Attention-deficit/hyperactivity disorder (ADHD) in kids

Attention-deficit/hyperactivity disorder (ADHD) most often starts in early childhood. Untreated ADHD can present serious challenges, especially to children who are told to sit still and focus in a classroom. Common signs are typically evident at home, too, or when a child struggles to play well with other kids. Some children grow out of the disorder, but for the vast majority, ADHD lasts into adulthood. 

An ADHD diagnosis does not mean your child is bad nor that you as a parent did anything to cause the condition. But a child with ADHD does need treatment and support beyond what you alone can provide.

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ADHD is defined, in general terms, as "is a behavioral condition that makes focusing on everyday requests and routines challenging" (American Psychological Association, n.d.). Without treatment, children with ADHD are prone to poor grades, likely to struggle with relationships, and have higher odds of substance abuse and injury later in life (Chang, 2020). ADHD can be diagnosed as early as preschool, and children who show signs of it at age 3 are much more likely to be formally diagnosed by age 13 (CHADD, n.d.). 

About 8.7% of U.S. adolescents ages 13 to 18 have been diagnosed with ADHD at some point in their lives (NIMH, n.d.). Boys are more than twice as likely as girls to be diagnosed with the disorder (Danielson, 2018). But some doctors think girls are just as likely to have ADHD, though they may develop it at older ages and have less noticeable symptoms. 

Overall, more children are diagnosed with ADHD now than in the past. This uptick in diagnoses is likely because of greater awareness, improvements in detection, and diagnoses of milder cases (American Academy of Child & Adolescent Psychiatry, 2013). 

Scientists have not yet identified the specific causes of ADHD. They believe a variety of factors contribute to ADHD in children, including genetic and environmental components. For example, 75% of children with ADHD have a relative with the disorder (American Psychiatric Association, n.d.). In this context, you may have heard that children born to women who smoked cigarettes during pregnancy are at an increased risk for ADHD. While researchers did find a link, there’s not enough evidence to conclude that smoking during pregnancy causes ADHD (Huang, 2018). There have been similar findings for alcohol consumption during pregnancy (Eilertsen , 2017). 

Signs of ADHD in kids go beyond a little fidgeting or occasional daydreaming. A child may have symptoms of either or both aspects of the disorder: inattention, which was once called ADD but is now considered part of ADHD, and hyperactivity-impulsivity. Here are the symptoms to look for if you think your child might have the disorder (NIMH, n.d.):

Primarily inattentive (the ADD variety)

• Can't pay close attention to details or makes careless mistakes

• Struggles to stay focused on tasks or activities

• Does not seem to listen well

• Doesn't follow through on instructions 

• Struggles to organize tasks, leading to missed deadlines

• Avoids or dislikes tasks that require sustained mental effort

• Often loses things needed for tasks or daily life

• Is easily distracted

• Forgets daily tasks, activities, or appointments

Primarily hyperactive-impulsive

• Fidgets, taps hands or feet, or squirms

• Can't stay seated

• Is relentless or "always on the go"

• Can't engage in leisure activities quietly

• Talks excessively

• Blurts out answers before a question is completed

• Struggles to wait in line

• Interrupts or intrudes on others

Some words of caution about interpreting these symptoms: 

• When a kid with ADHD enters adolescence, their hyperactive and impulsive tendencies tend to subside while inattention persists (Wolraich, 2019).

• A child might struggle exclusively with one aspect or both, and they may lean one way or the other over time. 

• Many children who do not have diagnosable ADHD may exhibit some of these symptoms now and then (American Psychiatric Association, n.d.). 

There is no single test for ADHD. Figuring out if your child has it will be a process. Whether you suspect it or a teacher does, your first step is to seek help from a healthcare provider. A psychiatrist, psychologist, or pediatrician can make an ADHD diagnosis. Healthcare providers should inquire with parents, teachers, and others about the child’s behavior in different settings, like at home, school, or with peers, the American Academy of Pediatrics (AAP) recommends. However, given the lack of access to mental health care and the reluctance of many insurers to pay for it, pediatricians are often relied on to diagnose and suggest care (Wolraich, 2019).

A diagnosis will be based on the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5), based on several thresholds (American Psychiatric Association, 2013):

• Six or more symptoms of inattention (see above) or of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults.

• Symptoms have been present for at least six months and which interfere with functioning or development

• Several symptoms must have been present before age 12 and present in more than one setting, such as at school and at home.

• Other mental disorders (such as a mood disorder, anxiety disorder, or a personality disorder) do not better explain symptoms. 

Given the complexities, experts advise against diagnosing ADHD on your own or with an online quiz or survey (American Academy of Family Physicians, n.d.).

Whereas boys with ADHD are often noticed and diagnosed because of their hyperactivity, ADHD in girls is often internalized, and the symptoms may go unrecognized. Girls with ADHD may suffer the same attention issues but usually are not hyperactive. Without anyone recognizing their disorder, girls are at risk for developing depression and anxiety, along with low self-esteem (Quinn, 2014). 

Other mental health conditions frequently coexist with ADHD. A survey among children six to 17 years with ADHD found that 27% also have conduct disorder, marked by aggressive, hostile acts toward others. About 14% of kids with ADHD also have depression, and 18% of kids with ADHD also have anxiety. Around half of kids with ADHD have a coexisting learning disorder (Larson, 2007). Some of the symptoms from any of the other above disorders can be similar to the primary symptoms of ADHD, making it hard for a non-professional to figure out what's making a kid's life hard (CHADD, n.d.).

Several medications have been proven to help most children with ADHD. The most common, including Adderall and Ritalin and their generic equivalents, have undergone rigorous testing for effectiveness and safety and are the mainstay of treatment for ADHD. They are effective in about 70-80% of patients (Magnus, 2020). These medications are stimulating for most people, though they have a calming effect on kids and adults with ADHD (American Academy of Family Physicians, n.d.).

ADHD medication should be accompanied by other long-term remedies and efforts mapped out with the help of healthcare professionals, including the following (American Academy of Pediatrics, 2019): 

• A long-term plan with goals and monitoring

• Education of parents about the disorder and training in behavior management

• Teamwork to include parents, teachers, doctors, other caregivers, and, of course, the child

• Family and individual counseling

Most of all, if your child has ADHD, you'll need a lot of patience. Without ongoing treatment and support, ADHD problems can compound with age. Hyperactivity or other behavioral issues that people might have viewed as "just being a kid" can become ever more serious problems for a teenager. These include an increased risk of sexually transmitted infections, substance abuse, or dangerous driving, along with poor grades and fewer job opportunities as a young adult (CHADD, n.d.; Chen, 2018; Chang, 2020).

Challenging as it may be to deal head-on with ADHD, getting a child diagnosed by a professional, and then creating a program for treatment and support promises to be far less trouble than leaving them unprepared to negotiate today's complex, rules-driven world.

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Current version

May 07, 2021

Written by

Robert Roy Britt

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.