Fidgeting and wriggling. Speaking out of turn. Staring out the window during class.
Almost every child exhibits these behaviors at times. But when they become the norm instead of the exception and start interfering with a child’s ability to do schoolwork and make friends, they may be signs of attention deficit hyperactivity disorder (ADHD), a condition affecting approximately 3 to 7 percent of all children. Without treatment, kids with ADHD can fall behind in school, develop behavioral problems, and have difficulty with friends and family.
While there is no “cure” for ADHD, parents, teachers, and physicians can do a lot to help kids manage their symptoms. We spoke with Douglas Newton, MD, MPH, a pediatric psychiatrist in Kaiser Permanente’s Colorado Region who is clinical lead for Pediatric Behavioral Health with the Kaiser Permanente Care Management Institute, to get his suggestions.
Symptoms of ADHD
The American Psychiatric Association identifies three types of ADHD: inattentive type, hyperactive-impulsive type and combined type. Download a checklist to help you determine if your child may have ADHD.
“If your child consistently demonstrates six out of nine symptoms for any type, that’s an indication that something might be going on,” said Dr. Newton.
Symptoms of inattentive ADHD include:
- making careless mistakes or having difficulty paying attention to detail
- trouble holding attention on tasks or play activities
- not seeming to listen when spoken to
- not following through on instructions and failing to finish schoolwork or chores
- trouble organizing tasks and activities
- avoiding tasks that require prolonged mental effort
- losing or misplacing things like school supplies and eyeglasses
- becoming easily distracted
- being forgetful in daily activities
Symptoms of hyperactive-impulsive ADHD include:
- fidgeting or squirming
- difficulty staying seated
- running or climbing at inappropriate times
- being unable to play quietly
- being constantly “on the go”
- talking excessively
- blurting out answers
- trouble waiting his or her turn
- interrupting or intruding by butting into conversations or games
Symptoms of combined type ADHD may include any symptom from the two lists above.
Confirming your child has ADHD
If you suspect your child has ADHD, talking with his or her classroom teacher is a great first step.
“You might ask, ‘Is he acting out or often interrupting the classroom? Is she getting out of her seat and unable to sit still?’” said Dr. Newton. “You also want to ask about less obvious behaviors such as constantly looking out the window instead of listening to instructions, difficulty staying on task and finishing work, and challenges with multi-step instructions.”
Your child’s behavior during playtime and recess is equally important to examine.
“One of the biggest problems I see with these kids isn’t failing in school — it’s the social impact of their ADHD,” said Dr. Newton. “The child might act impulsively, and as the other students become aware of this, the child can develop a reputation as ‘the bad kid.’ That can lead to problems like low self-esteem or depression. A teacher can be helpful in calling that out for the family.”
If your child’s teacher confirms your suspicions, the next step is to consult your child’s primary care provider. He or she may use a tool like the NICHQ Vanderbilt Assessment Scales to diagnose your child or refer you to a pediatrician or developmental pediatrician for testing. ADHD can also be diagnosed by a psychologist or psychiatrist.
The physician should also look for problems that can accompany ADHD or cause similar symptoms, including learning disabilities, depression, lack of access to physical activity during the school day, and exposure to trauma or adverse childhood experiences.
Once a definitive diagnosis of ADHD has been made — and other possible causes of your child’s symptoms have been ruled out — your physician may recommend treatment with medication. If you decide to proceed, the most proven approach is the use of stimulant medications, including amphetamines and methylphenidates. These medications can increase children’s attention span, make them less distractible and restless, and help them finish schoolwork and chores more easily.
“Our goal is to start with the lowest recommended dose, go slowly and watch for side effects,” Dr. Newton explained. The most common side effects include appetite suppression and sleep disturbances.
Your child must come in for a follow-up visit within 30 days of starting a medication trial, and follow-ups will continue until you find the right medication and dose. Afterward, your child will continue to be seen every four to six months to track social, emotional and academic development, as well as physical parameters such as weight, height and blood pressure.
While ADHD medication works quickly, Dr. Newton cautioned that it may take some time for children to unlearn negative behaviors developed over years. If behavior problems continue, your physician may recommend an evaluation from a therapist, psychiatrist or developmental pediatrician.
Supporting your child
With support from their parents and teachers, children with ADHD can learn to manage their symptoms and develop coping strategies.
- Develop a routine and stick with it. On weekday mornings, this might include getting up at a certain time, getting dressed and pulling school supplies together before breakfast. An after-school routine might include having a snack and playing outside for a set amount of time before settling in for homework.
- Help your child stay on task by using charts, checklists, and timers.
- Create a distraction-free place for doing homework. Whether this is a desk or the kitchen table, the space should be tidy, comfortable and far from distractions.
- Make sure your child eats nutritious meals and snacks. Eating a healthy breakfast is especially important if your child is taking medications for ADHD.
- Set a specific bedtime to make sure your child gets enough sleep. Being tired can worsen ADHD symptoms.
- Check in with your child’s teacher regularly to find out how your child is doing during lesson time, playtime and at lunch.
- Talk to the teacher about accommodations that may help your child succeed. These might include sitting near the front of the classroom and away from distractions, reminders to turn in homework and permission to use fidget toys that help your child channel excess energy.
If your child needs more help, ask the teacher if an Individualized Education Program or 504 Plan is appropriate. These are written documents, created with the school’s participation, that describe accommodations or special education services your child will receive.