What to Know About Kids & ADHD

Every parent in America has thought about the pandemic’s effects on their children over the last two years. This time has been hard for families with young kids. Amidst unexpected school closures and virtual learning, parents across the country report concerns about their children falling behind academically, having trouble learning, and, very commonly, struggling with attention. As a primary care pediatrician, I hear about these challenges each day in my office. 

Parents worry about ADHD and what they should do next. However, understanding children’s attention, what’s normal, and what needs further evaluation can be complex. Here is a roadmap to help break it down for you.

What is ADHD?

Children with ADHD show signs of inattention, hyperactivity, and/or impulsivity. Signs of hyperactivity include things like being in constant motion, frequently fidgeting, challenges staying seated, talking a lot. Inattention can be more subtle - children may daydream a lot, have a hard time paying attention, or get easily distracted. While most children with ADHD have more predominantly hyperactive or inattentive symptoms, some may have symptoms of both.

If you think these symptoms – constant motion, easily getting distracted, talking a lot – sound like most toddlers or young children, you are not alone. Many of these qualities overlap with normal behavior in early childhood. Kids younger than four years old naturally have short attention spans and are growing the part of their brain responsible for impulse control. For example, we’d only expect an average neurotypical three-year- to have sustained focus on a task for about five minutes. As a result, it is difficult to diagnose ADHD in children younger than four years old, which is one of the reasons that the American Academy of Pediatrics ADHD guidelines cover children four years old and older.

How is it diagnosed?

Boys are more than twice as likely as girls to be diagnosed with ADHD. There is often a family history. And we know that children with ADHD have specific differences in their brain activity and architecture. But, with proper diagnosis and early intervention, children with ADHD can develop the skills and tools they need to have successful lives.

I’m concerned about my child’s attention. What should I do?

Talk with your child’s teachers. Ask your child’s teachers about how your child is performing in school and any general observations they may have. Teachers can offer insight into any struggles your child faces, and it is important to get their perspective. They may also have recommendations about things to try to help a child who is struggling. Also, take note of the interpersonal dynamics in the classroom, with teachers and other children. Some questions to ask:

• How is my child’s behavior in the classroom?

• Do you have specific concerns?

• How long have symptoms been going on?

• Are they affecting my child’s progress in school or grades?

• What steps have you taken in the classroom already to help my child?

• Are there any other things going on in the class that might be contributing?

Work with your pediatrician. First, they will listen to any concerns that you, caregivers, or teachers have about your child. Then, they will ask you and your child questions to get a fuller picture of what is going on. Here are some questions they may ask:

• How many hours of sleep do they get?

• Do they snore?

• Do they ever seem like they are staring off into space for no reason?

• Do they have any problems with vision or hearing?

• Are they a selective eater, or do they have a varied diet?

• Are there any changes at home that could be causing stress?

• Are there any interpersonal issues at school with teachers or peers?

• Is there a history of trauma?

• Do they seem anxious or depressed?

• Are they taking any medications?

• Is there a family history of similar issues?

Next, your pediatrician will observe your child and conduct a full physical and neurologic examination.

Gather more information.

In addition to taking a full history, your pediatrician will ask you and teachers to fill out screening questionnaires for more details on attention, learning, daily functioning, and other mood issues. They may request report cards or test results as well. You can request formal neuropsychiatric or psychoeducational testing through your child’s school district. Some other guidelines to support a diagnosis include symptoms that:

• Happen in two or more settings (i.e., home and school).

• Affect a child’s daily functioning in school, groups, or relationships.

• Have been going on for more than six months.

• Start before a child is 12 years old.

There is no single test for an ADHD diagnosis. Instead, the process involves a lot of information gathering (from parents, caregivers, teachers, and clinicians) and medical evaluation.

If my child is diagnosed with ADHD, what happens next?

You will make a plan with your care team. You can work with your child’s school to request a plan (commonly, an Individualized Education Plan or 504 plan) that will allow your child to best meet their individual needs. This process gives your child support in the classroom setting - things like more one-on-one instruction, special attention in certain subjects, strategies for homework, and organization. Your pediatrician may recommend that your child see a mental health specialist like a psychologist or psychiatrist, or they may work with your child directly in the primary care setting. Evidence-based behavioral therapy is typically the first-line treatment for ADHD for preschool-aged children. For school-aged children, therapy and/or medication may be recommended. These supports should be re-visited regularly and adapted to your child’s needs. Your care team should work together to provide you with resources and strategies for your child.

As a parent of young children, I understand that these issues can feel overwhelming. We all want our children to do well. At the end of the day, the most important thing is ensuring that your child feels confident and capable. This process can give a child who is struggling tools to thrive in school and set a foundation for the rest of their lives.

Resources for Parents

American Academy of Pediatrics:

https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Understanding-ADHD.aspx

American Academy of Child and Adolescent Psychiatry:

https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/Home.aspx

https://chadd.org/about/

Anjuli Srivastava Gans, MD, is founder of Resilient Rascals and an attending physician at the Children’s Hospital of Philadelphia. As a leading expert on early childhood health + development, she hopes to bridge the gap between parents’ instincts and practical medical care that they can use at home. She lives in New Jersey with her husband and two children. For more advice from Dr. Gans check out her tips on traveling with kids or coughs and colds.