What Is ADHD in Children?
Attention deficit hyperactivity disorder (ADHD) in children is a difference in brain development that can affect their ability to focus and self-control.
It's one of the most common brain disorders in children, affecting nearly 10% of kids in the U.S. While it's most often diagnosed in children, ADHD can last into adulthood.
Symptoms of ADHD in Children
Symptoms of ADHD vary from child to child. But most kids tend to show a combination of these key signs:
- Inattention. Your child may have trouble paying attention or is easily distracted.
- Impulsivity. Your child acts without thinking, such as interrupting others.
- Hyperactivity. Your child is constantly in motion, overactive, or talks too much.
Signs of hyperactivity and impulsivity include:
- A hard time sitting still for quiet tasks
- Running or climbing at inappropriate times
- Talking too much or interrupting
- Trouble waiting their turn
Signs of inattention include:
- Trouble with finishing tasks
- Losing things often
- Being easily distracted
- Making careless mistakes
- Seeming not to listen
You may notice signs of hyperactivity before you see those of inattention or impulsivity.
ADHD symptoms in toddlers
While most doctors won't diagnose a child with ADHD until at least age 4, some kids may show symptoms before then. Most ADHD symptoms look a lot like typical toddler behavior. But there are a couple of potential signs that your young child might have ADHD:
- They often get into trouble at preschool or day care.
- Their behavior is different that that of most other kids the same age.
Childhood ADHD Types
Your child's symptoms largely determine which of the three main types of ADHD they have:
- Mainly hyperactive and impulsive type. Children show both hyperactive and impulsive behavior.
- Mainly inattentive type. This was formerly called attention deficit disorder (ADD). Children with these symptoms have trouble paying attention. You might not notice their symptoms as quickly as with the first type.
- Combined type (inattentive and hyperactive/impulsive). Children with this type of ADHD have several symptoms from the first two types. This is the most common form of ADHD.
Causes of ADHD in Children
Doctors don't know exactly what causes ADHD. But it's known to run in families. One out of 4 kids with ADHD also have a parent with ADHD.
Research has shown that children with ADHD may have differences in:
- Areas of the brain that control social skills, attention, and movement
- Chemicals that control communication in the brain
Experts also believe that the brains of children with ADHD tend to mature later than those of kids without the condition.
Studies have found no evidence that ADHD could be caused by:
- Poor parenting
- TV or video games
ADHD in Children: Risk Factors
Scientists are also studying whether these things are linked to higher chances of ADHD in children:
- Alcohol or tobacco use during pregnancy
- Premature birth
- Brain injury
- Exposure during pregnancy to certain environmental risks (like lead)
- Low birth weight
How often ADHD shows up in children
- About 1 in 10 children in the U.S. have been diagnosed with ADHD.
- Boys are more than twice as likely as girls to be diagnosed. Some researchers think girls may be underdiagnosed because they're more likely to have the inattentive type of ADHD rather than the more visible hyperactive or impulsive type.
- Six in 10 children with ADHD also have another mental, emotional, or behavioral disorder.
ADHD in Children: Diagnosis
There isn't a simple test for ADHD. Your doctor or a specialist will make a diagnosis based on a physical exam, medical history, and your child's symptoms.
Your child may get an ADHD diagnosis if they meet all of these conditions:
- They have at least six ADHD symptoms, such as fidgeting a lot or being easily disrupted.
- The symptoms last for 6 months or longer.
- These symptoms cause issues for your child in more than one setting, such as home, school, and socially.
- Their symptoms started before age 12.
Childhood ADHD Treatment
Studies show that long-term treatment with a combination of behavioral therapy and medications works better than medication alone.
For children under age 6, behavioral therapy is the recommended treatment. As they grow older, their doctor may prescribe medications as well.
Behavioral treatments for children with ADHD
A therapist or counselor can teach children techniques to help them better manage their behaviors. They can also teach parents skills to help them manage their children's behavior. These include:
- Creating more structure and clear expectations
- Encouraging routines
- Rewarding good behaviors and discouraging negative behaviors
School-age children also get therapy to help them with things like:
- Time management
- Planning ahead
Drug treatments for ADHD in children
A class of drugs called psychostimulants (or sometimes just stimulants) is an effective treatment for many children with ADHD. These medicines help children focus their thoughts and ignore distractions. Some nonstimulant medications also work in similar ways to treat ADHD. Some stimulant drugs include:
- Amphetamines, such as dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall XR, Mydayis), and lisdexamfetamine (Vyvanse)
- Methylphenidates, such as dexmethylphenidate (Focalin) and methylphenidate (Concerta, Daytrana, Ritalin)
Many ADHD medicines are available in short-acting (immediate-release), long-acting, and intermediate-acting (in between short and long) forms.
