Childhood ADHD
ADHD symptoms in kids
Does your child fail to sustain attention, chronically push appropriate limits at home and in public, or just can’t sit quietly when necessary? Not being able to stay within limits or sit quietly is normal childhood behavior if it happens at different ages and from time to time. Still, if this behavior occurs frequently and interferes with your child’s daily life, they may have ADHD.
Although it’s a common disorder, each treatment approach is unique and customized so that ADHD symptoms can be successfully managed with medicine and behavior treatments offered by Kentucky Mental Health Care.
Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD is a neurodevelopmental condition that can affect family life. The word “neurodevelopmental” refers to the nervous system, which includes the brain as it develops across the lifespan. With ADHD, children can have trouble with impulsivity, hyperactivity, distractedness, following instructions, and completing tasks, all described under the umbrella term of executive functioning skills. ADHD behavior usually appears by age seven though difficult behavior may show up before this; it’s best to wait until around this age to medically treat ADHD, although therapy can start sooner to help with executive functioning skills development.
When symptoms of Attention-Deficit Hyperactivity Disorder occur in childhood, they can persist into adulthood. Without proper acknowledgment and management of these behaviors early on, ADHD can result in behavioral, emotional, academic, vocational, and social problems that decrease the quality of life long term.
Areas we cover
Depression, Anxiety, ADHD, Bipolar Disorder, PTSD, OCD, Trauma, Grief, Personality Disorders, Eating Disorders, Addiction, Marriage Counseling & More
Learn more about the ADHD brain
Researchers are learning more and more about brain development and ADHD. Differences in the brain make it harder for people with ADHD to work on a task unless they’re really interested in it. It’s not a matter of being lazy or not being smart.
These lags happen in parts of the brain’s self-management system. This includes structures that play critical roles in emotional control and a skill called working memory.
These brain structures tend to be similar in size to those in adults without ADHD by young adulthood. This doesn’t mean ADHD goes away after the teen years, though. The symptoms of ADHD may change as kids get older, but ADHD is lifelong.
Brain structures need to work together to do things like shift focus or read or write. Different parts of the brain are connected by networks of neurons (brain cells).
Some neural networks take longer to develop or may be less efficient in kids with ADHD. One example is the “default mode network.” It plays a crucial role in resting the brain. In kids with ADHD, the brain takes longer to “switch off” activity in the default mode network when they need to focus on something.
It plays a crucial role in making decisions and learning new tasks. (That’s why it’s often called the “executive control circuit” or executive function skills) Differences in this and other neural networks may help explain ADHD symptoms like mind-wandering and trouble with impulse control.
Children struggling with executive function skills due to ADHD may:
- Have trouble starting and/or completing tasks
- Have difficulty prioritizing tasks
- Forget what they just heard or read
- Have difficulty following directions or a sequence of steps
- Panic when rules or routines change
- Have trouble switching focus from one task to another
- Get overly emotional and fixate on things
- Have difficulty organizing their thoughts
- Have trouble keeping track of their belongings
- Have difficulty managing their time
Brain networks are made up of brain cells that pass information along from neuron to neuron. To do this, the tail end of one neuron releases tiny amounts of chemicals called neurotransmitters. These chemicals have to cross a small gap — called a synapse — to get to the tip of the next neuron.
ADHD can affect this process in a few ways:
- The sending neuron may not release enough neurotransmitters.
- The receiving neuron may have trouble “catching” the neurotransmitters.
- The neurotransmitters may get sucked back up by the sending neuron too fast before making a good connection with the receiving neuron.
For many people with ADHD, treatment can improve these connections. Tapping into people’s interests can help too.
Brain researchers are learning more and more about ADHD. But we haven’t yet reached the point where brain scans can be used to diagnose people with ADHD, but a robust evaluation process by Kentucky Mental Health Care detailed below is the gold standard for ADHD diagnosis.
EVALUATION FOR ADHD
An ADHD evaluation is an in-depth process. It looks at many factors, like how much a child’s symptoms impact school and daily life. Kentucky Mental Health Care specialists can evaluate and diagnose children for ADHD.
