnaires are also used to garner further information.

The AAP recommends healthcare professionals evaluate children and adolescents aged 4-18 years old if they experience inattention, hyperactivity or impulsivity and are having behavioral or academic problems.

The AAP advices that the following steps should be worked through by your healthcare professional if ADHD is suspected:

• Gather information about the child’s symptoms from parents, caregivers, school staff and others who may be involved in the child’s care.
• Use ADHD rating scales - questionnaires or checklists - to help obtain more information to confirm the diagnosis. A number of rating scales exist, including the SNAP-IV (Swanson, Nolan and Pelham IV) teacher and parents rating scale and the ADHD RS-V (ADHD Rating Scale V), which measure symptom frequency and symptom severity, for example.
• Rule out other conditions that may have similar symptoms. Other tests may be necessary.
• Check for conditions that commonly exist alongside ADHD, such as anxiety and depression, autism spectrum disorder (ASD), and other conditions such as sleep disorders and tics.

The DSM-5 sets out the following criteria that must be met for a diagnosis of ADHD to be made:

• Displays persistent signs of inattentive and/or hyperactive-impulsive behavior that interferes with their development or functioning. The symptoms must not be due to oppositional behavior, defiance, hostility or a failure to understand instructions or tasks.
  • For a diagnosis of predominantly inattentive ADHD, children must have six or more of its symptoms. The symptoms must have persisted for at least 6 months and be to a degree that is not in keeping with the child’s developmental level and which negatively impacts social and academic activities.
  • For a diagnosis of predominantly hyperactive-impulsive ADHD, children must have six or more of its symptoms. The symptoms must have persisted for at least 6 months and be to a degree that is not in keeping with the child’s developmental level and which negatively impacts social and academic activities.
  • For a diagnosis of combined type ADHD the criteria for both inattentive and hyperactive-impulsive ADHD must be met.
• Several symptoms must have been present before 12 years of age.
• Several symptoms must be present in two or more settings, such as at home and school or at out-of-school activities and at home.
• There must be clear evidence that the symptoms interfere with, or reduce the child’s quality of social, academic or occupational functioning.
• The symptoms must not solely be due to other conditions.

ADHD often coexists with at least one other condition

People with ADHD often have other mental, emotional or behavioral disorders as well - an estimated two-thirds of people with ADHD will have at least one other condition. So in addition to evaluating your child for ADHD, your healthcare professional may also investigate the possibility your child has another condition as well.

Other conditions that coexist with ADHD include:

• Depression and anxiety
• ASD
• Learning disorders, including trouble processing information, and difficult reading, writing and doing math calculations
• Conduct disorder
• Oppositional defiant disorder
• Sleep disorders
• Bipolar disorder
• Speech problems
• Substance abuse disorders
• Tourette Syndrome

Treatment plans for children and adolescents with ADHD include behavior therapy, behavioral classroom interventions and medications

Following an ADHD diagnosis, it’s important to work with your healthcare professional to put in place a treatment plan for your child. Treatment can help with managing ADHD symptoms. Treatment plans for children commonly involve parent training in behavior management, behavioral classroom interventions and medication.

Parent training in behavior management

This training teaches parents the skills and strategies they need to help their child navigate living with ADHD. It helps parents develop a positive relationship with their child and provides children with skills they can use to manage their symptoms on an ongoing basis. Behavior therapy can help a child’s behavior, self-control and self-esteem. A therapist typically teaches parents behavior management skills over a number of sessions.

Not only is this type of behavior management recommended for all children with ADHD and should be started as soon as possible, but it is recommended as a first-line therapy for very young children. This is because parents have a great influence over their child’s behavior in the early years and because young children are unlikely to be able to change their own behavior without their parents' help.

Behavioral classroom interventions

Support at school is necessary for most children with ADHD. Behavioral classroom management - using reward systems to encourage positive behaviors - is a teacher-led approach that can help children with ADHD in a classroom setting. Children with ADHD may also benefit from organizational training, which teaches them planning skills, time management and how to keep their school work organized and reduce distractions.

The Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act 1973 are two US laws that cover special services and accommodations for children with disabilities.

Depending on your child’s needs they may be eligible for an Individualized Education Program (IEP), which provides individualized special education services to meet their unique needs, or a 504 plan, which provides services and changes to the learning environment to meet their needs as adequately as those of other students.

Having clear expectations, immediate positive feedback, and daily reports cards to aid communication between home and school are all thought to benefit children with ADHD.

Other support children with ADHD may need in school includes:

• Positive reinforcement and feedback
• Additional breaks and time to move about
• Changes to the classroom environment to limit distractions
• Support to stay organized
• Tailored instructions and assignments
• Extra time for exams and tests
• Technology solutions to help carry out tasks

Medications

Medication is used to help control ADHD symptoms, enabling children to pay attention and stay on task. ADHD medications need to be prescribed by a healthcare professional and taken as directed. Stimulant and non-stimulant medications are used to treat ADHD.

• Stimulation medications include: methylphenidate (Concerta, Daytrana, Jornay PM, and Ritalin), dextromethylphenidate (Focalin), mixed salts of amphetamine (Adderall, Dynavel XR, Evekeo ODT) and dextroamphetamine (Dexedrine, Vyvanse)
• Non-Stimulant medications include atomoxetine (Strattera), guanfacine (Intuniv) and clonidine (Kapvay)

For children aged 4-6 years old, the AAP Guidelines recommend that in the first instance treatment should include parent training in behavior management and/or behavioral classroom interventions.The AAP only recommends the medication methylphenidate for children aged 4-6 years with ADHD who continue to have serious problems that are not adequately helped by behavioral therapy.

In addition to the options list above, the US Food and Drug also approved EndeavorRX in June 2020, a prescription-only video game for ADHD.

Final word

ADHD is a neurodevelopmental disorder that affects many children. ADHD presents itself in different ways, so the symptoms can vary from child to child. It is important to talk to a healthcare professional if you think your child has ADHD.

ADHD doesn’t just affect children - it can also continue through into adulthood. Getting the right treatment is therefore important to minimize the ongoing impact of symptoms on life at home, school and work.

Behavior therapy and medication are the mainstays of treatment for ADHD. It’s vital to work with your child’s healthcare professional to put in place a treatment plan.
Diet can also have an impact on ADHD symptoms. Read our ADHD diet guide to learn more about diet changes that may help your child with ADHD.