It is normal for children to occasionally forget their homework, daydream during class, act without thinking, or get fidgety at the dinner table. But inattention, impulsivity, and hyperactivity are also signs of Attention-Deficit Hyperactivity Disorder (ADHD). ADHD can lead to problems at home and school and affect your child’s ability to learn and get along with others. For a child to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the child’s functioning, and cause a drop in normal development for his or her age. A clinician will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. ADHD symptoms may appear as early as the age of three and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or even missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some children with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.
The two main symptoms of ADHD are inattention and hyperactivity/impulsivity.
Inattention means that the child has trouble focusing, has difficulty keeping focus, or cannot remain organized. Inattention symptoms include:
- Overlooking details, making careless mistakes in schoolwork or during other activities
- Problems sustaining attention in tasks or play, including conversations, lectures, or even when reading for a period of time
- Not listening when spoken to directly
- Not following instructions
- Failing to finish schoolwork, chores or other duties
- Starting tasks and then quickly losing focus, becoming easily sidetracked
- Having problems organizing tasks and activities
- Poor time management, and failing to meet deadlines
- Avoiding tasks that require sustained mental effort, such as homework, schoolwork, completing reports or reading for long periods of time
- Misplacing objects necessary for tasks or activities, such as school supplies, pencils, books or eyeglasses
- Becoming easily distracted by unrelated thoughts or stimuli
- Acting in a forgetful manner during daily activities, such as chores or errands
Hyperactivity/Impulsivity means that a child is constantly moving about, even in situations for which this movement is inappropriate. Excessive movements associated with ADHD can also include fidgeting, tapping, or constant talking. These symptoms can also lead to performing actions and movements without first thinking about them, actions that may include the potential for harm. Actions that are performed solely for the desire for immediate rewards with the inability to delay gratification. An impulsive child may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.
Hyperactivity/Impulsivity symptoms may include:
- Fidgeting in their seats
- Leaving seats in situations when being seated is expected, such as in the classroom
- A feeling of being consistently restless
- The inability to quietly engage in games or hobbies
- Constantly being in motion or “on the go,” or act as if “driven by a motor”
- Non-stop talking
- Blurting out answers before questions have been completed
- Interrupting others in conversation
ADHD symptoms may evolve as children age. In young children with ADHD, hyperactivity/impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.
Unlike others, doctors and therapists at IDCC, do not look to medication for ADHD as a first answer. Instead, we work with young patients and their families to create structure and a daily routine and consider medication only after various other options first carefully weighed.
Examples of how the IDCC’s therapists work with children in a talk therapy approach including advising on how certain steps may be taken to help with ADHD or ADD including:
- A. Breaking tasks into manageable pieces
- B. Simplifying and organizing certain aspects of life
- C. Limiting distractions (i.e. turning off the tv while doing work or eating)
- D. Encouraging exercise and allowing for more time outdoors
- E. Regulating sleep patterns, bedtime should be at the same time on a daily basis
- F. Encouraging out-loud thinking (i.e. having your child speak thoughts out loud)
- G. Parents can also set an example for children by showing them how to wait patiently
- H. Helping children learn skills for self-regulation and consequence recognition
An important non-medical approach is behavior therapy or behavior management. Behavior therapy is based on several simple and sensible notions about what leads children to behave in socially appropriate ways. It is most effective in young children when it is delivered by a parent (or trusted guardian). Children generally want to please their parent because they want them to be proud of their accomplishments. When the relationship between parent and child is basically positive, this can act as an important source of motivation. A second reason that children behave appropriately is to obtain positive consequences for doing so (i.e. privileges or rewards). Children will also behave appropriately to avoid the negative consequences that follow inappropriate behavior. The goal of behavior therapy, therefore, is to increase the frequency of desirable behavior by increasing the child’s interest in pleasing parents and by providing positive consequences when the child behaves. Inappropriate behavior is reduced by consistently providing negative consequences when such behavior occurs.
Medication can also be used to treat symptoms of ADHD. Research has shown that most children who use medication report having increased self-esteem, fewer disruptive behaviors, and improved relationships with parents, siblings, and teachers. A comprehensive analysis is done before prescribing and medication and dosing is prescribed in a manner the mitigates the risk of adverse effects.
That being said, doctors have concluded that medication combined with behavior therapy is the optimal treatment of children with ADHD. While medication works on a neurological level to regulate the brain, behavior therapy addresses specific problem behaviors by teaching the child how to structure their time, establish predictability and routines, and increase positive outcomes.