An ADHD evaluation usually takes around three hours. That includes the initial visit, a follow-up, and filling out paperwork.
Here are eight things that go into a full ADHD evaluation:
This meeting will help to identify your child’s strengths and challenges. The evaluator will look for situations in your child’s life that might be having an impact. These situations could be happening at home, at school, or in the community.
The evaluator will ask about your child’s health, both past and present. That includes details about any problems during the pregnancy or delivery. The evaluator might also ask about:
- Early infancy
- Developmental milestones
- Allergies
- Appetite
- Sleep patterns
- Height and weight
- Hospitalizations
- Ongoing developmental or medical problems
The evaluator will look at challenges in three key areas: home, school, and social relationships. It’s important to talk about your child’s strengths, interests, and passions, too.
These questionnaires are a way to collect information from you about what your child is struggling with. The evaluator will then compare the results to the behavior of other kids that age. (The evaluator might use other assessments, too.)
The evaluator will look at report cards and standardized testing. They’ll also want to know if your child gets tutoring or any extra support in the classroom. Your child’s teacher(s) may be asked to fill out a rating scale, too.
To get an ADHD diagnosis, kids need to meet certain criteria. There are two official lists of symptoms—one for inattention and one for hyperactivity-impulsivity. Kids 16 and under must have six out of nine symptoms on each or both lists. (Not all kids with ADHD have hyperactivity-impulsivity.) Anyone 17 or over must have five on either list.
You can see the lists in this PDF.
Mental Health challenges could exist on their own or co-occur with ADHD. These include learning differences or mental health issues like anxiety and depression. Kentucky Mental Health Care providers can evaluate mental health needs and provide comprehensive support if needed. We will give a referral if we feel there are developmental delays or learning differences evaluations required.
This is to go over the results and explore possible treatments like ADHD medication or therapy. The evaluator might even talk about changing family routines and getting support at school.
If you’re still on the fence about getting your child evaluated, try to talk it through with someone you trust. Maybe it’s a friend or relative who’s been through something similar.
What is the difference between ADHD and ADD (Attention-Deficit Disorder)?
ADHD is the only term assigned to this diagnosis. Still, there are different presentations of ADHD — ADHD Inattentive Presentation, ADHD Hyperactive/Impulsive Presentation, ADHD Combined Presentation (both inattention and H/I behavior), and a fourth type called Unspecified ADHD; a diagnosis used when symptoms are unclear.
Based on a review of the collected information, your healthcare provider may diagnose an adult or child with one of the types of ADHD:
- Predominately hyperactive/impulsive type: You or your child must have had hyperactive/impulsive behavior for the past six months but not meet the criteria for inattention.
- Predominately inattentive type (formerly known as attention deficit disorder, or ADD): You or your child must have behaviors of inattention present for six months but do not meet the criteria for hyperactive/impulsive.
- Combined type (inattentive and hyperactive/impulsive): Symptoms from both types of ADHD must be present for the past six months. This is the most common form of ADHD in children.
- Other specified/unspecified ADHD: Children, teens, or adults have inattentive type behaviors but do not meet the above conditions for diagnosis.
Remember that symptoms can change over time, and therefore so can the diagnosis of the type of ADHD.
About 11% of children between the ages of four and 17 have ADHD. Symptoms of ADHD typically first appear between the ages of three and six years old. The average age of ADHD diagnosis is seven years old. In children, it’s three times more common in young boys than girls. Males are almost three times more likely to be diagnosed with ADHD than females.
ADHD isn’t just a childhood disorder. In adulthood, it’s diagnosed equally between males and females. About 4% of American adults over the age of 18 contend with ADHD behaviors daily.
By definition, ADHD is better referred to as a neurodevelopmental disorder, not a “mental illness.” “Mental illness” is a very broad term for any type of condition that affects mood, behavior, or thinking. ADHD is better described as a pattern of behavior — something different in how a person does things — rather than describing it as something “wrong” with people. Evidence indicates that ADHD is associated with neural pathways in brain functioning (the default mode and the task-positive mode). This functioning yields problematic behavior at certain ages (stages of development) — thus, the term neurodevelopmental disorder is a better broad category name for the problem of ADHD.
