Maybe you’ve noticed your child can’t seem to sit still and tends to drift off into his or her own world, but the idea of getting an evaluation for attention deficit hyperactivity disorder (ADHD) makes you anxious.
Just the suggestion that something may not be right with your child can be a lot to process.
Take a deep breath and know that ADHD is a common and treatable neurobehavioral disorder. As many as 6.1 million children have been diagnosed with ADHD in the United States, according to the Centers for Disease Control and Prevention (CDC). About 2 million of these kids were diagnosed between the ages of 2 and 5. Up to 60 percent of children with ADHD will continue to experience ADHD symptoms in adulthood, including trouble at work and in relationships.
No one knows exactly what causes ADHD. Genetics and environmental exposures may play a role. It’s important to understand that ADHD is not caused by eating too much sugar, watching too much television or your parenting, the CDC says.
There is no blood test or imaging test that can say your child definitely has ADHD. Instead, the diagnosis is based on a copious medical history. Your doctor may refer you to a child psychologist or psychiatrist for the evaluation, if needed. The doctor will ask questions about any symptoms that your child is experiencing at home or in school. Input from caregivers and teachers is an essential part of this process. The doctor may also want to observe your child at home or at school, according to the national nonprofit group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
ADHD can travel with or mimic a host of other conditions. Hearing and vision tests can help rule out other problems that may contribute to or drive your child’s symptoms. The CDC reports that, in 2016, about 5 in 10 children with ADHD had a behavior or conduct problem, and three in 10 children with ADHD had anxiety. Other conditions often associated with ADHD include depression, autism spectrum disorder, sleep problems and certain types of learning disabilities, the CDC says. The Mayo Clinic stresses, however, that ADHD doesn't cause these other psychological or developmental problems.
It’s normal to want to do your due diligence before your first appointment with a doctor to discuss your child’s symptoms. Self-test questionnaires with explanations of results and next steps are widely available on the internet. These can be helpful if they come from a reliable source. The information you learn from them can be shared with your doctor to aid the assessment. They do not, however, take the place of a diagnosis from your doctor, CHADD warns.
As part of the evaluation process, your doctor may ask you, your child or his or her teachers to review checklists that rate ADHD symptoms. According to CHADD, some commonly used ADHD symptom checklists include:
- Child Behavior Checklist (CBCL/6-18): This tool, meant for children ages 6-18, consists of a checklist of 120 questions.
- Conners’ Rating Scales: These tools, which have 27 or 28 questions, include:
- Conners’ Parent Rating Scale-Revised for parents/caregivers
- Conners’ Teacher Rating Scale-Revised for teachers
- The Conners-Wells' Adolescent Self-Report Scale, which can be used to measure symptoms in teens.
- Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS): This scale asks for information on your perception of your child’s social functioning and school performance. It has 45 questions.
- Teacher Rating Scale (VADTRS): This tool collects information on school performance and ADHD symptoms from your child’s teacher. It has 43 questions and is based on 4- and 5-point scales with high scores indicating more severe ADHD symptoms.
- ADHD Rating Scale-IV (ADHD-RS-IV): This rating scale offers separate forms for parents/caregivers and teachers.
Information gathered via these questionnaires can help your doctor make an informed ADHD diagnosis.
According to CDC research, about half of children with ADHD are diagnosed by a primary care physician, behavior rating scales are used about 90 percent of the time to assess for ADHD and about 8 of 10 diagnoses incorporated information from an adult other than a family member.
Children are diagnosed with one of three types of ADHD: predominantly inattentive, predominantly hyperactive-impulsive or a combined type.
1. ADHD predominantly inattentive
A child must display six of the following symptoms in more than one setting, such as at home and in school, to meet the criteria for this type of ADHD, according to the CDC:
- Failure to pay close attention to details
- Difficulty sustaining attention
- Trouble listening
- Poor follow-through with instructions
- Organization challenges
- Avoidance of tasks requiring sustained attention
- Losing objects
- Easy distraction
This type of ADHD was formerly known as attention deficit disorder (ADD).It tends to be more common in girls. Sometimes children with this type of ADHD slip through the system because, unlike their counterparts with the hyperactive/impulsive type of ADHD, they're not disruptive in class.
