Suspecting or hearing that your child has ADHD can trigger a number of feelings. It can also raise many questions. You may wonder about symptoms, evaluations and how you can help.

The journey of parenting a child with ADHD can sometimes feel lonely. But the fact is that 9 to 10 percent of kids ages 3 to 17 in the United States have been diagnosed with attention-deficit hyperactivity disorder. Learning as much as you can about ADHD is a great first step to getting your child the help he needs.

What is ADHD?

A good way to understand what ADHD is to establish what it isn’t. It isn’t the result of bad parenting or of your child being lazy or disobedient. ADHD is a biological condition that makes it hard for many children to sit still and concentrate.

There are various areas of the brain that control your child’s ability to concentrate and “hit the brakes.” These areas may be less active and develop more slowly in kids with ADHD. The best evidence for this occurs in the front part of our brain, or the frontal lobe. This can upset the balance of certain brain chemicals. It can also explain why your child may have more trouble socially than his peers.

Kids don’t outgrow ADHD. The symptoms may change over time but ADHD is a lifelong condition. That doesn’t mean your child can’t be happy and successful. There are many effective strategies and treatment options you can try to manage your child’s symptoms.

Kids (and families) are all different, so not all options will work for you. It takes trial and error to see what fits your child and family. But finding the right strategies and seeing an improvement can boost everyone’s confidence.

Three Types of ADHD
For many people, the words “hyperactive” or “out of control” come to mind when they hear the term ADHD. If your child doesn’t have those symptoms, a diagnosis of ADHD can be puzzling. Kids who don’t seem hyperactive often aren’t diagnosed as early.

There are actually three types of ADHD, and one of them doesn’t include symptoms of impulsive and hyperactive behavior.

ADHD, Predominantly Hyperactive-Impulsive Presentation: Kids who have this type of ADHD have symptoms of hyperactivity and feel the need to move constantly. They also struggle with impulse control.

ADHD, Predominantly Inattentive Presentation: Kids who have this type of ADHD have difficulty paying attention. They’re easily distracted but don’t have issues with impulsivity or hyperactivity. This is sometimes referred to as attention-deficit disorder (or ADD).

ADHD, Combined Presentation: This is the most common type of ADHD. Kids who have it show all of the symptoms described above.

How common is ADHD?

ADHD is one of the most common childhood conditions involving the brain. According to the Centers for Disease Control and Prevention, between 9 and 10 percent of kids in the U.S between the ages of 3 and 17 have been diagnosed with ADHD.[1] Boys are more than twice as likely girls to have ever been diagnosed with ADHD.

What causes ADHD?

Researchers don’t know the exact cause of ADHD. But they have identified factors showing it’s a brain-based biological condition. Knowing there are medical reasons for why your child talks constantly or can’t stop daydreaming can help you see things in a different light. The possible causes of ADHD include:

Genes and heredity: Studies show that AHDH runs in families—meaning it may be genetic. If your child is diagnosed with ADHD, there is a significant chance that you have it too, even if you’ve never been diagnosed. As many as 35 percent of children with ADHD have a parent or sibling who also has the disorder.[2]

Differences in the brain: Certain areas of the brain may develop at a slower pace or be less active in kids with ADHD. Johns Hopkins Medicine reports that kids with ADHD also may have lower levels of a brain chemical called dopamine that helps to regulate mood, movement and attention.[3]

Environmental factors: Prenatal exposure to alcohol and cigarette smoke could increase the chances of getting ADHD, says the National Institute of Mental Health. So does exposure to high levels of lead during infancy and early childhood.[4] There’s no evidence that sugar or food additives cause ADHD. Find out more about sugar, food additives and ADHD.

Brain injury: Traumatic brain injury (TBI) is a lot less common than ADHD. But ADHD-like symptoms are sometimes present in the relatively small number of kids who have TBI. Recent studies show high rates of attention problems in acquired brain injuries (such as concussion and brain tumors).[5]

What are the symptoms of ADHD?

You may have been concerned about some of your child’s behaviors. Once you recognize them as signs of ADHD, you’ll be in a better position to help.

Observing and taking notes to share with your child’s doctor and teacher are key first steps to finding the best treatments, strategies and supports. If your child’s teacher is the first to mention concerns and observations, try to be receptive.

Symptoms of ADHD fall into three categories: inattention, impulsivity and distractibility. For your child to be diagnosed with attention-deficit hyperactivity disorder, the signs have to be present for at least six months.