No, although they are both neurodevelopmental disorders. Except, many children with autism have ADHD. But the two conditions are, by expression and definition, quite different.
ADHD is not a learning disability, though it certainly can impair learning. About 30% to 40% of children with ADHD also have a learning disability. Like those with a learning disability, children with ADHD are eligible to receive special education services.
What are the symptoms of ADHD?
Children, teenagers, and adults with ADHD have an ongoing pattern of three types of core behaviors:
- Inattentiveness: Difficulty sustaining attention to tasks.
- Impulsivity: Doing things on sudden urges, without thinking, such as talking out in class, throwing a toy, or interrupting someone in conversation. In adults, the impulses may be irresponsible such as spending too much money.
- Hyperactivity: Restlessness such as fidgeting, inability to stay seated when sitting is expected, such as in church or school, moving or climbing when it’s inappropriate to do so.
Children, teens, and adults with ADHD are diagnosed by the behavior pattern that is most actively present. The three most common ADHD presentations are Predominantly Inattentive, Predominantly Hyperactive/Impulsive, and the combination of these types.
- Fails to pay close attention to details or makes careless mistakes in schoolwork, at work, or during other activities.
- Has trouble paying attention during tasks or play.
- Appears not to listen even when spoken to directly.
- Has difficulty following through on instructions (for example, often fails to finish schoolwork, chores, or other duties in the workplace).
- Often has difficulty organizing tasks or activities.
- Avoids or dislikes tasks that require continuous mental effort, such as schoolwork, homework or preparing reports, completing forms, and reviewing lengthy papers.
- Frequently loses needed items, such as books, pencils, tools, wallets/purses, keys, paperwork, phone, and eyeglasses.
- Can be easily distracted by actions or thoughts unrelated to the current task.
- Is often forgetful in daily activities (such as doing chores, running errands, returning phone calls, paying bills, and keeping appointments).
- Fidgets with or taps hands or feet or squirms frequently.
- Leaves seat in the classroom or the workplace when remaining seated is expected.
- Runs or climbs excessively when it’s inappropriate; constantly feels restless (if an adolescent or adult).
- Has trouble playing or engaging in leisure activities quietly.
- Always seems “on the go” or “driven by a motor.”
- Talks too much.
- Blurts out the answers before questions have been completely asked; older children may often finish sentences for others who are talking.
- Frequently has trouble waiting for their turn.
- Often interrupts or intrudes on others’ conversations or games.
MANAGEMENT AND TREATMENT FOR ADHD
Medication for ADHD
A group of drugs called psychostimulants are an effective treatment for ADHD. The two most commonly used medicines in this class are methylphenidates (often known as Ritalin) and dextroamphetamines (similar to Adderall). These medicines help people with ADHD focus their thoughts and ignore distractions. Stimulant medicines are effective in 70% to 90% of patients with ADHD. New medicines are also being developed.
Examples of short-acting (immediate-release), intermediate-acting, and long-acting forms of these medications include:
Methylphenidates
- Short-acting: Ritalin®, Focalin®, Methylin Chewable®, Methylin Solution®.
- Long-acting intermediate release: Ritalin SR®, Methylin®, Metadate ER®.
- Long-acting extended-release: Concerta®, Aptensio® XR, Metadate CD®, Metadate ER®, Ritalin LA®, Focalin XR®, Daytrana®, Quillivant XR® (liquid) Jornay.
D-Amphetamines
- Short-acting: Dextrostat®, Dexedrine Tabs®, Evekeo®, Zenzedi®, Adderall®, ProCentra®.
- Long-acting intermediate release: Adderall®, Dexedrine Spansule®.
- Long-acting extended-release: Vyvanse®, Adderall XR®, Dyanavel® XR, Adzenys® XR-ODT.
