Your health care team

Childhood attention deficit-hyperactivity disorder (ADHD) is diagnosed after a child has shown six or more specific symptoms of inactivity and/or hyperactivity on a regular basis for more than six months in more than two settings. There is no single test for ADHD.

If your child has been diagnosed with ADHD, he or she will likely be under the care of a team of health professionals. These professionals should have extensive experience treating ADHD, and should communicate with each other (and with you) on a regular basis about your child’s care.

A doctor can diagnose ADHD with the help of standard guidelines from the American Academy of Pediatrics. The diagnosis of ADHD involves the gathering of information from several sources, including school staff, caregivers, and parents. The doctor will consider how a child's behavior compares with that of other children the same age.

The diagnosis of ADHD will probably be made by a pediatric psychologist or doctor –a pediatrician, psychiatrist, or neurologist (a specialist in diseases of nervous system). Other members of the team might include nurses, nurse practitioners, physician assistants, social workers, and other therapists (counselors, family therapists, etc)

Conditions that might accompany childhood ADHD

• Learning disabilities — In about 20% to 30% of children with ADHD, there is a specific learning disability. Dyslexia, a type of reading disorder, is widespread among children with ADHD.
• Tourette’s syndrome — Very few children have this syndrome, but many of the cases of Tourette’s syndrome have been associated with ADHD. Tourette’s syndrome is a neurological disorder causing people to have various nervous tics and repetitive mannerisms. Some people with Tourette’s syndrome might clear their throats frequently, snort, sniff, or bark out words.
• Oppositional defiant disorder — As many as one-third to one-half of all children with ADHD have oppositional defiant disorder (ODD). These children are often disobedient and have outbursts of temper.
• Conduct disorder — About 20% to 40% of ADHD children might eventually develop conduct disorder (CD), a more serious pattern of antisocial behavior. These children frequently lie or steal, and tend to disregard the welfare of others. They risk getting into trouble at school or with the police.
• Anxiety and depression — Some children with ADHD might have anxiety or depression. If the anxiety or depression is recognized and treated, these children will be better able to handle the problems that accompany ADHD.
• Mania/bipolar disorder — A few children with ADHD will go on to develop mania. Bipolar disorder is marked by mood swings between periods of intense highs and lows. The bipolar child might have elated moods and grandiosity (feelings of importance) alternating with periods of depression or chronic irritability.

Symptoms of ADHD in a child

• Signs and symptoms of inattention may include:
  • Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
  • Often has trouble sustaining attention during tasks or play
  • Seems not to listen even when spoken to directly
  • Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
  • Often has problems organizing tasks or activities
  • Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
  • Frequently loses needed items, such as books, pencils, toys or tools
  • Can be easily distracted
  • Often forgetful
• Signs and symptoms of hyperactive and impulsive behavior may include:
  • Fidgets or squirms frequently
  • Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
  • Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless
  • Frequently has difficulty playing quietly
  • Always seems on the go
  • Talks excessively
  • Blurts out the answers before questions have been completely asked
  • Frequently has difficulty waiting for his or her turn
  • Often interrupts or intrudes on others' conversations or games
• ADHD behaviors can be different in boys and girls:
  • Boys are more likely to be primarily hyperactive, whereas girls are more frequently undiagnosed as they tend to be quietly inattentive.
  • Girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly.
  • Boys tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.

In addition, the doctor will do a physical examination. A full medical history will screen for other conditions that might affect a child's behavior. Among the possible causes of ADHD-like behavior are:

• A sudden life change (such as divorce, a death in the family, or moving)
• Undetected seizures
• Medical disorders affecting brain function
• Anxiety
• Thyroid disorders
• Lead toxicity
• Sleep dysfunction
• Depression

The medical history also will help put a child's behavior in context. In addition, sharing the family history can offer important clues about a child's condition. The doctor will ask what symptoms a child is showing, how long the symptoms have occurred, and how the behavior affects a child and his/her family.

Types of ADHD in children

Doctors might classify symptoms as the following types of ADHD:

• Combined type (inattentive/hyperactive/impulsive) — Children with this type of ADHD show all three symptoms. This is the most common form of ADHD.
• Hyperactive/impulsive type — Children show both hyperactive and impulsive behavior, but are able to pay attention.
• Inattentive type (formerly known as attention deficit disorder [ADD]) — These children are not overly active. They do not disrupt the classroom or other activities, so their symptoms might not be noticed.

Medicine overview for childhood ADHD

A class of drugs called psychostimulants appears to be the most effective treatment for childhood ADHD. These medicines, including methylphenidate (Ritalin®, Concerta®, Focalin XR®, Ritalin LA®, Daytrana® ), Metadate CD, and dextroamphetamine (Adderall XR®, Vyvanse®), help children to focus their thoughts and ignore distractions. Stimulant medicines are effective in 70% to 80% of patients. Non-stimulant medicines include atomoxetine (Strattera®), Intuniv®, and Kapvay®. They are often used as adjunct therapy or can be used independently.

