There are a variety of reasons a child may have trouble sitting still, following directions or paying attention. Often, this behavior could be due to age or maturity level. However, frequent hyperactivity or trouble concentrating could be a sign of attention deficit hyperactivity disorder (ADHD).
So how can you tell if your child is exhibiting normal childhood behaviors or if they are exhibiting symptoms of ADHD? The answer might depend on the age of your child, along with several other factors.
"Most 2-to 3-year-olds are hyperactive and impulsive – that's part of normal development," explains Catherine Karni, M.D., Medical Director of Outpatient Services at Children's Health℠ and Professor of Psychiatry at UT Southwestern. "We become concerned about ADHD in a child when the symptoms extend beyond that."
What is ADHD?
ADHD is a neurological disorder characterized by difficulties with attention and/or impulsivity that exceed normal expectations. A person with ADHD may find it difficult to maintain focus in certain situations. Some people with ADHD may be impulsive and restless, finding it hard to sit still, but this is not always the case.
Most symptoms of ADHD begin in childhood and become more noticeable when a child begins school. A child with ADHD who demonstrates impulsivity and difficulty sitting still may become less hyperactive as he or she grows older. Difficulties with focus and attention also can improve as the brain matures. However, symptoms of ADHD sometimes can continue into adolescence and adulthood.
Signs of ADHD in children
Diagnosing ADHD in children is based on several factors, including attention levels and activity levels. A child with ADHD may have the following symptoms beyond what most children their age demonstrate:
- Trouble sitting still
- Difficulty following directions
- Poor planning and organizational skills
- Disruptive in a classroom setting (e.g., talking, leaving seat)
- Forgetful (due to inconsistent attention)
- Hard time keeping hands to oneself
- Impulsive behavior
Symptoms of ADHD can affect not only a child's academic performance but also a child's social development. For example, if a child is not carefully focusing on subtle facial cues or tone of voice, he or she may not react appropriately in some social situations. A hyperactive child also may affect their peers' behavior or the mood of their classroom.
Signs of ADHD are not limited to the classroom or particular instances. To meet criteria for a diagnosis of ADHD, symptoms must have been ongoing for at least six months and must be interfering with your child's ability to function.
"Evidence has to be present in multiple settings, and we want to see a pattern of difficulties that are affecting function over a period of time, not just in the context of a stressful situation," explains Alice Ann Holland, PhD., a board-certified pediatric neuropsychologist and Research Director for the Neuropsychology Service at Children's Health and Assistant Professor at UT Southwestern.
Diagnosing ADHD in Children
According to the Centers for Disease Control and Prevention, approximately 9.4% of U.S. children between the ages of 2-17 have been diagnosed with ADHD in their lifetime. "There are studies that show that the rates of diagnosis are increasing; however, it's not clear if that's relative to greater incidence, or if it's because of more awareness – for example, schools implementing screening measures," says Dawn Johnson, M.D., Associate Medical Director at Children's Health.
Dr. Johnson stresses that it's important not to confuse signs of ADHD with immaturity. "Maturity level must be considered when evaluating for an ADHD diagnosis," she says. Pediatricians often offer screenings for ADHD and then, if necessary, may refer your child for a comprehensive evaluation by a developmental pediatrician or pediatric psychologist to confirm the diagnosis.
It's also important to know that ADHD can co-occur with other conditions such as autism spectrum disorder, depression, anxiety, learning disorders and language disorders. At the same time, some conditions – such as depression, anxiety and trauma – can result in symptoms that look like ADHD without ADHD being present.
"It often may not be clear what is causing the symptoms, so a comprehensive evaluation by a clinician who has experience in children's mental health can be helpful to determine if an ADHD diagnosis is appropriate," says Dr. Johnson.
Treatment for ADHD in children
"Although there is no 'cure' for ADHD, available treatments may help reduce symptoms and improve functioning," says Dr. Karni. "ADHD is commonly treated with medication, education, training, therapy or a combination of treatments."
One treatment that has been supported by research is behavior modification, which involves a behavioral therapist working with the child to identify certain behaviors that need to be addressed. A reward system may be established, such as a sticker chart or bestowing privileges, in order to encourage the child to work on the behavior. Parents are actively involved in this process, with the therapist teaching them how to most effectively reinforce positive behaviors for their child.
Ongoing coordination of care with a child's teachers and therapist is an important part of ADHD treatment. Parents can request school services and accommodations, such as a 504 plan, to ensure their child receives the support he or she needs to learn best in school.
There are also different medications – both "stimulants" and non-stimulants –that have been shown to reduce symptoms of ADHD. These medications are considered the first line of treatment for ADHD but should always be supplemented with behavioral supports and interventions. ADHD medications may have some side effects, including decreased appetite and problems with sleep. Each child responds to medications differently, so talk to your doctor about what to expect if your child begins medication for ADHD.
With the right treatment, children with ADHD can be highly successful in managing their symptoms. However, left untreated, ADHD can have long-term effects on a child, including an increased risk for poor self-esteem, low morale, poor relationships, dropping out of school, depression and even subsequent substance abuse. It's important for parents to recognize the signs and symptoms of ADHD and to seek help if they are concerned.
Diagnosing ADHD in children is based on several factors, including attention levels and activity levels. However, it's important not to confuse signs of ADHD with immaturity. Experts from @Childrens share what to watch for.
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