Non-stimulant medicines include atomoxetine (Strattera®,) guanfacine (Intuniv®), and clonidine (Kapvay®). They are often used as an additional treatment or can be used on their own if the healthcare provider approves. New non-stimulant formulations are in the pipeline of several pharmaceutical companies.
There’s no way to know which medicine(s) and dosage level(s) will work best for you or your child until you try it out. Your healthcare provider may need to prescribe several different formulations and see how your child reacts. Typically the physician will “start low (in dose) and go slow.”
The most common side effects of ADHD medications include decreased appetite, trouble sleeping, and irritability. Fortunately, side effects are often mild and short-lived and usually happen early in treatment. If they continue or interfere with you or your child’s daily life, your provider will probably change your medication or lower the dose. The most important question to ask is, “Does the benefit of the medicine outweigh the side effect?” The most effective treatment is medicine combined with behavioral therapy.
Therapy for ADHD
Kids and families affected by ADHD often find it helpful to work with a mental health professional. It’s important to base the type of therapy you choose on what your child and family need. Here are some options:
Behavior therapy: One of the goals of behavior therapy is to change negative behaviors into positive ones. It often involves parental training and support in using a rewards or behavior modification system at home, based on positive reinforcement, not punishment. Behavioral therapy is helpful for some kids with ADHD and is often used along with medication.
Cognitive behavioral therapy (CBT): This is a type of talk therapy. Cognitive behavioral therapy aims to get kids to think about their thoughts, feelings, and behavior. It’s not specifically for ADHD, but it may be helpful for some kids. In part, CBT helps kids replace negative thoughts with ones that are more realistic and positive. It also helps kids build self-esteem, which tends to be negatively affected by ADHD. CBT is effective for treating anxiety and depression. Anxiety and/or depression occur in about 50 percent of people with ADHD.
Social skills training: This training teaches social skills that will improve the child’s ability to act positively and effectively with peers and adults in school and at home. It also provides a setting to practice the skills in a safe, accepting atmosphere.
School support interventions: A specialist may work with your child’s educational team to conduct a multi-factored evaluation (MFE) to create an individualized education plan (IEP), 504 plan, or other classroom-based intervention.
Organizational skills training: This training teaches older children skills to help them improve time management, organizational skills and effectively use executive functions to increase efficiency and work completion at home and school.
What happens if ADHD is left untreated?
Symptoms will continue if ADHD is left untreated and people are left to manage them on their own. Untreated ADHD makes life more complicated than it has to be. Children may struggle at school, home, and in social situations, and adults may struggle with work, education, interactions with friends and family, and more.
OUTLOOK / PROGNOSIS FOR ADHD
What can I expect if my child has ADHD?
ADHD is a complicated condition with various symptom expressions. If you or your child have ADHD, educate yourself as much as possible about the behaviors that make life difficult. Consider medicines and behavioral treatments in combination for the most effective long-term results. Our Kentucky Mental Health Care providers will help you with these. They will sum up the results of the ADHD evaluation and will recommend the appropriate treatment. A combination of pharmacotherapy and behavioral therapy is generally recommended. A trained behavioral health clinician can give general guidelines for managing your child’s ADHD, and these can be tailored to your family’s needs and your child’s strengths and weaknesses.
Also, it is always helpful to have appropriate expectations for yourself and your child. Don’t expect your child to get out of bed the first time you wake them up, and don’t be too hard on yourself if making progress is difficult. It is always best to have your partner and friends help with tasks like organizing and time management. Stay in contact with your healthcare provider, especially if there is a change in your or your child’s behaviors or a reaction to prescribed medications.
How long will my child have ADHD?
ADHD does not go away, but many people learn to manage it successfully in their adult lives. ADHD is a lifelong condition, and behaviors are often successfully managed with medicine and behavioral treatment.
LIVING WITH ADHD
A child with ADHD typically may become hyper-focused with activities of interest. For example, children can spend hours in front of a screen playing video games, but they may have trouble finishing even simple homework assignments, or they may throw tantrums and refuse to do chores or schoolwork at home.