Signs of Inattention

Forgets things, seems “daydreamy” or confused and appears to not be listening

Finds it hard to concentrate and jumps quickly from one activity to another

Gets bored with an activity unless it’s very enjoyable

Struggles to get organized and finish tasks

Has difficulty learning new things and following directions

Is smart but doesn’t understand or “get” things you expect him to or that his peers grasp easily

Signs of Impulsivity

Is impatient and has trouble waiting for a turn

Blurts out inappropriate things and interrupts people

Overreacts to feelings and emotional situations

Doesn’t understand the consequences of his actions

Signs of Hyperactivity

Talks almost constantly

Moves nonstop even when sitting down

Moves from place to place quickly and frequently

Fidgets and has to pick up everything and play with it

Has trouble sitting still for meals and other quiet activities

When Symptoms Appear
Parents often don’t notice signs of ADHD before their kids start school. Kids whose main symptoms are distractibility and inattention are typically diagnosed during grade school, reports John Hopkins Medicine.[6]

Kids with severe hyperactivity and poor impulse control are more likely to be diagnosed as preschoolers. The American Academy of Pediatrics doesn’t recommend giving a diagnosis of ADHD until a child is at least 4 years old. It’s hard to know what falls within the range of typical behavior when kids are that young.[7]

Symptoms May Change Over Time
Children don’t outgrow ADHD, but their symptoms may change as they become older. Nearly one-third of kids with ADHD may no longer need medication after puberty. With the right treatment, the other two-thirds will continue to find ways to manage symptoms so they don’t interfere with the demands of adulthood.

What skills are affected by ADHD?

How might ADHD affect your child’s skills and abilities? It depends which symptoms your child has and how severe they are. And it also depends which areas your child has particular strengths in. You can build on your child’s strengths and use them to help in weaker areas. Here are the skill groups that ADHD affects most.

Social skills: Kids with ADHD often have a tough time making and keeping friends. Being hyperactive or impulsive can make it hard for your child to follow social rules, control emotions and say the appropriate thing. Other kids may find it hard to interact with your child if he constantly interrupts or doesn’t take turns

Self-control: Many kids with ADHD need to move around a lot, and that isn’t limited to moving from place to place. The American Academy of Neurology reports that even when they’re doing specific activities like tying their shoes, writing, playing a musical instrument or even driving a car, people with ADHD often use extra body movements. This can make those tasks a lot harder to manage.[8]

Organization, planning and learning: ADHD affects the part of the brain that deals with executive functioning. This is the ability to plan, organize and think ahead. Losing track of calculators, notebooks and assignment sheets can make it hard to complete assignments and homework. Losing track of his own thought process can make it even harder. Your child may struggle with breaking down a school assignment or a household job into steps and getting started.

Other skills that may be affected include:

Understanding directions

Thinking things through

Paying attention to new information

Applying knowledge from one area to a different one

Staying focused without getting bored

Being aware of one’s own thought processes (the opposite of daydreaming)

How is ADHD diagnosed?

Many symptoms of ADHD are to some degree typical childhood behavior. That means diagnosing it isn’t always easy. It’s a collaborative effort. It begins with you keeping track of your child’s symptoms and behavior to share with your child’s doctor.

To be diagnosed with ADHD, kids need to have had several symptoms for at least six months before age 12. It may streamline the diagnostic process if you can show that the behavior has been ongoing and keeps your child from doing what other kids his age can do.

There’s no single test that will confirm your child has ADHD. Here are the steps involved in getting a diagnosis.

Step 1: Get a medical exam. A medical exam isn’t as formal as it sounds. You and your child’s doctor will talk about your concerns and come up with a plan to rule out other medical causes for your child’s symptoms.

Conditions like seizure disorders, hearing impairments or chronic ear infections can affect cognition (mental processing) and cause anxiety or depression. The doctor can rule out some things right in the office. But your child may also need to see a specialist such as an audiologist or neurologist for more in-depth testing.

Step 2: Get a referral to a mental health professional. After ruling out medical causes, your child’s doctor will likely refer you to a mental health professional. This might be a licensed clinical social worker, a child psychologist or a developmental pediatrician. This professional will gather information from your child’s medical history and school records. They’ll also talk to caregivers and other people who know your child well.

It’s important for the mental health professional to know if your child is experiencing major life stressors like a divorce, a move or a death in the family. They’ll also need to know if other family members have learning and attention issues. The mental health professional will also:

Provide questionnaires or behavioral rating forms. The people closest to your child, including you, your child’s caregiver and your child’s teacher, will be asked to fill these out. The purpose is to see if all of you are noticing the same behaviors. Common screening tools include the Behavior Assessment System for Children (BASC-2), and Achenbach Child Behavior Checklist (CBCL), which has more than 100 questions about whether you see certain behaviors in your child.

