Diagnosis
In general, a child shouldn’t receive a diagnosis of attention-deficit/hyperactivity disorder unless the core symptoms of ADHD start early in life — before age 12 — and create significant problems at home and at school on an ongoing basis.
There’s no specific test for ADHD, but making a diagnosis will likely include:
- Medical exam, to help rule out other possible causes of symptoms
- Information gathering, such as any current medical issues, personal and family medical history, and school records
- Interviews or questionnaires for family members, your child’s teachers or other people who know your child well, such as caregivers, babysitters and coaches
- ADHD criteria from the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association
- ADHD rating scales to help collect and evaluate information about your child
Diagnosing ADHD in young children
Although signs of ADHD can sometimes appear in preschoolers or even younger children, diagnosing the disorder in very young children is difficult. That’s because developmental problems such as language delays can be mistaken for ADHD.
So children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental pediatrician.
Other conditions that resemble ADHD
A number of medical conditions or their treatments may cause signs and symptoms similar to those of ADHD. Examples include:
- Learning or language problems
- Mood disorders such as depression or anxiety
- Seizure disorders
- Vision or hearing problems
- Autism spectrum disorder
- Medical problems or medications that affect thinking or behavior
- Sleep disorders
- Brain injury
Treatment
Standard treatments for ADHD in children include medications, behavior therapy, counseling and education services. These treatments can relieve many of the symptoms of ADHD, but they don’t cure it. It may take some time to determine what works best for your child
Stimulant medications
Currently, stimulant drugs (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These medications help improve the signs and symptoms of inattention and hyperactivity — sometimes effectively in a short period of time
Examples include
- Amphetamines. These include dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall XR, Mydayis) and lisdexamfetamine (Vyvanse).
- Methylphenidates. These include methylphenidate (Concerta, Ritalin, others) and dexmethylphenidate (Focalin).
Stimulant drugs are available in short-acting and long-acting forms. A long-acting patch of methylphenidate (Daytrana) is available that can be worn on the hip
The right dose varies from child to child, so it may take some time to find the correct dose. And the dose may need to be adjusted if significant side effects occur or as your child matures. Ask your doctor about possible side effects of stimulants
Stimulant medications and certain health risks
Some research indicates that using ADHD stimulant medications with certain heart problems may be a concern, and the risk of certain psychiatric symptoms may be increased when using stimulant medications.
- Heart problems. Stimulant medication may cause an increased blood pressure or heart rate, but the increased risk of serious adverse effects or sudden death is still unproved. However, the doctor should evaluate your child for any heart condition or family history of heart disease before prescribing a stimulant medication and monitor your child during stimulant use.
- Psychiatric problems. Stimulant medications may rarely increase the risk for agitation or psychotic or manic symptoms with stimulant medications use. Contact the doctor immediately if your child has sudden new or worsening behavior or sees or hears things that aren’t real while taking stimulant medication.
Other medications
Other medications that may be effective in treating ADHD include
- Atomoxetine (Strattera)
- Antidepressants such as bupropion (Wellbutrin SR, Wellbutrin XL, others)
- Guanfacine (Intuniv)
- Clonidine (Catapres, Kapvay)
Atomoxetine and antidepressants work slower than stimulants do and may take several weeks before they take full effect. These may be good options if your child can’t take stimulants because of health problems or if stimulants cause severe side effects
Suicide risk
Although it remains unproved, concerns have been raised that there may be a slightly increased risk of suicidal thinking in children and teenagers taking nonstimulant ADHD medication or antidepressants. Contact your child’s doctor if you notice any signs of suicidal thinking or other signs of depression
Giving medications safely
It’s very important to make sure your child takes the right amount of the prescribed medication. Parents may be concerned about stimulants and the risk of abuse and addiction. Stimulant medications are considered safe when your child takes the medication as prescribed by the doctor. Your child should see the doctor regularly to determine if the medication needs to be adjusted
On the other hand, there’s concern that other people might misuse or abuse stimulant medication prescribed for children and teenagers with ADHD. To keep your child’s medications safe and to make sure your child is getting the right dose at the right time
- Give medications carefully. Children and teens shouldn’t be in charge of their own ADHD medication without proper supervision.
- At home, keep medication locked in a childproof container. And store medication away from the reach of children. An overdose of stimulant drugs is serious and potentially fatal.
- Don’t send supplies of medication to school with your child. Deliver any medication yourself to the school nurse or health office.
ADHD behavior therapy
Children with ADHD often benefit from behavior therapy, social skills training, parent skills training and counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health professional. Some children with ADHD may also have other conditions such as an anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem
Examples of therapy include
- Behavior therapy. Teachers and parents can learn behavior-changing strategies, such as token reward systems and timeouts, for dealing with difficult situations.
- Social skills training. This can help children learn appropriate social behaviors.
- Parenting skills training. This can help parents develop ways to understand and guide their child’s behavior.
- Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavior patterns and learn ways to deal with their symptoms.
- Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
The best results occur when a team approach is used, with teachers, parents, therapists and physicians working together. Educate yourself about ADHD and available services. Work with your child’s teachers and refer them to reliable sources of information to support their efforts in the classroom.
