Approximately 11 percent (6.4 million) of children between the ages of 4 and 17 are diagnosed with ADHD in the United States. Boys receive the diagnosis more frequently than girls, but the reason for this is not understood.
The most common signs of ADHD are:
- difficulty focusing
- difficulty staying still
- not attending to details
- acting quickly without thinking of potential consequenses (being impulsive)
Many children with ADHD have average to above average intelligence. They understand what is required or expected of them, but have trouble completing tasks, chores, and/or following directions due to their difficulties with sitting still, paying attention, and attending to details.
It is extremely common for children without ADHD (especially very young children) to have these same difficulties, especially when they have anxiety about something or are very excited. The difference is that children with ADHD display these symptoms over a long period of time, in multiple settings (school, home, the community, etc.). The symptoms also could impact their ability to function in school (socially, academically, and behaviorally) and at home (following directions, making good choices, completing tasks like chores and homework).
There are many strategies and treatments which can help children with ADHD manage their symptoms and lead successful lives.
The former name of ADHD is ADD (Attention Deficit Disorder). In 1994 the name was changed to ADHD and given three subtypes:
1. ADHD: inattentive type:
- often does not pay attention to details and makes careless mistakes in school work, chores, etc.
- difficulty sustaining attention during tasks or play activities (may be distracted by movement or noises, may day dream, may get frustrated or seem to give up, may jump quickly from one activity to another, may lose interest quickly)
- seems to have difficulty listening (e.g., in conversation, when given directions, or during a teacher lecture)
- difficulty following through on verbal instructions (e.g., does not do what was asked, or only completes the first step of a two or three part direction)
- problems with organization (e.g., has a disorganized desk at school, has a disorganized school bag, has trouble organizing the steps needed to complete a project or task)
- seems to avoid or dislike tasks that require sustained attention or mental effort
- often loses or can’t keep track of things
- easily distracted when expected to pay attention or maintain focus
In order to be diagnosed with ADHD: inattentive type, the child must present with six or more of the symptoms above (for children up to age 16), or five or more symptoms for adolescents 17 and older. Symptoms must also be present for at least six months.
2. ADHD: hyperactive-impulsive type:
- fidgeting or squirming (e.g., taps hands and feet, frequently moves in seat)
- trouble staying seated
- frequent running or climbing where it is not appropriate (adolescents may feel restless rather than running or climbing)
- trouble playing or engaging in leisure activities quietly
- excessive talking
- interrupting or intruding on others
- blurting out answers before hearing the full question
- difficulty waiting (e.g. waiting ones turn, waiting in line)
In order to be diagnosed with ADHD: hyperactive-impulsive type, the child must present with six or more of the symptoms above (for children up to age 16), or five or more symptoms for adolescents 17 and older. Symptoms must also be present for at least six months and be considered disruptive (e.g., interfering with functioning or progress at school, work, or home).
3. ADHD: combined type – Enough symptoms to meet criteria for both inattention and hyperactive-impulsive type, present for the past six months.
Additional Criteria for an ADHD Diagnosis
- Symptoms were present before age 12.
- Symptoms are present in two or more settings (e.g., home and school, school and work).
- Symptoms interfere with functioning (social, behavioral, academic, etc.) at school, home, or work
- Symptoms cannot be explained by another disorder (e.g. Mood Disorder, Anxiety Disorder, Major Depression, Schizophrenia).
- Behaviors cannot be linked to stress in the home or classroom. Children recently or frequently exposed to anxiety producing situations (e.g. divorce, death, abuse at home, frequent anger or fighting in the home, bullying at school, new school, illness, or any other significant life event) may display symptoms of ADHD. It is important to consider whether the onset of symptoms coincided with an event of this kind in order to avoid misdiagnosis.
- Medical factors that could contribute to symptoms should also be ruled out by your child’s doctor such as vision or hearing problems, illness, allergies, or medication side effects.
Side-Note : *Also, assess whether or not the child is being challenged. Children with very high intelligence, may appear bored, inattentive, or restless if the material presented is too easy or not challenging for them.
Working with or raising children with ADHD can be frustrating, but it is important to remember that these children are not purposely acting out or being difficult. They often need modifications made to their environment to meet their needs. See our article Have You Tried These Strategies for Children With ADHD? for several ideas on how to modify your child’s home and school environments to meet his needs and manage his symptoms. Some children also benefit from medication. If behavioral modification alone is not enough, consider exploring medication options with your doctor.
