Answers to questions families often have about caring for their child with attention deficit hyperactivity disorder (ADHD)
What is ADHD?
ADHD stands for attention deficit hyperactivity disorder. About 10% of children and teenagers in the United States have been diagnosed with it. It’s a condition that affects how people pay attention, control their energy, and manage impulses. People with ADHD might have some combination of:
- Lots of energy that can be hard to control (hyperactivity): They might feel like they always need to move, talk, or do something.
- Acting quickly without thinking (impulsivity): They may sometimes interrupt, blurt out answers, or do things without thinking about the consequences.
- Becoming distracted easily (inattention): It’s hard for them to stay focused on something for a long time, especially if it’s not very interesting to them.
- Some people with ADHD are mainly inattentive, some are mainly hyperactive/impulsive, and some are a combination of both.
It’s important to know that having ADHD doesn’t make someone less smart or capable—it just means their brain works a little differently. People with ADHD often have lots of creativity, big ideas, and enthusiasm. Still, they might need extra help staying organized and focused.
How do you get ADHD?
Although the exact cause of ADHD is unknown, it is thought that a combination of genetics and people’s environment contribute to it. ADHD tends to run in families. Many with ADHD have a parent or sibling who also has it. Boys are more likely to be diagnosed than girls. Stress, lack of sleep, anxiety, depression, poor nutrition, a history of trauma, medication side effects, and other medical problems can cause ADHD-like symptoms.
What are the symptoms?
Preschoolers with hyperactive/impulsive ADHD may be constantly active, touching things, interrupting others, changing activities, and climbing on furniture. Teenagers with hyperactive/impulsive ADHD frequently seek new experiences and hobbies or engage in risky behaviors without thinking about the consequences.
Preschoolers with inattentive ADHD may have difficulty following directions or paying attention while reading a picture book. Teenagers with inattentive ADHD may find it hard to finish homework and perform required tasks. They can struggle to stay organized at school, forget about assignments, miss due dates, or complete only part of an assignment. These difficulties can cause teens to fall behind and find school unenjoyable. Similarly, it can be difficult for teens with ADHD to stay organized at home. They may have trouble finishing chores or remembering to complete chores with multiple steps. They may frequently lose items or find it challenging to keep their room clean.
Many children with ADHD are able to concentrate or even become more focused on their favorite activities for long periods. For example, they may sit for hours playing video games but then struggle to concentrate on tasks that they find difficult, such as homework or chores. Teachers are often a good resource for helping families recognize if the child struggles with activity level, impulse control, or distractibility.
How is ADHD diagnosed?
Most children with ADHD are diagnosed and treated by the child’s pediatrician or family doctor. Some children may be diagnosed with ADHD and treated by a psychiatrist. Usually, ADHD is not diagnosed before age 4.
Children who are struggling with distractibility, hyperactivity, impulsivity, or behavior problems that make it difficult to do well in school or at home should be evaluated for ADHD. An ADHD evaluation will generally take a few visits with your doctor and require gathering information about school behavior and performance, behavior with family and friends, and other medical or mental health concerns. To be diagnosed with ADHD, a child must be struggling in at least 2 settings (usually at home and school). For example, if a child only has challenges at home but does well at school, ADHD is unlikely to be the explanation. Developmental delays, low IQ, language disorders, or other chronic problems, such as vision or hearing problems, past traumatic experiences, and other behavioral health conditions, can make it harder to diagnose ADHD. Sometimes, specialized educational testing or a neuropsychological evaluation may be needed to help understand if a child has ADHD and/or other conditions that can overlap.
Can my child have ADHD and other behavioral health conditions?
Yes. Although some children have only ADHD, many children with ADHD also have other behavioral health conditions. It is common for children with ADHD also to have anxiety, depression, behavioral problems, autism, developmental delays, developmental language disorders, or learning disorders. If your child is frequently worried, sad, angry, or struggling to learn or make friends, ask your doctor if they think these things are caused by ADHD alone or if there might be something else going on.
What is the expected outcome?
ADHD is a life-long condition. However, most children learn skills to help manage their symptoms and play to their strengths. Hyperactivity symptoms tend to improve in teenage years while distractibility/inattention remains. Not all children or adults will need medication to manage ADHD.
How will my family’s life be affected?
Although a child’s ADHD may greatly affect the family, there are many treatments available. ADHD symptoms and related behaviors can be managed to help a child lead a happy and productive life. Effective management of ADHD can improve the quality of life for a child and their family.
What is the treatment for ADHD?
For children over 6 years old, the most helpful treatment for ADHD combines medications and support from teachers and parents. The most effective medications for ADHD are called stimulants. Stimulant medications increase attention and focus by increasing the brain’s access to chemical messengers called norepinephrine and dopamine. Stimulant medications come in 2 groups known as methylphenidates and amphetamines. About 70% of children who take stimulant medications for ADHD will see improvement in symptoms. Other types of medications may be considered in place of or in addition to stimulants. A doctor may consider other types of medication if stimulants are not working well for a child or if a child has side effects. Long-term medication use may be needed to help manage the symptoms of ADHD since it is a long-term condition.
Behavior therapy (also called behavior modification or psychosocial treatment) is the most helpful non-medication treatment for children. It may include helping parents and teachers improve structure and communication. Parent-training therapy is a specific kind of therapy that works well for many children with ADHD. This approach coaches parents on how to structure a child’s life at home, set limits, and manage their ADHD symptoms. Occupational therapists can also help children improve organizational skills and come up with strategies to manage extra energy and improve attention.
How can school help my child with ADHD?
