Attention-deficit/hyperactivity disorder or ADHD is a neurodevelopmental disorder that results in inattention, impulsivity, and hyperactivity that causes difficulty at home, school, or in other settings. ADHD is diagnosed into one of three types: Inattentive, Hyperactive-Impulsive, or Combination. Inattention includes wandering off task, not persisting or maintaining focus, and difficulties with organization. Hyperactivity can appear as excessive motor activity such as constant movement, squirming, fidgeting or excessive verbal activity. Impulsivity is the lack of ability to delay gratification, social intrusiveness, and jumping into activities or decisions without regard for consequences. ADHD may also frequently co-occur with specific learning disability, speech and language delays, and an increased risk for mental health challenges such as anxiety and depression. However, with support, there are specific strengths in the different viewpoints and thinking skills that individuals with ADHD can have.
Children typically start showing symptoms between 2-6 years of age. Although many aspects of ADHD such as being impulsive and having excessive energy may seem typical of children in this age range, children identified with ADHD experience more extreme behaviors than expected for their developmental level which limit their safety, social relationships, and overall functioning. Parents can seek an assessment if they notice these behaviors or have any developmental concerns.
A few early signs in toddlers and preschool age include:
ADHD affects around 9% of US children ages 2-17, with boys being more than twice as likely as girls to be diagnosed with ADHD. Similar to other neurodevelopmental conditions, the higher prevalence in boys may in part be due to girls being mis-diagnosed or overlooked as inherent biases in the diagnostic process are only recently being addressed.
ADHD reflects differences in brain structure and function in the areas that help control attention and activity level. We know that ADHD frequently runs in families, and has a strong genetic component with a 25% chance of a child with ADHD also having a parent with ADHD. There are some environmental factors that can also increase the risk or chance of having ADHD including head injuries, prematurity, and prenatal exposure to alcohol, nicotine, or lead.
Medication and behavioral treatment are the two most common ways of helping to manage ADHD in children. Parent training and support in how to employ new strategies at home is often a very useful initial intervention for families. As parents learn new skills in responding differently to their children, the ADHD symptoms can become more manageable. After about age 6, medication can also be very effective in helping children so that they can better focus their attention, regulate their emotions, and keep track of information. An MD such as a pediatrician or psychiatrist can prescribe and oversee the use of ADHD medications. There are two main categories of medications that are typically used, depending on individual child factors:
In addition to medications, children often benefit from behavioral therapy and social skills groups. At school, students can access a number of classroom accommodations such as extended time on tests, being seated at the front of the classroom, and having frequent movement breaks and fidget toys available.