It may take some time for you and your a doctor to find the best medication, dosage, and schedule for a child with the condition. And medications don't work for all children with ADHD.
ADHD drugs sometimes have side effects such as headaches or appetite loss. But usually, side effects are mild and don't last long.
No alternative treatments have been proven to help relieve ADHD symptoms. But some people report benefits from:
- Yoga. This gentle form of exercise could help your child relax and learn discipline. Some yoga studios offer classes specifically for children.
- Meditation. Whether they do it with an instructor or through a device, this may help your child feel calmer.
- Neurofeedback training. In this type of training, your child focuses on a task while a doctor scans their brain activity using an electroencephalograph (EEG). They use feedback from the machine to help the child be aware of when they're losing focus.
Which treatment is best for my child?
No single treatment is right for every child with ADHD. Your doctor will consider your child's needs and history and work with you to find the best solution.
For example, a treatment that gives your child side effects may be the wrong choice. If a child with ADHD also has anxiety or depression, a treatment combining medication and behavioral therapy might be best.
About 3 in 4 children with ADHD in the U.S. get treatment for their condition. Researchers find that:
- About 30% use medications alone for treatment.
- About 15% get behavior treatment alone.
- About 32% get both meds and behavior treatment for their ADHD.
Your child's role in their treatment
When they're old enough, children with ADHD should play an active role in managing their own symptoms. This might look like:
- Asking questions and offering opinions at doctor visits
- Having a role in taking any medications on time
- Helping decide any special arrangements they need in the classroom
ADHD Health Disparities
Research doesn't always agree on which racial and ethnic groups are most likely to have childhood ADHD. The CDC says that roughly 17% of Black children, 15% of White children, and 14% of Hispanic children have been diagnosed with ADHD or a learning disorder. But other research has found that Black children are less likely to be diagnosed with ADHD than White children. There's evidence that Black and Hispanic children with ADHD are less likely to get treatment, too.
Because doctors use input from parents and teachers to diagnose ADHD, personal opinions and biases play a role. Other reasons for disparities could include:
- Teachers may be more likely to identify symptoms in certain groups.
- Parents may fear that an ADHD diagnosis could result in stigma and increase racism against their children.
- Families may distrust the health care system or lack access to health care.
Research has also found that both boys and girls who live in families with incomes below the poverty line are more likely to be diagnosed with ADHD.
Complications of ADHD in Children
ADHD that goes untreated can lead to lifelong complications. These include:
- Substance use disorder
- Trouble getting and holding a job
- Eating disorders
- Other mental health issues such as depression or anxiety
- Unstable relationships
- Poor academic performance
- Risky behaviors that could led to automobile accidents or legal problems
- Sleep issues
Discipline and ADHD in Children
Children with ADHD need structure, partly because it's often hard for them to regulate their own behavior. That means clear boundaries about what's acceptable and what's not, as well as praise or rewards for good behavior.
Positive feedback is important, since their behavior can become more disruptive when most of their interactions with adults are negative ones. Losing your temper can just make things worse. And punishment becomes less effective the more often you resort to it.
Some things that can help:
- Create both verbal and written expectations. For example, post a chart that lists your child’s responsibilities and the house rules.
- Make rewards immediate, such as gaming time or gold stars that can be redeemed for prizes. Since kids with ADHD have trouble with planning for the future, it may not work to offer a new bike for a year’s worth of good grades, for example.
- Be clear about consequences and enforce them right away – but do so calmly. Punishing a child in the heat of disappointment or anger doesn't work well and leads to bad feelings for both of you.
- Remain supportive and encourage them even when you need to correct their behavior. Many kids with ADHD are extra-sensitive to criticism.
Should I give time-outs to a child with ADHD?
Time-outs can be a useful tool for correcting behavior – if they're done correctively. To make sure they're effective:
- Keep them brief and consistent with the issue. For young kids, 1-2 minutes is plenty. (If they're preschoolers, a 30-second to 1-minute time-out can work if they stay quiet during that time. A minute per year of age should be the upper limit.
- A prompt, such as a timer to signal the beginning and end of the time-out, may help. If your child won’t cooperate, remind them that the time-out can't start until they're quiet and in their time-out spot.
- Stay calm. If you tell them to go to time-out and they ignore you, add a minute to the time-out. If they refuse again, add another minute. If they ignore you a third time, don't pick them up and carry them to time-out. Attention, even negative attention, may reinforce the behavior. Instead, give them a consequence that's meaningful to them, such as no video games for the rest of the day. Enforce this calmly, and don't talk about it further.
