How can parents or teachers or anyone who works with children tell whether a seemingly overactive or inattentive child has something going on that might suggest attention deficit hyperactivity disorder?
Symptoms of ADHD are sometimes difficult to identify. One child’s behavior might look different than another’s, and age plays into that. Or there might be something else happening such as anxiety or depression or trauma.
Some of the classic symptoms — fidgeting, losing things, not following instructions — are often typical, if annoying, childhood behaviors, making it difficult to discern a normally rambunctious child from one with a disorder.
“A lot of children are active and should be at the ages of 5, 6, 7, 8, 9. But when it starts to maybe impact their social environment, when it might impact their school environment or impact the school environment for another child, that’s when (parents or teachers) start asking questions,” said Dr. Chris Rich, a child psychiatrist at University of Utah Health and Intermountain Primary Children’s Hospital, where he’s the medical director of outpatient psychiatry and behavioral health services.
Start with a pediatrician
Probably the best place to start looking for answers is through a visit to a pediatrician or primary care provider who is often well-versed in child behavioral issues. Doctors have screening tools and assessments that help pin down what is going on, Rich said.
“It’s really important to do a wide assessment as we’re working with these kids and not just walk in like, ‘Oh, they have ADHD. Let’s just lock in on that.’ It’s really important to make sure we’re looking at the whole child,” he said.
ADHD is one of the more common childhood psychiatric conditions. It is caused by differences in brain development and function and it often runs in families. It affects both kids and adults, and while symptoms can change over time, they usually don’t go away completely.
The Centers for Disease Control and Prevention estimates 7.1 million or 11.4% of U.S. children aged 5–17 years have ever been diagnosed with ADHD, according to a national survey of parents using data from 2022. It’s more prevalent in 12- to 17-year-olds than in 5- to 11-year-olds.
Boys were nearly twice as likely to be diagnosed with ADHD than girls. Black children and white children were diagnosed at three times the rate of Asian children. Symptoms can vary in severity, but about 6 in 10 children had moderate or severe ADHD, according to the CDC.
ADHD symptoms
There is no biological test for ADHD. Rich said it is basically a subset of symptoms — nine describing inattention and nine describing hyperactivity or impulsivity.
Inattention includes failure to pay close attention to detail, difficulty sticking to tasks, not listening to people, not following through on instructions and difficulty organizing.
Hyperactivity/impulsivity includes fidgeting, foot or hand tapping, running around or getting in and out of a seat, blurting out answers in a classroom or other social setting and difficulty waiting one’s turn.
Six of the symptoms of sufficient severity and level of impairment in either category must persist over six months in different settings such as home and school to qualify for a diagnosis.
“When a pediatrician or a child psychiatrist does an assessment, we really do look for other concurrent issues that could be going on. Specifically, I’ve seen a lot of kids present with school stress and school’s way hard for them and they’re very anxious about school. Do they have anxiety? Do they have stress?” he said.
“I’ve found that with the proper treatment and recognizing it, their confidence soars and all of a sudden they’re doing much better in school, they’re understanding their math assignments and science.”
Treatment options
Treatment for ADHD could be behavioral therapy, which often includes parent training, school supports and lifestyle modifications, or medication. It could also be both.
“There’s a lot of ways we can treat ADHD symptoms. It doesn’t have to be medication only. There can be behavioral modifications. There can be other nonstimulant medication. There can be strategies at school,” Rich said.
Behavior therapy focuses on changing negative behaviors into positive ones through a system of rewards and consequences. Parents play a key role by using rewards to target specific behaviors, like starting homework on time or raising a hand in class.
Rich said schools can make accommodations based on diagnosis, such as more time on a test, more time to hand in assignments or moving to a different seat in class.
Medication
Medications — usually prescription stimulants — are divided into two categories: amphetamines (like Adderall and Vyvanse) and methylphenidates (like Ritalin and Concerta).
The medications amplify the activity of the neurotransmitters dopamine and norepinephrine in the nerve cells of the brain, according to a New York Times story. Dopamine helps create the desire for something and the motivation to get it, while norepinephrine can increase alertness and make it easier to focus.
People with ADHD may have a deficit of both of those chemicals, so when they use stimulants it essentially helps “even them out,” Dr. Anthony L. Rostain, chairman of the department of Psychiatry and Behavioral Health at Cooper University Health Care, told the Times.
Rich said when medication is working well, kids are getting that dopamine impact in the prefrontal cortex that helps them sit through all of a class for an hour, whereas without they could only sit five or 10 minutes.
Even with medication, social intervention strategies still can be helpful for things like working out relationships, how to get along with others and how to handle disagreements. He advocates for parents being involved and working on positive reinforcement, organizational skills and promoting executive functioning skills, even with teenagers.
While ADHD is a common childhood disorder, it can continue into adulthood, but there is limited information about diagnosis and treatment in adults, according to the CDC.
In 2023, an estimated 15.5 million U.S. adults had an ADHD diagnosis, about half of whom received their diagnosis in adulthood and about a third of whom used stimulant medication.