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If you suspect your child has the mental health concern of attention deficit hyperactivity disorder (ADHD), there are two things you need to know. The first is, does your child truly have an ADHD diagnosis? The second is, if yes, how do you help a child with ADHD? This article covers indications that a child has ADHD and offers what you need to know as a parent of a child with ADHD.
Children and the Three Types of ADHD
Childhood ADHD, also known as pediatric ADHD, is considered a developmental condition of inattention and distractibility with or without hyperactivity. According to the book that defines all mental illnesses in North America, the Diagnostic and Statistical Mental of Mental Disorders, Fifth Edition (DSM-5), the three types of ADHD are:
• Predominantly inattentive
• Predominantly hyperactive/impulsive
• Combined
The important part in the above is understanding that hyperactivity may not always be present in ADHD. This matters because those with ADHD without hyperactivity often aren’t diagnosed due to the lack of this symptom cluster.
What Is Attention Deficit Hyperactivity Disorder (ADHD)?
There are interactive symptoms, hyperactive/impulsive symptoms, and symptoms that apply overall that define ADHD. The type of symptoms your child experiences will indicate the type of ADHD they have.
Inattentive Symptoms of ADHD in Children
According to the DSM-5, the following defines inattentiveness in childhood ADHD.
First, in order to qualify for a diagnosis, your child must have experienced at least six of the following symptoms of inattention and the symptoms must have persisted for at least six months to a degree that is maladaptive (Actions preventing children from adapting, adjusting, or participating in different aspects of life. Such actions are often disruptive and may contribute to increased distress, discomfort, and anxiety over time.) and inconsistent with developmental level:
• The child often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
• The child often has difficulty sustaining attention in tasks or play activities.
• The child often does not seem to listen to what is being said.
• The child often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace. (It’s required that this not be due to oppositional behavior or failure to understand instructions.)
• The child often has difficulties organizing tasks and activities.
• The child often avoids or strongly dislikes tasks (such as schoolwork or homework) that require sustained mental effort.
• The child often loses things necessary for tasks or activities (school assignments, pencils, books, tools, or toys).
• The child is often easily distracted by extraneous stimuli.
• The child is often forgetful in daily activities
Hyperactivity/Impulsivity Criteria for ADHD in Children
According to the DSM-5, hyperactivity/impulsivity is defined this way.
In order to qualify for a diagnosis, your child must have experienced at least six of the following symptoms of hyperactivity-impulsivity and the symptoms must have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
• The child fidgets with or taps hands or feet, or squirms in seat.
• The child leaves their seat in the classroom or in other situations in which remaining seated is expected.
• The child runs about or climbs excessively in situations where this behavior is inappropriate.
• The child has difficulty playing or engaging in leisure activities quietly.
• The child is unable to be or is uncomfortable being still for extended periods of time. (This may be experienced by others as the child being “on the go” or difficult to keep up with.)
• The child talks excessively.
• The child blurts out answers to questions before the questions have been completed.
• The child has difficulty waiting in lines or awaiting their turn in games or group situations.
• The child interrupts or intrudes on others.
Other Overall Criteria for Childhood ADHD
• The onset of pediatric ADHD is no later than 12 years old.
• The symptoms must be present in two or more situations, such as school, work, or home.
• The disturbance must cause clinically significant distress or impairment in social, academic, or occupational functioning.
• The disorder must not occur exclusively during the course of schizophrenia or another psychotic disorder and is not better accounted for by mood, anxiety, dissociative, or personality disorder or substance intoxication or withdrawal.
Does My Child Have ADHD?
While any concerned parent would want to know if their child had ADHD immediately, it’s important to understand that the diagnosis of ADHD can only be made be a qualified mental health professional. And while the history you provide a professional is invaluable, additional testing may be needed to assess the child’s psychology and physiology for an accurate diagnosis to be made. The following are examples of tests that may be needed for a formal diagnosis of childhood ADHD:
• The Conners' Parent and Teacher Rating Scale
• Timed computer tests such as the Conners’ Continuous Performance Test (CPT), the Integrated Visual and Auditory (IVA) CPT, or both (to assess impulsivity and inattention)
• The Nadeau/Quinn/Littman ADHD Self-Rating Scale for Girls
• Various neuropsychological tests (to assess the patient's executive function)
• A learning disability evaluation (intelligence quotient [IQ] vs achievement)
These tests and others are used to ensure what your child has is ADHD and not another disorder like posttraumatic stress disorder or pediatric bipolar disorder, for example.
A Test for Attention Deficit Hyperactivity in Children
To take a very informal test on whether you child has ADHD, see here. If the test suggests your child has ADHD, take the results to a qualified mental health professional.
Treatments for Childhood ADHD
The first-line medications for children with ADHD remains stimulant medications. Examples of these include methylphenidate-based medication and amphetamine/mixed amphetamine salts-based medication. While common sense may suggest that stimulants would make an already-stimulated brain worse, this isn’t the case in kids with ADHD. In kids with ADHD, stimulant medications calm their brain and allow them to better focus and be still. While these medications aren’t perfect and do come with side effects, they can be very effective at treating a child with ADHD.
One other interesting treatment for children with ADHD comes in the form of a video game. While that may seem counter-intuitive, the Food and Drug Administration (FDA) has approved a video game for the treatment of kids with ADHD. See here for more.
