Attention deficit hyperactivity disorder (ADHD) in childhood

Attention deficit hyperactivity disorder (ADHD) is a condition that affects a young child’s behavior and learning. Children with ADHD often have difficulty concentrating and are easily distracted, and they may also be impulsive and overactive. ADHD is not the child’s or the parents’ fault, and many children with ADHD say they do not understand why they sometimes feel out of control or very lonely.

ADHD is a neurodevelopmental disorder – a disorder of brain development – that can affect a number of areas of how a person functions, including:

• inattention
• impulsivity – such as talking over the top of others, having a ‘short fuse’ or being accident prone
• overactivity – constant restlessness and fidgeting
• emotional regulation
• social navigation

ADHD is not a sign of low intelligence. With understanding, care and medical treatment, children with ADHD can be successfully supported to manage these difficulties. All young children have a limited attention span and sometimes act without thinking, but only a few of these children have ADHD.

Diagnosis#

If you are concerned about your child, see your doctor. They can refer your child to a pediatrician (a doctor who specializes in child and youth health), a psychologist or a child psychiatrist who can assess your child.

There is no single test for ADHD. A specialist can only diagnose it after a detailed assessment, which involves collecting a range of information about the child – especially from parents or carers and from the child’s school. For ADHD to be diagnosed, the symptoms must be obvious in most areas of the child’s life and across two or more settings, such as at school and at home.

The assessment can include a history of the child’s behaviors, any trauma or illness they have experienced, and their relationships and family. Doctors and psychologists use a variety of tools, scales and criteria when diagnosing ADHD.

Inattention#

A child with symptoms of inattention may, on a regular basis:

• not give close attention to details, or make seemingly careless mistakes in schoolwork or other activities
• have difficulty sustaining attention in tasks or play
• not seem to listen when spoken to directly
• not follow through on instructions or finish schoolwork, chores or other duties (not because they are being willful or do not understand)
• have difficulty organizing tasks and activities
• avoid, dislike or be unwilling to do tasks that need ongoing mental effort, such as schoolwork or homework
• lose things needed for tasks, such as toys, school assignments, pencils, books or tools
• be easily distracted
• be forgetful in daily activities

A child with six or more of these symptoms for at least six months – to a degree that interferes with everyday life and is beyond what is usual for their age – may be diagnosed with the inattentive aspect of ADHD.

Hyperactivity and impulsivity#

A child with symptoms of hyperactivity or impulsivity may often:

• fidget with their hands or feet, or squirm in their seat
• leave their seat in the classroom or in other situations where staying seated is expected
• run about or climb excessively in inappropriate situations
• have difficulty playing or taking part in leisure activities quietly
• be ‘on the go’ or act as if ‘driven by a motor’
• talk more than average
• answer before questions have been completed
• have difficulty waiting their turn
• interrupt or intrude on others, for example by interrupting conversations or games

A child with six or more of these symptoms for at least six months – to a degree that interferes with everyday life and is beyond what is usual for their age – may be diagnosed with the hyperactive-impulsive aspect of ADHD.

Types of ADHD#

Using these criteria, a health professional can determine which type of ADHD a child has:

• ADHD combined type – the child meets the criteria for both inattention and hyperactivity-impulsivity over the past six months.
• ADHD predominantly inattentive type – the child meets the criteria for inattention but not for hyperactivity-impulsivity.
• ADHD predominantly hyperactive-impulsive type – the child meets the criteria for hyperactivity-impulsivity but not for inattention.

Causes#

The exact cause of ADHD is not known. The leading theory is that it is a neurodevelopmental disorder, with several factors that may affect brain development, including:

• genetics – some research suggests that gene changes may play a part
• environment – exposures during pregnancy and life
• life experiences
• lack of early attachment – if a baby does not bond with their parent or caregiver, or has traumatic experiences related to that attachment, this may contribute to inattention and hyperactivity

Caring for a child with ADHD#

Caring for a child with ADHD can be challenging, but there are many ways you can help your child learn and reduce stress in the family. Make sure everyone who cares for the child uses a consistent approach and works as a team. Try to take regular breaks, as it is valuable to get some respite from the demands of caring.

It may help if you:

• develop consistent routines at home and at school
• keep rules clear and simple, and give reminders calmly
• get physically close to the child and make sure you have their full attention when you talk
• give only one or two instructions at a time, and ask the child to repeat them to be sure they have understood
• praise your child when they behave appropriately and acknowledge their achievements
• be clear about the consequences for behavior you find unacceptable – for example, using ’time out’ for younger children (roughly between 18 months and six years), or logical consequences for older children

Managing ADHD#

There are a number of ways to help reduce a child’s ADHD symptoms. These include:

• medication – ADHD medications are most commonly stimulant medications, which can reduce hyperactivity and impulsivity and improve a child’s ability to focus, work and learn
• psychotherapies – such as behavior therapy and cognitive behavior therapy
• counseling
• learning some stress management techniques
• joining a support group

Parents and carers may also benefit from parenting skills training that helps them learn how to encourage and reward positive behaviors in their child.

ADHD was once thought to affect only children, but its symptoms and effects can continue into adulthood.

Key points#

• The exact cause of ADHD is not known.
• For ADHD to be diagnosed, the symptoms must be obvious in most areas of the child’s life.
• A child with symptoms of hyperactivity may often talk more than average.
• ADHD is a neurodevelopmental disorder and is not a sign of low intelligence.
• ADHD medications are most commonly stimulant medications.

Where to get help#