2. ADHD predominantly hyperactive-impulsive
A child must have six of the following symptoms in more than one setting, such as at home and in school, to meet the criteria for this type of ADHD, according to the CDC. Symptoms include:
- Fidgeting or squirming
- Trouble staying seated
- Excessive running and climbing
- Problems engaging in quiet activities
- Acting as of driven by a motor
- Excessive talking
- Blurting out answers before questions are asked
- Difficulty waiting
- Interrupting others
3. ADHD combined presentation
To be diagnosed with this type of ADHD, a child must meet the criteria for both inattentive and hyperactive-impulsive ADHD.
Diagnosed, and then what?
Once a diagnosis of ADHD has been established, you will need to work with your doctor and child to develop a treatment plan to help your child thrive at home and in school.
ADHD treatment in children involves medication, behavioral therapy and support at school, the American Academy of Pediatrics (AAP) explains. Stimulant medications are usually the initial medication choice. Non-stimulants can be added to the mix if stimulants don’t work as well as expected. They can replace stimulants if stimulants cause too many side effects. Stimulant side effects may include decreased appetite, trouble sleeping, anxiety and headaches, among others.
Parent training in behavior management is the first-line treatment for preschoolers who are diagnosed with ADHD, according to the latest guidelines from the AAP. This involves learning ways to change your child’s behavior by rewarding them when they do something good, such as saying things like “great job listening and waiting your turn to share,” as well as setting limits and establishing and sticking to routines. You'll learn that kids with ADHD do well with structure, such as consistent wake and bed times, and need rules that they can understand and follow. Other types of therapy may also help families cope with the stress that an ADHD diagnosis can put on a household.
Working with your child's school, to ensure that your child gets the appropriate support, may also be needed. A study in the Journal of Attention Disorders in 2018 found that as many as one in five students with ADHD receive no school services despite experiencing significant academic and social impairment. This gap was especially pronounced among children from non-English-speaking and lower-income families.
Because there's no cure for ADHD, treatment will be ongoing. You will need to work with your child and doctor to monitor medication as well as symptoms, which can morph over the course of a lifetime.
Remember, too, that knowledge is power. If your child is diagnosed with ADHD, the best thing you can do is learn as much as possible and stay updated about the condition and its treatments.
- Centers for Disease Control and Prevention: “ADHD Facts” https://www.cdc.gov/ncbddd/adhd/facts.html
- CDC: “ADHD Causes.” https://www.cdc.gov/ncbddd/adhd/facts.html#Causes
- CHADD: “Diagnosing ADHD.” https://chadd.org/about-adhd/diagnosing-adhd/
- CDC: “ADHD and Other Conditions.” https://www.cdc.gov/ncbddd/adhd/conditions.html
- Mayo Clinic: “ADHD Symptoms/Causes.” https://www.mayoclinic.org/diseases-conditions/adhd/symptoms-causes/syc-20350889?p=1
- CHADD: “ADHD Rating Scales.” https://chadd.org/adhd-weekly/which-adhd-rating-scales-should-primary-care-physicians-use/
- CDC: “How US children are diagnosed with Attention-Deficit/Hyperactivity Disorder.” https://www.cdc.gov/ncbddd/adhd/features/how-us-children-diagnosed.html
- CDC: “ADHD Diagnosis.” https://www.cdc.gov/ncbddd/adhd/diagnosis.html
- American Academy of Pediatrics: “ADHD.” https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/default.aspx
- Journal of Attention Disorders, December 2018:” Predictors of Receipt of School Services in a National Sample of Youth With ADHD.” https://journals.sagepub.com/doi/abs/10.1177/1087054718816169?journalCode=jada