- Practice time-outs. Ask your child to pretend that they misbehaved, and that they're being sent to time-out. They can practice going without putting up a fight.
- Make sure you're reinforcing good behaviors so they understand the difference. For example, if you put your child in time-out for hitting their sister, you should have been praising them earlier for playing well with their sister. And you should praise them after time-out for having a good attitude.
Living With Childhood ADHD
Childhood ADHD costs
If your child has been diagnosed with ADHD, you'll likely have costs such as:
- Visits to doctors and mental health specialists
- Expenses due to accidents or injuries
According to one study, parents with private insurance can expect extra health care expenses of $2,857-$3,922 a year for a child with ADHD, depending on the child's age. Those with Medicare will pay $2,712 to $3,509 more than they would for a child without the condition.
Childhood ADHD and mental health
Having ADHD doesn't mean your child has mental health issues. But children with ADHD are at higher risk of having other mental health conditions, including:
- Personality disorders such as obsessive-compulsive disorder (OCD)
Some mental health disorders might be related to the effects of ADHD. For example, problems at school could trigger depression. In these cases, treating ADHD might be enough to resolve the issue. But if your child has a mental health disorder along with ADHD, they'll need treatment for both conditions.
Diet for ADHD in children
There's little scientific evidence that any certain food or diet can help with ADHD. But we do know that a healthy, balanced diet helps keep a child's body and brain working well. And since ADHD medications can lower appetite, children who take these meds may have a harder time eating well.
While certain vitamin or mineral supplements might improve symptoms in children who lack these nutrients, there's no evidence they can help others. Talk to your child's doctor before giving them a dietary supplement.
Managing ADHD in children
Support groups and parenting skills training can help you learn more about ADHD and how to parent a child with the condition.
In general, here are a few tips for helping a child with ADHD:
- Try to make sure your child gets the right amount of sleep for their age.
- Watch for signs that your child may be stressed or overstimulated and intervene.
- Keep playtimes and other social interactions short to help your child retain self-control.
- Talk to your child's teacher and school administrators about your child's ADHD. They can help you decide whether accommodations would help and tell you how to apply for them.
- Regular exercise (30-60 minutes a day) helps many kids with ADHD manage some of their symptoms.
Set the stage for long-term success
As children with ADHD grow, they need to learn how to succeed on their own. To get them started on the path to independence:
Focus on their strengths. Since kids with ADHD often dwell on the things they have trouble doing, encourage then to spend time on things they do well, whether that's art, math, or sports. Spending time on things they're good at boosts self-esteem and helps them understand their strengths.
Emphasize organization. From an early age, help your child find tools and habits that they can use later on, such as:
- Organizers and checklists
- Text messages and computer reminders, once they're old enough to use a cellphone and computer
- Meditation to help them sit still in quiet surroundings
- Waiting for pauses in conversations instead of interrupting others
Get help. Make sure your child knows that finding help is a smart move, not a sign of weakness. This may include:
- Working with a tutor
- Going to their school’s writing center or using other resources
- Having sessions with an ADHD coach
Childhood ADHD Prognosis
For about 7 out of 10 children, ADHD symptoms last into their teens and early adulthood. By age 25, symptoms lessen for 16% of them, while 9% of children no longer have symptoms at all. But for about 35% to 65% of children, ADHD is a lifelong condition.
Is ADHD in children curable?
There's no cure for ADHD, but with the right treatment, symptoms can be more manageable. While not all medications work for every child, certain stimulant meds have been shown to reduce ADHD symptoms in kids by about 70% to 80%.
What to expect with ADHD in children
With the right treatment, the long-term outlook for most kids with ADHD is positive. Some learn to deal with their symptoms so well that they no longer qualify for an ADHD diagnosis by the time they're adults.
For others, ADHD lasts a lifetime. But with treatment and symptom management, many lead healthy, fulfilling lives.
ADHD can also have positive aspects, such as:
- High energy
- The ability to focus intently (hyperfocus) on things you're really interested in
Conditions Similar to ADHD in Children
Several other conditions have symptoms that are similar to those of ADHD in children. And many of them are more likely to affect kids who also have ADHD. They include
- Learning disabilities such as dyslexia (problems with reading) or dysgraphia (problems with writing)
- Mood disorders such as depression or bipolar disorder
- Anxiety disorders
- Language disorders, in which children have trouble expressing themselves or understanding others
- Behavior disorders such as conduct disorder or oppositional defiance disorder (ODD), in which a child is often angry, defiant, or aggressive
Kids with ADHD have issues with focus and attention that may last their whole lives. But treatment, a healthy lifestyle, and support from parents can help them manage their symptoms. Work with your child's health care providers and teachers to find the best solution for them.