Your child uses a certain kind of attention — called automatic attention — when doing something of interest to them. However, things that require effort, such as homework, need a different type of attention — called directed or effortful attention — which is harder to use and requires much more effort.
What are some additional strategies for managing my child’s ADHD at home?
You may find the following strategies helpful for managing ADHD in the home:
Give clear and specific directions and limits: Children with ADHD need to know exactly what others expect from them.
“Catch” your child being good: Punishing a child only teaches them what not to do. Recognizing and acknowledging positive behaviors is an effective way to teach your child what to do. This increases the expression of appropriate behavior.
Set up an effective behavior system: Create a consistent system to reward appropriate behavior and respond to misbehavior with alternatives such as a “time out” or loss of privileges. Corporal punishment (spanking) is never effective in any circumstance. A common practice is to use “marbles-in-a-jar,” wherein the child earns one marble for a specified appropriate behavior in the household. When a certain number of marbles are earned, they can be exchanged for a privilege.
Stick to a schedule: Follow the same routine every day, from wake-up time to bedtime. The schedule should include time for homework and play.
Use a calendar or planner the child can see: Create a place to write down important reminders, responsibilities, and events. These tools may be beneficial for adolescents and young adults who struggle with time management.
Organize items needed every day: Have a place for everything and keep everything in its place. This includes clothing, backpacks, and school supplies. An organization checklist may be helpful.
Pick out a homework area: Set up a home workstation for school work in a quiet space without clutter or distractions.
Use less verbal prompting: Give clear and brief instructions. Find ways to silently redirect a child to tasks, such as a gesture, a special sign, or quick “instruction lists” taped to a mirror the child uses.
Set a timer: Have a timeframe for working on homework. If the child does not finish, take a break and set a new time to finish.
Allow breaks: Allow time to rest and recharge, especially if a child has long assignments or homework from many classes.
Praise effort and completion: Reward the child’s completed work instead of punishing incomplete work. Refrain from telling your child how smart they are. When children think they are “smart,” the next time they confront difficult work, they quit because they don’t want to present themselves as incapable of completing the work (i.e., not being smart).
What strategies can parents with ADHD use to resolve conflicts with children with ADHD?
Accept the fact that you are angry, frustrated, and fearful. So is your child or teen. You can’t help your child through tough times if you can’t control your own emotions. You may find it helpful to seek the help of a healthcare provider.
Admit to your child that having ADHD is not easy, that it takes a lot of effort to stay on track. Tell them about some of the challenges you faced and the ways you successfully managed them. Use humor to deflect anxiety or anger. Make it a habit to reinforce your child’s strengths.
If you are about to lose your temper, use these techniques: Avoid accusation and focus on the behavior. Focus on solutions to the problem and teach your child or teen to find alternatives that work. Make it clear that your child is not only their behaviors and that they, within reason, can control them. If you or your child starts to shout, break the pattern by speaking softly.
You may have challenges like your child’s, but they are their person. ADHD is an explanation of behaviors, not an excuse for them. Your failures don’t mean you shouldn’t have reasonable expectations for your child.
Parents who have a sense of humor during tense, stressful situations may make their child or teen feel more accepted, less anxious, and better able to manage their emotions.
Don’t let the perception that you’ve failed as a parent because of your child’s challenges affect your interactions with them. You are a role model for your child, imperfections and all. Your child is constantly watching you. Model behavior that you would like your child to imitate.
What makes ADHD symptoms worse?
Certain behaviors are expected depending on the age of a person. Because the brain doesn’t develop at the same rate in everyone, cognitive functions may be poor in some people and not in others. A child ten years old, for example, might only have the abilities of a younger child eight years old rather than their same-age peers. Therefore, as you or your child get older, the problem is not that ADHD gets worse; it’s that the child’s abilities are not developing synchronized with age.
