This article is about childhood attention deficit hyperactivity disorder (ADHD). The adult ADHD FAQ is here.

Is ADHD even a real disorder, since most children show some of the symptoms some of the time?

While there is not one specific proven test to determine who has ADHD, it is nevertheless a real disorder. ADHD is characterized by a specific constellation of symptoms, functional problems and developmental history that follows predictable patterns. However, the diagnosis should not be assigned casually.

Can a child have an attention deficit disorder and not be hyperactive?

Yes. This is known as ADHD, Predominantly Inattentive presentation. Children with this presentation will often daydream and have a hard time focusing.

How does ADHD affect a child’s schooling?

Children with ADHD are at increased risk for lower academic performance and social problems (including peer problems and teacher conflicts). They have a greater chance of dropping out of school. Many repeat grades or receive lower academic scores due to problems with attention span, hyperactivity, and impulsivity. A very typical problem is displayed by children who do not turn in schoolwork to the teacher even though it has been completed. Many have “chaotic” book bags. Entry into middle school is especially challenging for children with ADHD because they are now expected to be able to switch from class to class.

Is there a specific test to diagnose ADHD?

No, there is not one magic test. But professionals qualified in assessing children’s development and behavior will conduct a comprehensive assessment to ascertain whether the individual does indeed have the disorder.

What kind of psychological work-up should be done to make a diagnosis?

The psychological assessment should be tailored to an individual child’s specific problems and strengths. It is not necessary to put children through an assessment mill where everyone always gets the same type and amount of tests. Depending on what the child’s problem areas are, some things need to be examined more intensely, while other things may not merit much, if any, scrutiny at all. Talking to a mental health specialist who assesses and treats ADHD for a living is a good first step.

Where should I go to get a diagnostic evaluation?

Where you seek an evaluation depends on your community and on the insurance plan the individual is covered by. The person conducting the evaluation should be a professional trained in assessing children’s development, emotions, and behavior. Preferably, the professional should specialize in the assessment and treatment of ADHD, if such a professional is available.

Has the outpouring of media attention paid to ADHD affected how frequently and accurately patients are diagnosed with the disorder?

Some families develop preconceived notions that their children may have ADHD and come to health professionals expecting a confirmation of their home diagnosis. That can cause some problems, particularly if parents are attached to the idea and begin “shopping around” until they find someone who confirms the diagnosis.

Are the medications recommended for ADHD safe for children?

Psychostimulant medications have been thoroughly studied and few long-term side effects have been identified. Problems, when they do occur, are generally mild and short-term. The most common side effects are loss of appetite and insomnia. Rarely, children experience a negative mood or an increase in activity as the medication wears off. These side effects can be addressed by changing the dosage or by changing to a slow-release formulation.

Is Ritalin overprescribed?

Results from a seminal study published in The Journal of the American Medical Association in April 1998 showed that while there may be some individual cases of children put on Ritalin when they have not had a thorough enough evaluation, generally there is no evidence that the medication is overprescribed. It is more likely that we see increased rates of Ritalin prescription because more children are being identified and brought in for treatment.

How effective are medication-free treatments?

Parent training and behavior modification can substantially improve the behavior of children with ADHD if these methods are applied consistently and correctly. But like medication, it can only be helpful if it is used faithfully and accurately. Not all families are willing or able to go along with such treatments. The NIMH’s Multimodal Treatment for ADHD (MTA) study indicates that in general medications are more effective than psychosocial interventions.

My teenager does not want to continue medications any longer. What should I do?

It is developmentally normal for a child entering adolescence to want to start taking charge and make their own decisions about many things in their lives, including what clothes they wear, who their friends are, and whether to take medication. It is important for the health professional to find a sensitive way to deal with their feelings so they do not end up in a power struggle. Sometimes adolescents will be more inclined to cooperate if they are given a more formal trial to show whether the medications still help.

What could and should my child’s school be doing to help?

Children with ADHD may qualify for special school services or accommodations under either of two federal laws: the Individuals with Disabilities Education Act, Part B [IDEA] or Section 504 of the Rehabilitation Act of 1973.

Children covered by IDEA are entitled to education services that meet the standards of a free appropriate education. IDEA also requires that if a child’s behavior impedes learning, a functional behavior analysis must be conducted and a positive behavior plan developed. In addition, schools are prohibited from expelling — and suspending for more than 10 days — students whose behavior results from their disability, unless drugs or weapons are involved or the child is a danger to himself or others.

Section 504 is a civil rights statute that makes it illegal for schools to discriminate against children with disabilities and requires them to provide reasonable accommodations, which may include the provision of services. To be eligible for Section 504, a child must have an existing identified physical or mental condition that substantially limits a major life activity. Because learning is considered a major life activity, children with ADHD are entitled to protection under the law if the condition substantially limits their ability to learn.

Children with ADHD may benefit from modified instructions, special classroom assistance, behavior management and assistive technology (such as tape recorders or visual aids).