Ask you to fill out ADHD rating scales. Like the CBCL, rating scales ask about your child’s behavior. But the questions are more specifically about behaviors seen in kids with ADHD. The American Academy of Child and Adolescent Psychiatry recommends that pediatricians use the SWAN Rating Scale or the SNAP-IV Rating Scale.[9] Many clinicians use the Conners’ Rating Scale[10] or the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS). Rating scales usually have a version for parents and a version for teachers. Sometimes older children are asked to rate themselves as well. The idea is to gather information from more than one source and from more than one setting, such as home and school.

Test your child’s attention span. Clinicians often use Conners’ Continuous Performance Test (CPT-3). The test is for kids age 8 and up. It consists of pressing a button on a keyboard when any letter other than X appears on the screen. The test takes about 15 minutes and is designed to provide insights into things like impulse control and sustained attention.

Speak with and observe your child. Most mental health professionals will want to see for themselves how your child interacts with people and the world around him. If yours doesn’t ask to meet your child, find out whether they’ll observe your child at school.

Before making a diagnosis the professional will want to know:

Are the behaviors excessive and do they affect many aspects of your child’s life?

Do they happen more often in your child compared with peers?

Are the behaviors a constant problem or a response to a temporary situation?

Do the behaviors occur in several settings or only in one place, such as the playground, classroom or home? Observing your child in the classroom or on the playground will give insights into how your child reacts in social situations. The psychologist may also want to test your child for a learning disability.

Step 3: Put it all together. Your child’s doctor and the mental health professional will look at all the information they collected. For your child to be diagnosed with ADHD:

The symptoms must be present in two or more settings, such as at home and at school.

The symptoms must be severe enough to negatively affect your child’s social skills and schoolwork.

The symptoms must have been present for at least six months and to have appeared before age 12.

The number and type of symptoms are also important. If your child has six or more symptoms of inattention, he can be diagnosed with the inattentive type of ADHD. If he has six or more symptoms of hyperactivity and impulsivity, he can be diagnosed with the hyperactive/impulsive type. Kids who meet the criteria for both the inattentive and the hyperactive/impulsive types will be diagnosed as having the combined type of ADHD.

The requirements are the same for people 17 and older—except that instead of showing at least six symptoms for one of the three types, they need to show at least five.

The diagnosis will specify the type of ADHD and also whether it is mild, moderate or severe.

What conditions are related to ADHD?

Kids with ADHD often have other conditions as well. Doctors refer to this as comorbidity. Some conditions look a lot like ADHD because they have some of the same symptoms. It’s important that your child’s issues are properly identified so you can start an appropriate treatment program. Here are issues that often coexist with ADHD:

Learning disabilities. Some learning disabilities make it hard for children to stay organized. Children with certain forms of dyslexia have trouble processing and responding to directions (written or spoken).

Social (pragmatic) communication disorder. This condition makes it hard for a child to converse in socially appropriate ways. Kids with social communication disorder may have trouble understanding body language, puns, sarcasm and statements that don’t mean exactly what they say.

Auditory processing disorder. This can make it hard for kids to understand and follow spoken directions. There’s a “disconnect” somewhere between the ear and brain, making a child appear inattentive or unable to follow directions. Auditory processing disorder can coexist with ADHD. But sometimes one gets misdiagnosed for the other.

Motor and oral (vocal) tic disorders. Although the most commonly known tic disorder is Tourette syndrome, there are others as well. Tic disorders can cause body movements and vocal sounds that kids can’t control.

Behavior disorders. Oppositional defiant disorder is common in children with the combined type of ADHD. So is conduct disorder.

Emotional regulation issues. More than just temporary emotional difficulties, mental health conditions such as anxiety disorders, depressive disorders and obsessive-compulsive and related disorders can cause symptoms beyond a child’s control.[11] Some of those symptoms are also seen with ADHD, such as emotional outbursts, high energy and the need to have things be “just so.”

ADHD and many of the issues described above share a common thread: executive functioning issues. Executive functioning skills allow us to plan, organize, remember things, prioritize, pay attention and get started on tasks. A child with ADHD or another disorder may lack skill in one or more executive functions.

How can professionals help with ADHD?

The professionals will tell you about the various treatment options and educational strategies that can help your child manage and work around ADHD symptoms. What you choose will depend on your personal views, your child’s age and symptoms, other health issues and your experience with any previous treatments.