There is no specific test that can determine ADHD. ADHD is often diagnosed through an evaluation. Evaluations can be done by a child psychologist or psychiatrist. Sometimes your child’s pediatrician will also evaluate for ADHD. To evaluate the child, the doctor will gather information regarding the child’s symptoms and history (e.g.,developmental milestones, educational performance, description of behaviors, medical history). Measures to collect this information can include interviewing the parents and teachers, reviewing educational, medical, or other relevant records, and asking parents and teachers to complete questionnaires (also called rating scales) about the child’s symptoms. After completing the evaluation, the doctor can determine if the child meets criteria for ADHD.
You can also ask your child’s school for an ADHD evaluation, by the school psychologist. School evaluations are often more comprehensive than private evaluations. In addition to the measures mentioned above, School evaluations can include IQ testing, academic assessments, classroom observations and functional behavior assessments.
It is also important to note that studies have found that 30 to 50% of children with ADHD also have learning disabilities (Barkley, DuPaul, and McMurray 1990; DuPaul and Stoner 1994; Fletcher, Shaywitz, and Shaywitz 1994; McGee et al. 1991) which school psychologists often evaluate for as well. (A private child psychologist may also evaluate for a learning disability if you request that they do so).
Side-Note: *In some cases IQ testing reveals a very high intelligence level. If this is the case with your child, make sure that the cause of inattentive or hyperactivity was not due to the fact that your child was not being challenged in his or her classroom.
Evaluations conducted by the school can lead to an educational classification of ADHD and entitle your child to special education services. Keep in mind that special education looks very different from what it looked like in the past. Children can receive special education services in the general education classroom or in a smaller class setting, depending on the needs of the child. Special education will allow your child to receive accommodations and specially designed instruction to meet his needs. He will have his own academic goals that the school will be responsible for implementing.
If your child is doing fine academically and not demonstrating behavior problems at school, it is unlikely that a school evaluation is the best route to go. The main purpose of a school evaluation is to determine if your child needs special education. Even if your child has ADHD, special education may not be necessary if he/she is succeeding in a general education classroom without support. If you believe this is the case, but still would like to get help for your child’s symptoms, a private evaluation through a psychologist, psychiatrist, or doctor (or through a mental health clinic) would be a better option. To find a private psychologist, psychiatrist, or mental health clinic, you can: ask your doctor for a referral, check your health insurance website or call your health insurance provider, or do a Google Search for mental health providers in your area.
If you are concerned about your child’s social skills in school but not concerned about his academic progress or behavior, talk to you child’s school team (guidance counselor, principal, teacher, etc.) to determine what programs the school might have to help your child with social skills.
Receiving an educational classification of ADHD through a school based evaluation is not the same as receiving a medical diagnosis of ADHD from a private doctor (psychologist, psychiatrist, physician). School based evaluations cannot help to obtain services such as wrap around support (e.g., receiving professional behavior support for your child from a community agency) or exploring medication as an option. If your child receives a diagnosis of ADHD from a private doctor or clinic, talk to the professional who gave the diagnosis about what services your child can benefit from and exactly where to find those services. You can also do a Google Search for ADHD services and resources in your area. Contact the agencies on the list to find out what services or resources they have to help you or your child.
If you think your child may benefit from special education and services outside of school, your best option is to request a private evaluation and an in school evaluation.
If your child receives a medical diagnosis of ADHD and you are concerned about his school performance, but do not want to consider special education at this time, a 504 plan is another option. A 504, also called a Chapter 15, is a legal document that requires your child’s school to provide accommodations for your child, so they are not falling behind their peers due to their disability.
Examples of accommodations are:
- extended time to take tests or complete assignments
- a behavior support plan in the classroom
- alternative location in the building to take tests that is free from distractions
- movement breaks throughout the day
- seating the child close to the point of instruction and as far away from distractions as possible (e.g., the window, the door, pencil sharpener, talkative peer)
Talk to your child’s school for more specific information about 504’s and to determine what accommodations your child may need. You can also read more about 504 plans by doing a Google Search.
We also recommend reading our article Academic or Behavior Problems in School: Info for Parents.
Recommended Book: Learning To Slow Down & Pay Attention: A Book for Kids About ADHD
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