Sometimes parents wonder where the line between normal childhood behaviors and the very real symptoms of Attention Deficit Hyperactivity Disorder (ADHD) lies. If this is you, you’re not alone. Your pediatrician’s office is the best place to start if you have concerns. Your doctor has the experience and tools needed to help diagnose and manage ADHD based on decades of research and hands-on experience.
What are Early Signs of ADHD?
The signs of ADHD fall into three main categories: inattention, impulsivity and hyperactivity. Of course, there is some overlap in ADHD symptoms and behaviors all children exhibit from time to time. But according to the American Academy of Pediatrics, the big difference is that parents of ADHD-diagnosed children see these behaviors on a daily basis for an extended period of time, even after their peers seem to have outgrown them. The long checklist of signs includes signs like not listening and disorganization, squirming, fidgeting and seemingly non-stop motion, and impulsive behaviors like unwillingness to take turns. These are just a few examples of a range of behaviors identified by the AAP.
According to the AAP, it’s difficult to diagnose ADHD in children under the age of 4 and becomes more challenging once again once children reach the teen years. The elementary years are generally the best window for diagnosis. Pediatricians often see a bump in referrals in early elementary school, especially in children whose symptoms fall primarily in the hyperactivity category. We also tend to see a bump in referrals around third grade, especially in children whose symptoms lie primarily in the area of inattention, as classwork becomes more challenging at that time. Age 8 or 9 is often when we see more diagnoses in girls, as their symptoms often (but not always) fall into the inattention category.
How Is ADHD Diagnosed?
There’s no single, specific test for ADHD. Instead, diagnosis is a process that involves children, parents, educators and your pediatrician. However, there is a standard survey called the Vanderbilt Assessment that pediatricians use as a starting point in diagnosing ADHD. This survey involves a series of questions about a child’s behavior at home, at school and in social settings.
Your pediatrician will ask for a Vanderbilt report from parents, educators, caregivers and other adults who regularly spend time with your child to help get a complete picture of your child’s behavior. The assessment includes an extensive checklist of symptoms in those three areas: inattention, impulsivity and hyperactivity.
Your pediatrician will also do a physical and neurological exam and go over your child’s medical history to see whether there are underlying factors that may contribute to your child’s behavior.
And of course, your pediatrician will spend time talking with and observing your child.
How Do You Treat ADHD?
Successful treatment of ADHD usually involves a combination of therapy and medication. However, recommended treatment depends on the child’s age and severity of the diagnosis.
For students with mild ADHD who are performing on grade level in school, your pediatrician may recommend starting with behavioral therapy and lifestyle management techniques. But in most cases, both therapy and medication are recommended. In terms of medication, stimulants like Adderall XR and Concerta continue to be the most effective medications for ADHD in most cases.
Non-stimulant medications are also prescribed for ADHD for children with other underlying conditions like depression or anxiety and usually involve care from a psychiatrist working in cooperation with your pediatrician.
Once your child’s treatment plan begins, you’ll need to follow up with your pediatrician regularly for medication check-ups in addition to yearly physicals. In many cases, your pediatrician will start with a low dose of medication and may need to go higher or adjust the prescribed medication. The early stages of the diagnosis require patience from families as we work out the best treatment program for your child.
How Do You Manage ADHD?
Managing ADHD involves not just medical treatment and behavioral therapy but a cooperative effort by families and educators. The AAP recommends that families work with their pediatricians to set up behavioral “target outcomes” for their child, including improved family relationships, improvements in classwork and homework and reducing disruptive behaviors. The AAP underscores that parents and educators should be committed to following through with the child’s management plan and monitoring behavior for the long term. Supporting a child through ADHD treatment can be a tough but extremely rewarding undertaking.
For parents, the AAP is an excellent resource with pages of great information on ADHD treatment and management, including a list of tools for helping remove distractions, helping children focus and helping them negotiate challenging interactions with peers and authority figures. Your pediatrician can also help with tips and suggestions for setting realistic goals and finding effective ways to meet them.
What Are Risk Factors Involving ADHD?
Research and has shown that children diagnosed with ADHD often also have other conditions that affect behavior. According to the AAP, some of the most common include:
- Learning disabilities: ADHD itself is not considered a learning disability by the AAP, but the associated behaviors can get in the way of success in school. In addition, many children have diagnosable learning disorders in addition to ADHD, so working closely with school staff is important to effectively meet all of the child’s needs.
- Oppositional defiant disorder: this diagnosis, often associated with the impulsive/hyperactive elements of ADHD, is reflected in children who lose their temper easily and show a defiant attitude toward authority figures, along with other symptoms. Behavioral therapy is usually recommended for this diagnosis, and when treated collaboratively with ADHD, it can make school and home a happier, more productive environment.
- Language disorders
- Mood disorders or depression
- Anxiety disorders
In the cases of children with anxiety, mood disorders and depression, your child will likely need medications different from the ones generally prescribed for ADHD. And where these coexisting conditions are present, your pediatrician will usually recommend working with a specialist to diagnose and treat these conditions to get just the right combination of therapies for your child.
Working Together for ADHD Management
Your pediatrician shares your goal of creating an environment in which your child is able to learn and thrive. In cases of ADHD diagnosis, this means adopting a holistic approach involving families, educators, caregivers, your pediatrician and specialists. This usually means medication and behavioral therapy, along with changing approaches and expectations at home and at school. Working together, this team can help your child have a happy, successful experience at home and at school.