ADHD medicines are available in short-acting (immediate-release), intermediate-acting, and long-acting forms. It might take some time for a doctor to find the best medicine, dosage, and schedule for an individual with ADHD. ADHD drugs sometimes have side effects, but these tend to happen early in treatment. Usually, side effects are mild and short-lived.

Behavioral treatments for children with ADHD

Behavior therapy is an alternative treatment pursued by the significant number of patients who do not respond to stimulants or are reluctant to take the drugs. Many patients also supplement their drug treatment with some kind of behavior therapy. The evidence for behavior therapy’s effectiveness is much weaker than the evidence for stimulant medications, however, and almost all studies comparing behavior therapy with stimulants alone indicate a much stronger effect from stimulants than from behavior therapy. Behavior therapy is not without some supporting data, although few high quality studies of the treatment exist.

Research shows that behavior therapy can be particularly good for certain subgroups within ADHD patients, for example, children who have poor relationships with parents or lots of opposition and aggression in the family. ADHD is a unique chronic disorder that might also be treated in some cases with educational therapy, although very little information exists on such treatment.

Children with ADHD might need help in organizing. Therefore, it is a good idea to do the following:

• Schedule — Have the same routine every day, from wake-up time to bedtime. The schedule should include homework time and playtime.
• Organize needed everyday items — Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies.
• Use homework and notebook organizers — Stress the importance of writing down assignments and bringing home needed books. It might be helpful for both parents and teachers to sign any assignment book.

Children with ADHD need consistent rules that they can understand and follow. If children follow rules, they should be rewarded. Children with ADHD often receive, and expect, criticism. Children’s good behavior should be sought out and praised.

Alternative behavioral treatments

Alternative treatments for ADHD include allergy treatment, megavitamins, biofeedback, restricted diets, anti-motion sickness treatment, and eye training. Currently, there is no strong scientific evidence to support the efficacy of these alternative treatments for ADHD. Consumers should exercise caution when considering alternative treatments.

One alternative ADHD treatment, Brain Gym®, is said to develop the brain's neural (related to the nervous system) pathways through movement. It is meant to prepare students of all ages to practice and master the skills required for the mechanics of learning. Though this strategy might be effective, scientific research has not yet substantiated its effectiveness.

Helpful tips for doing homework

Parents can help a child with ADHD achieve academic success by taking steps to improve the quality of the child’s homework. Parents should make sure that a child with ADHD is:

• Seated in a quiet area without clutter or distractions
• Given clear, concise instructions
• Encouraged to write each assignment in a notebook as it is given by the teacher
• Responsible for his/her own assignments — Parents should not do for the child what he or she can do for himself or herself.

Children with ADHD need consistent rules that they can understand and follow. If children follow rules, they should be rewarded. Children with ADHD often receive, and expect, criticism. Children’s good behavior should be sought out and praised. Parents should:

• Provide clear, consistent expectations, directions, and limits — Children with ADHD need to know exactly what others expect from them.
• Set up an effective discipline system — Parents should learn discipline methods that reward appropriate behavior and respond to misbehavior with alternatives such as "time out" or loss of privileges.
• Create a behavior modification plan to change the most problematic behaviors — Behavior charts that track a child’s chores or responsibilities and that offer potential rewards for positive behaviors can be helpful tools. These charts, as well as other behavior modification techniques, will help parents address problems in systematic, effective ways.

ADHD and driving

Teens with ADHD may demonstrate good knowledge of driving rules, but applying these rules is a different matter. Rather than rule-of-the-road knowledge, it is poor driving performance that distinguishes individuals with ADHD from their peers. Learning new skills may be difficult. Patience, supervision, and time are necessary to develop perception, good judgment, and reaction skills through practice behind the wheel. Talk with your teen to see how he feels about driving. Increased responsibility and attention to new stimuli may be overwhelming.

Teen driving privileges should be discussed in light of the overall ADHD treatment plan. It is a parent's responsibility to establish rules and expectations for safe driving behaviors.

Tips for the teacher

With simple adjustments in the classroom, teachers can more easily work with the strengths and weaknesses of the child with ADHD.

It is helpful for teachers to:

• Give assignments one at a time to avoid work overload
• Pair written instructions with oral instructions
• Give clear instructions
• Set up clear rules of behavior and consequences for breaking these rules
• Seat the child near a good role model or near the teacher

Kids and relationships

Not all children with ADHD have trouble getting along with others. For those who do, however, steps can be taken to improve a child’s relationships. The earlier a child's difficulties with peers are noticed, the more successful such steps might be. It is helpful for parents to:

• Recognize the importance of healthy peer relationships for children
• Involve a child in activities with his or her peers
• Set up social behavior goals with the child and implement a reward program
• Encourage social interactions if the child is withdrawn or excessively shy
• Encourage a child to play with only one other child at a time