Looking for help can be hard when you don’t know what you’re looking for. Understanding the symptoms of attention deficit hyperactivity disorder is only the beginning.
Hearing that your kid is having trouble sitting quietly or learning grade-level material can worry any parent who wants to see their child succeed.
The dreaded “parent-teacher conference” can be stressful enough without hearing from a teacher that your child may have attention deficit hyperactivity disorder (ADHD). Where does a parent even begin to learn about ADHD and what it could mean for their family?
The answer is right here, so take heart.
An ADHD diagnosis is based on several factors, not just one individual behavior (or lack of behavior, for that matter). Still, if you suspect your child has ADHD, consider talking with a professional. There are benefits to getting the condition diagnosed early.
ADHD varies from person to person. Someone with ADHD may experience one symptom more than others, or they may not experience a specific symptom at all.
- Hyperactivity: Your kid may struggle to sit still and seem to be in constant motion
- Impulsivity: Your child or teen may have difficulty controlling outbursts or acting before thinking
- Inattention: Your child may struggle to stay focused on tasks they aren’t interested in
Any child can be very active or have a short attention span, but children with ADHD experience these symptoms stronger or more frequently than other kids their age. This often leads to them having behavioral issues at home and school.
Because ADHD symptoms can vary in intensity, the diagnosis is divided into 3 subtypes.
To qualify for a subtype, at least 6 symptoms must be present at home and/or at school over a period of 6 months or longer.
Also, these symptoms have to be present before the age of 12. They must have impacted a child’s schoolwork and social functioning. They can’t be better explained by another diagnosis, such as anxiety or personality disorder.
The 3 subtypes of ADHD are:
- Predominantly hyperactive-impulsive presentation: A child displays at least 6 symptoms of hyperactivity-impulsivity but fewer than 5 symptoms of inattention.
- Predominantly inattentive presentation: A child displays at least 6 symptoms of inattention but fewer than 5 symptoms of hyperactivity-impulsivity.
- Combined presentation: A child displays at least 6 symptoms of both inattention and hyperactivity-impulsivity.
Hyperactive-impulsive type of ADHD
Hyperactive-impulsive characteristics in a child tend to be easier to diagnose because the child is so active and seems to have constant energy.
“Hyperactive symptoms include over-activity,” said Dr. Dina Hirshfeld-Becker, co-director of the Child Cognitive Behavioral Therapy Program at the Massachusetts General Hospital. “Children may also have trouble inhibiting speech and impulses, so they may talk too much in class.”
She continued, “They may also engage in risky or daredevil-like behaviors like jumping off of structures that are too high or darting out in the street.”
Inattentive type of ADHD
Especially during their school years, children with inattentive characteristics struggle with schoolwork, which causes them to be misunderstood. They sometimes appear forgetful or absent-minded, often forget to write down their homework assignments or take a notebook home.
Less exciting tasks are tough for them to focus on, and more exciting tasks can dominate their focus so completely that it is difficult for them to move onto something new.
“The most noticeable signs are problems focusing or concentrating on things (especially boring things) over time, distractibility… and being consistently inconsistent,” explained Dr. Allison Kawa, a licensed clinical psychologist and clinical director at the Los Angeles Center for Integrated Assessment. “These kids and teens get high grades and low grades in the same subject for no discernable reason. When they are ‘on,’ they are amazing, but they can’t seem to get to ‘on’ when needed at times.”
Combined type of ADHD
The combined type of ADHD is diagnosed for kids who experience at least six or more symptoms of both inattentive and hyperactive-impulsive types of ADHD.
The severity of each symptom can vary within the combined type. Symptoms can improve or become worse based on stress factors in the kids’ lives or how well the family manages their ADHD.
“Things like the fit between the student and their academic or home environment, level of stress, and even activity level all play into the severity of symptoms,” Kawa explained.
For example, “many kids who would have probably fallen into the ‘mild’ category pre-COVID-19 are looking more ‘moderate’ and ‘severe’ given the stress of quarantine, limited access to exercise, and distance-learning demands,” Kawa said.
The short answer: yes. But ADHD presents a little differently in each person, and symptoms can vary based on age and how well the condition has been treated as a person ages.
For example, stressors in low-income communities, coupled with a lack of healthcare provisions or costly school accommodations, can negatively impact the diagnosis and management of childhood ADHD.
The biggest issue is that ADHD is not even recognized, let alone treated the same, within all communities. It has been historically undertreated within particular communities depending on race, ethnicity, and gender.
Early signs of ADHD
In very young children, there can be some early signs of ADHD. However, the symptoms can be difficult to identify because toddlers and young kids are naturally high energy and have short attention spans.
“Symptoms of ADHD can often be observed [in 3- to 4-year-olds],” Hirshfeld-Becker said. “Unfortunately, the disorder may not be formally diagnosed until years later, meaning that the child has to endure many years of being misunderstood.”
ADHD characteristics in children ages 3–5
Signs of ADHD won’t always present clearly to parents of very young kids. If a parent suspects their child has ADHD at this age,it’s likely because the symptoms are especially severe.
For example, a 3- to 5-year-old with ADHD might not sit still at circle time, Kawa explains, or they may have “trouble playing with peers because they impulsively snatch toys, struggle to stick with games, break things, or otherwise disrupt the game.”