Although ADHD doesn’t get “worse,” the tasks expected of the person become more complicated with age and circumstances, such as increased demands in school. Therefore, the problematic behaviors (such as completing things on time) become more problematic. For example, the child may get a lower grade for turning in late work. Examples of other complications include:
New and more complex challenges frequently arise in school. As a child advances in grade level, academic tasks become more complex, such as writing lengthy reports or studying numerous chapters of a history book. Task complexity in reading, spelling, math, and interacting with classmates pose problems to the child who has limited ability to meet demand. The student with ADHD may struggle even more without additional collateral support from parents and teachers.
Children with ADHD may be criticized and punished by parents and teachers, they may be looked down on by peers because of their inability to finish tasks or remember their schoolwork, and some may not know how to play appropriately with their friends. Adults can be penalized by supervisors at their jobs for forgetting to do work and, at times, even by family members for failing to stay organized or stay focused on tasks to completion.
Psychiatric disorders like depression and anxiety are common in people with ADHD. Children are 62% more likely to have at least one disorder. Adults with ADHD are six times more likely to have a disorder. People with ADHD are also more likely to abuse drugs and alcohol.
So many things can cause additional stress in the life of someone with ADHD. Examples include serious medical illnesses, domestic violence, divorce, loss of employment, or the death of a friend or family member.
According to recent data, 17.5% of children ages four to 17 in the United States received no treatment — behavioral or pharmacological — for ADHD. Treatment is vital for managing ADHD symptoms.
In addition to the formal symptoms used to diagnose ADHD in children and adults, are there other easily identified behaviors and problems that indicate an adult may have ADHD?
Yes. The following behaviors and problems might stem directly from ADHD or might be the result of related adjustment difficulties in adults:
- Chronic lateness and forgetfulness.
- Anxiety.
- Lack of organizational skills.
- Low self-esteem and self-inefficacy.
- Employment problems.
- Difficulty controlling anger.
- Impulsiveness.
- Perception of laziness (Very few people are lazy. What we call laziness is most likely avoidance behavior.)
GETTING ADHD TREATMENT & SUPPORT
How should I prepare for my child’s appointment to discuss ADHD?
If you think your child has a problem with attention, hyperactivity, or impulsivity, and it seems that their behavior at home and performance at school are being affected. Your next step is to contact Kentucky Mental Health Care for an evaluation.
If the symptoms are affecting your child’s schoolwork, contact the school and request an evaluation. When making this request, be as specific as possible about your child’s type of educational or behavioral difficulties.
Schools must evaluate children (ages three to 21) if evidence of a disability affects their learning. This evaluation is free and must, by law, include appropriate standardized tests. School testing can lead to accommodations in the classroom. The school will not diagnose ADHD but will note the symptoms and often assign “Other Health Impaired” (OHI). Get a copy of the school’s report and bring it with you to the appointment.
If necessary, the family provider may suggest you take your child to a professional who specializes in ADHD and other developmental, behavioral, or mental health concerns. We can take this referral or request, and a Kentucky Mental Health Care Provider specializing in childhood ADHD will administer the evaluation and follow-up treatment.
What questions should I ask my child’s Kentucky Mental Health Care provider about ADHD?
- Does my child have a learning disability in addition to ADHD?
- What type of ADHD does my child have?
- Does my child have a psychiatric illness in addition to ADHD?
- How do I explain to my child what ADHD is?
- What’s the best medicine for my child? (Please remember that you won’t know until you try.)
- How do I improve my child’s self-esteem and self-efficacy?
- How do I talk to my child’s teachers about their ADHD?
- How do I judge if a medication is worth the side effects that come with it?
- What are the side effects of the prescribed medications?
- What are my child’s strengths? What are my child’s weaknesses?
There may seem like there’s a lot to do for your child between dealing with school and healthcare providers and monitoring homework. If you also have ADHD, there’s even more to do, like attending therapy sessions, taking your own medicines, and monitoring your children. There are long to-do lists, and they are especially complicated if you have ADHD and may give a sense of feeling overwhelmed like your child often feels. However, it is possible to have things work far better than they are, and we are here at Kentucky Mental Health Care to improve your child’s life and your own.