Educational interventions and psychological therapy can be used alongside medication treatment. Educational interventions can be helpful in improving work habits at school, organizational skills, and approaches to schoolwork. Psychological therapy including behavioral modification therapy and family therapy can be helpful for kids with ADHD who also have problems with others such as their peers.
Additionally, according to Medscape:
“Psychologists, behavioral developmental pediatricians, clinical social workers, and nurse practitioners who are well familiarized with ADHD can be invaluable in improving social skills, decreasing family and peer conflicts, and increasing prosocial behaviors in children with ADHD.”
It’s also important to know that many children with ADHD have other concurrent concerns such as learning disabilities, anxiety, mood disorders, and others. These issues must be addressed alongside the ADHD.
Medication Treatment for Kids with ADHD
There are several categories of medication treatment for children with ADHD. The categories include:
• Psychostimulants – This category of medication for ADHD has been around for decades and has well-studied effects. These medications are controlled substances, though, due to possibility of misuse. When dosed and used correctly, however, they are known to have a lack of major side effects. Examples of psychostimulants include methylphenidate (Ritalin – various formulations) and mixed amphetamine salts (Adderall).
• Alpha2-adrenergic agonists – This class of medication can be helpful in treating hyperactivity, tics, or delayed sleep onset in kids. These medications may be used alongside psychostimulants in some cases. These medications are not controlled substances. Examples of this treatment medication include guanfacine (Intuniv) and clonidine (Kapvay).
• Antidepressants – Some kids with ADHD significantly improve on some antidepressants, typically when added to another medication. However, psychostimulants are still considered first-line treatments. Examples of useful antidepressants include imipramine (Tofranil) and bupropion (Wellbutrin).
• Selective norepinephrine reuptake inhibitors – This non-stimulant class of medication treatment is made up of substances that are not controlled. Examples include viloxazine (Qelbree).
● Natural treatment options include L-theanine, a substance that helps with focus and relaxation. Other methods are to naturally increase dopamine such as to do lists, getting adequate sleep, eating an anti-oxidant rich diet, as well as protein rich foods such as legumes.
No matter which medication or treatment for ADHD you are considering, all the risks and rewards should be discussed with a qualified medical practitioner like a psychiatrist.
Tips for Parenting a Child with ADHD
While professionals can be critical in helping a child with ADHD, there are parenting tips that can help a child as well. According to Healthline, these parenting tips can help:
• Decide ahead of time which behaviors are acceptable and which are not. This is part of behavior management therapy, which involves rewarding positive behavior and removing rewards following negative behavior with appropriate consequences. However, for this to take place, it has to be clear to the child which behaviors are acceptable and which are not. No matter what is decided, it’s important to sick to it.
• Define the rules, but be flexible. While being consistent with rewards and consequences is critical, you can’t be overly strict as children with ADHD may not adapt to changes as well as other kids. Allowing for mistakes lets kids learn.
• Don’t discourage unusual behaviors that aren’t detrimental. Additionally, if quirky behavior is present, but not detrimental to your child, it’s best not to discourage it just because you think it’s unusual.
• Managing aggression and destructive, abusive, or intentionally disruptive behavior is important. A “time-out” can be useful in calming you and your child. Acting out in public can be handled by removing the child in a calm and decisive manner. A “time-out” can be explained to them as a period to calm down and think about their negative behavior.
• Create structure for your child. Routines matter for all children but even more for kids with ADHD. Rituals around meals, homework, playtime, and bedtime can make for easier days.
• Break tasks into small, manageable pieces. Color-coding chores on a calendar and breaking down routines into specific tasks can make everything more manageable.
• Limit distractions. Kids with ADHD get distracted easily. Excessive screen time and easily accessible screens should be avoided.
• Encourage exercise to burn off excess energy. Not only is exercise healthy for children in general and creates healthy ways to handle increased energy, it also focuses a child on specific movements. According to Healthline, “Exercise may also help to improve concentration, decrease the risk for depression and anxiety, and stimulate the brain in healthy ways.”
• Regulate a child’s sleep. A lack of sleep exacerbates the symptoms of ADHD in kids so helping your child get more and better sleep is important. Good sleep hygiene like no screens before bedtime, avoiding stimulants (like sugar) at night, ensuring a comfortable bed and blanket, and keeping a cool bedroom can all help. Bedtime is also a perfect opportunity to create a specific routine.
For more tips on parenting a child with ADHD, see this article.
Sources
1. ADDitude Editors. Does My Child Have ADHD? Symptom Test for Kids. ADDitude. Published April 25, 2023. https://www.additudemag.com/adhd-symptoms-test-children/?src=test
2. Cuncic A MA. What Is Maladaptive Behavior? Verywell Mind. Published online May 17, 2022. https://www.verywellmind.com/what-is-the-meaning-of-maladaptive-3024600
3. Porter E. Parenting Tips for ADHD: Do’s and Don’ts. Healthline. Published September 17, 2018. https://www.healthline.com/health/adhd/parenting-tips#what-not-to-do
4. Wilkes MA MD. Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Medication: Alpha2-adrenergic Agonists, Antidepressants, Stimulants, Norepinephrine Reuptake Inhibitors, Selective. https://emedicine.medscape.com/article/912633-medication#showall
5. Wilkes MA MD. Pediatric Attention Deficit Hyperactivity Disorder (ADHD): Practice Essentials, Background, Pathophysiology. https://emedicine.medscape.com/article/912633-overview?_ga=2.151217841.968576202.1686067970-96000106.1685712394
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