Parents might also suspect their little one has ADHD because their child’s actions are dangerously impulsive. For example, they may run across the street without looking, wander off in a crowded area to follow someone’s dog, or climb tall, wobbly pieces of furniture at home.
ADHD characteristics in children ages 6–12
The signs and impact of ADHD become more visible when a child turns 6 because they start going to school for a full day and receive regular updates from teachers.
“These children have real trouble conforming to classroom expectations… so they often draw negative attention from teachers and parents,” Hirshfeld-Becker explained.
“Some important warning signs are when the teacher reports that the child is ‘disruptive’ or ‘talkative’ in class, that the child is ‘careless’ on assignments, that the child misses assignments or generally has spotty (variable) school performance,” Hirshfeld-Becker added.
Signs of ADHD in teens
As children grow up, the symptoms of ADHD can change.
For example, Dr. Jessica Myszak, a child psychologist and the director of The Help and Healing Center in Glenview, Illinois, said, “Symptoms may change over time. A child may have primarily hyperactive symptoms at first but then later experience more inattentive symptoms as they grow and mature.”
In some cases, children can outgrow or better manage their ADHD so that it doesn’t impact their adolescent years as much.
However, that’s not true for all teens. Stressors (and hormones) become more intense during these years, which can make ADHD harder to control.
Diagnosing ADHD as a teenager
Even though ADHD symptoms can change in adolescents, the disorder does not typically develop for the first time during the teen years.
If someone receives an ADHD diagnosis in their teenage years, it is likely because the disorder went undiagnosed or because the person wasn’t in an environment where the symptoms were clearly visible.
“Many children learn to compensate for their symptoms, and if there is an especially good match between the child and their school environment, symptoms can be masked for years,” Kawa explained.
“It is not unusual for very bright, motivated people with ADHD to be diagnosed as adolescents or even as adults, but when you look at their childhood history, the symptoms were always present to some degree.
“If attention symptoms are developing in adults with no prior history of attention problems,” it is likely “attributable to anxiety, trauma, or other mental health conditions,” Myszak said.
ADHD in girls and boys
While every person’s ADHD presentation is different, boys typically show behaviors more in line with hyperactivity, and girls typically show more attention-deficit behaviors.
Studies also show that for approximately every girl diagnosed with ADHD, 3 to 7 boys are diagnosed.
One of the reasons for this might be that hyperactive boys are more likely to draw negative attention from their teachers, while a girl might be overlooked and undiagnosed because she’s written off as shy, quiet, or “just not getting it” when it comes to her schoolwork.
ADHD in children of color
“There are no inherent differences in the way ADHD manifests across race or ethnicity, but the child or adolescent’s home, school, and broader community will play a significant role in how much support or stress they feel,” Kawa said.
“This, in turn, can impact the severity and functional impact of symptoms,” she added.
Studies have shown that African American children received ADHD diagnoses only two-thirds as often as white children.
This is possibly due to hesitancy in getting children evaluated, inadequate access to and availability of care, as well as a tendency for some specialists to underdiagnose ADHD when evaluating kids in certain communities.
To receive an appropriate diagnosis for children of color, it’s important to meet with a specialist who is culturally competent and sensitive to the child’s specific needs.
ADHD in LGBTQ+ youth
LGBTQIA+ children with ADHD can face very different experiences in their lives based on the support or acceptance they receive at home or among their classmates.
“This is a population that, depending on their level of psychosocial support and acceptance, often has difficulty concentrating because they are grappling with really complex issues at a young age,” said Kawa.
“LGBTQ+ children and teens can be more impacted by their ADHD if their environment is not feeling safe and supportive.”
Parents of LGBTQIA+ youths need to provide a strong base of support that reduces extra stressors so that symptoms of ADHD can be more manageable.
You can have your kid evaluated by a specialist, who can rule out other possible explanations for their symptoms.
“It is important to remember that attention problems in children and teens are like a fever: They tell you that something is going on, but not specifically what the issue is,” Kawa said.
A pediatrician, a neurologist, or a mental health professional can give a diagnosis.
“ADHD can be assessed by behavioral observations, by parent interview about symptoms, and with standardized checklists of behaviors completed by parents and teachers,” Myszak said.
After completing an evaluation, a diagnosis can be made about what is causing a child’s behavioral issues.
When it comes to ADHD, knowledge is power. The more a parent researches ADHD, the easier it will be to understand what their child is going through.
“For parents facing a new diagnosis for their child, I let them know that many successful people have ADHD, and determining the correct diagnosis is half of the battle,” Myszak said.
There are many effective treatments for ADHD, and parents can find what works best for their child and family.
Showing kindness and compassion for someone with ADHD will also help them thrive in their environment. It’s important to remember that frustrating behaviors are often outside of their control.
“Kids with untreated ADHD, especially before it is diagnosed and understood, can be challenging to teach and to parent, so the children sometimes face a lot of negative comments,” Hirshfeld-Becker said.
“Once children, parents, and teachers understand that the disorder is what is making these tasks challenging and that the disorder can be treated, they can all work together as a team to manage the disorder.”