ADHD in Children: Symptoms, Causes, Treatment

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:

• Sugar
• Vaccines
• 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

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.

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
• Medications
• Coaching
• Tutoring
• 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:

• Depression
• Anxiety
• 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.

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
• Creativity
• 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

Takeaways

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.