Don’t panic if the first strategies you try aren’t effective. You may need to try several approaches to find the best fit for your child. Here are some of the treatments and approaches used by professionals to treat ADHD:

Medication
Deciding whether to treat ADHD with medication is a personal and sometimes difficult decision. For most kids with ADHD, stimulant medications such as methylphenidate and amphetamines are effective in helping to manage symptoms.[12] These medications work by balancing the brain chemicals responsible for focus, attention and impulse control.

Possible side effects include decreased appetite, irritability, trouble sleeping and anxiety. But these are usually mild and disappear over time. Stimulant medications may also complicate or amplify any coexisting conditions your child has. (There are also non-stimulant medications that might help some kids with ADHD.)

Therapy
There are different types of therapy that address behavior, emotional and social issues. Depending on your child’s symptoms and response to therapy, you may consider trying more than one type. Behavior therapy helps kids with ADHD learn skills to manage their behavior, improve organization and cope with stress. Psychotherapy can help with the emotional issues.

Some therapists provide social skills training. Working in small groups or one-on-one, they help kids learn appropriate ways to interact in social situations. This may be done privately or as part of a school program.

Your Child’s School
If your child has been diagnosed with ADHD and evaluated for special services, you and the school will develop a plan of supports and accommodations. But even without special services, the school can do a number of things to help your child academically.

Response to intervention (RTI) is a process some schools use to screen all students and provide extra help to those who are falling behind. If your child attends a school that uses RTI, he might get small group instruction. If he doesn’t make enough progress this way, the program moves on to intensive one-on-one instruction. RTI also involves close monitoring of progress and other elements that can be helpful to you and your child.

Informal supports are strategies your child’s teacher can use, such as a rewards-based behavior plan or seating your child away from distractions.

If RTI and informal accommodations don’t help your child make progress, you can request or the school may recommend a 504 plan for your child. This is a written plan detailing how the school will accommodate your child’s needs. Depending on your child’s symptoms, he might get extended time on tests and assignments or be allowed to take tests in a quiet room. He may be given a chance move about at certain times in the school day.

If those steps aren’t successful, either you or the school can request an evaluation for special education services. The evaluation will determine whether your child qualifies for an Individualized Education Program (IEP). An IEP can open the door to even more resources. For example, your child might be able to use assistive technology to help with memory and organization.

Parent Advocates and Support Group
You’re not the only one raising a child with ADHD. There are many parent resources and support groups available to help both you and your child. Seek the support you need and deserve. Our online community is a great place to connect with other parents. And every state has at least one Parent Training and Information Center (PTI) sponsored by the U.S. Department of Education.

What can be done at home for ADHD?

Parenting a child with ADHD can be challenging. But there are many things you can do at home to help your child manage symptoms and learn key skills like organization and planning. You can also try some of the strategies from our behavior experts. These steps can help you make positive changes in your child’s life and in your family life.

Learn as much as you can. A better understanding of ADHD and its main symptoms is a great first step. Learning about executive functioning issues is also helpful since many kids with ADHD have them. Knowing that your child isn’t willfully ignoring your directions or fidgeting on purpose makes it easier to find real solutions rather than treating it as a discipline issue.

Observe and take notes. Watching your child more closely and taking notes on his behavior may reveal patterns and triggers. Your notes will be helpful when you’re talking to family members, your child’s doctor, teachers and anyone else helping your child.

Listen to your child. What does he say (or not say) about his behavior and how it makes him feel? What does he say about strategies that help? Can he sense how medication helps or hinders him? Try to figure out what your child is expressing when he acts out or avoids situations or tasks.

Set schedules and stick to them. Be the planner your child isn’t yet ready to be. You can help by putting a daily routine into place. Post weekly schedules with pictures for young children and short simple sentences for older ones. Many kids with ADHD find security in routine. If your child has trouble making transitions to a different schedule or activity, learn how to help him through it. Preparation goes a long way!

Provide easy ways to organize. Try labeling storage bins, drawers and cupboards. Your child will know exactly where everything goes when he puts things away. You can make other simple changes at home. Teach your child to use checklists and help him break tasks down into smaller, more manageable steps.

Develop a system of reminders. Invent a system (much like a secret code) to remind your child what needs to be done and what is appropriate behavior. Consider a hand on the shoulder, a finger to the lips, a few key words or a cell phone alarm.

Catch your child doing well. When you’re tired and frustrated, it’s easy to criticize. Remember to praise your child when you notice something specific that he did well. Being praised for effort and genuine achievement can help your child feel loved and supported. It can give him the confidence to work harder at building skills and the motivation to try new things.

Be consistent. Knowing that the rules, rewards and consequences always stay the same gives kids a structure they can rely on.

[7] "ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents." Pediatrics 128.5 (2011): 1007–022. American Academy of Pediatrics. Print.

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