Do you think your child has ADHD? How to tell and how to get help

Consider a child who seems to be always on the go, unable to sit still, and who does not appear to listen to a word you’ve said. This same child is constantly getting in trouble in school for speaking out of turn and interrupting others.

Sound familiar? This child may be suffering from attention deficit hyperactivity disorder (ADHD), a condition that affects a number of children in their personal and academic lives.

ADHD is a condition in which someone has trouble with impulsivity, hyperactivity, and/or paying attention. The person shows some symptoms for at least six months, starting before age 12. For a diagnosis of ADHD, these symptoms should be considered inappropriate for what is expected for a child of a particular age. The child’s issues with attention, impulsivity, or hyperactivity must cause problems with social or academic functioning and occur in at least two settings (e.g., home, school, with family).

There are three subtypes of ADHD:

1. Inattentive. At least six of the following difficulties must be present: not paying attention to details, not maintaining attention in tasks or play, not listening when spoken to, not following through with instructions, trouble organizing tasks and activities, constantly losing things, or persistent forgetting.

2. Hyperactive/Impulsive. At least six of the following must be present: fidgeting, leaving classroom seat or running around when inappropriate, difficulty staying quiet, talking too much, blurting out answers, trouble waiting, interrupting others.

3. Combined. For a child meeting criteria for both subtypes.

Most cases of ADHD are genetic. Children diagnosed with ADHD are born with subtle chemical differences in the brain that cause overactivity, impulsivity, and distractibility. Parents and schools do not cause ADHD, but negative circumstances can make it worse.

Issues with concentration can stem from many factors. Depressed individuals often have trouble focusing and paying attention. Restlessness and fidgeting can be a key feature of anxiety or a side effect of medication or drug use. Some youths have difficulty paying attention to certain subjects but not others, which could suggest a more specific learning disorder.

The age and severity of symptoms determines the best way to treat ADHD.

For preschool children, behavior therapy is often recommended first to help parents manage ADHD-related behaviors (such as impulsivity and aggression). Medication may be added to the treatment if symptoms remain uncontrolled.

For school-age children (6 years and older), medication is the most effective initial treatment as it corrects some of the brain chemistry differences detected in ADHD. Several studies have shown that therapy alone is insufficient to treat the core symptoms of poor attention span, over-activity, and impulsivity. However, the combination of therapy and medication can be useful to improve overall functioning. In some cases, schools should provide special accommodations. Other types of therapy may be added to help the child with issues related to negative behaviors, self-esteem, anger, depression, or anxiety stemming from ADHD.

Many children with ADHD may feel rejected by peers who are unable to deal with their distracted, hyperactive, or impulsive behaviors. Frustration with not being able to sit still or concentrate can lead to acting out or physical aggression. Substance abuse is more common in youth with ADHD, and treatment might lessen that risk. Children with ADHD tend to have difficulty in completing schoolwork, leading to poor grades and lowered self-esteem. Untreated ADHD leads to repeated frustrations and failures in school. One study found that one in three students with the combined subtype of ADHD drop out of high school.

If you think your child may have ADHD, consult your pediatrician or schedule an appointment with a child and adolescent psychiatrist, psychologist, or social worker. Get help for your child and get your child on a positive track.

Julie Furst, M.D., is a child and adolescent psychiatry fellow under the guidance of James Luebbert, M.D., a child and adolescent psychiatry attending at Thomas Jefferson University Hospitals.