Some children may receive support at school, especially if they have learning or speech-language disabilities in addition to ADHD. These school supports may include accommodations as well as special services. There are 2 types of plans that can provide a child with accommodations or special services in school. There are 504 Plans and Individualized Education Plans (IEP). You will need to communicate with your child’s school to determine if your child is eligible. The type of plan your child may qualify for depends on their difficulty level at school. Children who qualify for a 504 plan may be eligible for accommodations like additional time on tests, allowing breaks, or different homework assignments. Children who qualify for IEPs may be able to receive individualized support from the school psychologist, speech-language pathologist (SLP), occupational therapist (OT), or resource classes. Each IEP is different and based on a child’s needs. If you think your child may need additional supports in school, reach out to your school to ask about accommodations or special services for your child. Start by asking your child’s teacher whom to contact about a 504 or IEP plan.
What are the side effects of stimulant medications?
The most common side effects are poor appetite, difficulty sleeping, stomach aches, and headaches. Other possible side effects include anxiety or nervousness, increased heart rate and blood pressure, tics, irritability, and effects on growth. Starting with a low dose and raising it slowly can avoid many side effects. Some types of stimulants are designed to be taken once per day and last 8-12 hours, while others last for only 3-4 hours and need to be taken twice daily. The doctor can help you choose the stimulant medication that makes the most sense. Some children have increased irritability when their medication wears off in the afternoon or evening. Adding a small dose of stimulant in the afternoon may reduce this irritability. Since 1 stimulant may work better than another for your child, talk to your doctor and consider trying a different kind before giving up.
Will my child be more likely to use drugs if they take stimulants?
Research shows that children and teens who are prescribed stimulants for ADHD are not more likely to use drugs than those who are not treated with stimulants. It’s important to remember, however, that stimulants are controlled substances. This means that stimulant prescriptions are monitored by the government because there is potential for people to misuse them. Some people use stimulants illegally to get high or to obtain extra energy/focus when they do not have ADHD. Because stimulants are controlled substances, you can only pick up 1 month of medication from the pharmacy at a time.
Parents should keep stimulant medication bottles out of reach of children. Children/teens should not be allowed to take stimulants to school unless parents have made special arrangements with the school for them to take their medication at school. Children/teens should never be allowed to share or sell their medications to friends or family members.
I’ve heard that stimulants are associated with heart problems. Is there a safer remedy, such as a diet?
Research has shown that healthy children do not have a higher risk of serious heart problems when they take stimulants. Some children who have a history of heart problems or who have family members with serious heart problems may need extra evaluation by their doctor before taking a stimulant.
Although children generally benefit from a balanced diet, changes in diet have not been shown to be adequate treatment for ADHD.
How long will my child need to be on medication?
ADHD medications do not cure ADHD, but they help manage the symptoms. Some children’s symptoms will improve with time. Other children will continue to benefit from medication even in adulthood. A person can continue to take ADHD medications as long as they are helpful. Follow up regularly with your doctor to make sure medications are still helping and to decide how long your child should take medications.
What is a medication holiday?
Medication holidays are periods when your child takes breaks from their stimulant medication. Many children will not need to take breaks from their medication, and some children cannot take breaks because their symptoms are too severe without medication. If you struggle daily to remember to give your child medications, medication holidays can make remembering harder. You can discuss medication holidays with your doctor if there are times when you feel it would make sense to take a break from stimulants (such as prolonged school holidays or even weekends). This would not apply to children on non-stimulant medications for ADHD, such as atomoxetine or extended-release preparations of guanfacine and clonidine.
Will my child be shorter if they take stimulants?
Some children may experience a slowing in height growth due to stimulant medications. Many will catch up, but some studies have shown a slight decrease in height with stimulant use (1-2 cm). Some children may also experience lower appetite as a side effect of their stimulants and struggle to gain weight. It is important to see your primary care doctor regularly to track weight and height before, during, and after stimulant use to identify any concerns about growth.
Will my insurance cover behavior therapy for ADHD?
Many insurers do not cover behavioral therapy for ADHD. Insurers may cover behavioral therapy for related conditions, such as depression, anxiety, substance use, or anger management. If a child has these concerns in addition to ADHD, behavior therapy should list those as the primary focus of treatment. Insurers may cover occupational therapy to work on executive function, organization, and fine motor skills like writing. Similarly, some insurers may cover speech-language therapy to work on speech, language, literacy, and social problems.
Can I give my child coffee or other caffeinated drinks instead of stimulants?
Parents should not give children caffeine to treat ADHD. Giving children caffeine can lead to negative side effects, including increased anxiety or depression, difficulty sleeping, stomach aches, or changes in behavior. Caffeine also can interact with other medications a child may be taking and cause side effects. Many caffeinated drinks, like energy drinks, contain high levels of caffeine that may not be safe for children. Using caffeine regularly also puts children at risk of becoming dependent on caffeine. If you feel your child needs help for ADHD, talk to your doctor about options for treatment.
Article History
This article was originally published on the Medical Home Portal and updated before publication on TRiP. The Medical Home Portal, retired in July 2024, provided diagnosis and management information for pediatric conditions, guidance for immediate steps after a positive newborn screen result, and in-depth family education to improve outcomes for children with complex medical care needs. The full archive can be found at the Medical Home Portal Archive.
Topical Reviews in Pediatrics (TRIP) includes archival and updated content from the Medical Home Portal and features new, contemporary topics in pediatrics.
- 2023 revision: Maggie MooreA; Jennifer Goldman, MD, MRP, FAAPR
- 2020 revision: Jennifer Goldman, MD, MRP, FAAPA
- 2015 revision: Jennifer Goldman, MD, MRP, FAAPA; Robyn Nolan, MDR
- 2012 first publication: Lynne M. Kerr, MD, PhDA
AAuthor; CAContributing Author; SASenior Author; RReviewer
