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Attention Deficit Hyperactivity Disorder ADHD

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Answers to questions families often have about caring for their child with attention deficit hyperactivity disorder (ADHD)

What is ADHD?

ADHD is a condition that involves some combination of hyperactivity, impulsivity, and/or inattention that interfere with someone’s ability to function. Symptoms begin in childhood, and ADHD is usually identified between 4 and 18 years of age. Three types of ADHD have been defined: predominantly inattentive, predominantly hyperactive/impulsive, and a combination of those two.

How do you get ADHD?

While ADHD tends to run in families, and studies of twins and adopted children support a strong genetic component, the genetics are not well understood. A child's environment also plays a role in some cases of ADHD. Many other things can cause ADHD-like symptoms, such as stress, lack of sleep, anxiety, depression, poor nutrition, a history of trauma, medication side effects, and other medical problems.

What are the symptoms?

Toddlers with the hyperactive/impulsive type of ADHD may constantly be physically active, running in circles, and climbing on furniture, while adolescents with this type may engage in risky behaviors and sports. Preschoolers with the inattentive type may have difficulty paying attention while reading a picture book, while adolescents may find it hard to finish homework and perform required tasks.
Many children with ADHD will be able to concentrate or even hyperfocus on their favorite activities for long periods, such as playing video games for hours, but have a hard time concentrating on tasks they need to do, such as homework. Teachers are often a good resource to help families recognize if the child is struggling with activity level, impulse control, or distractibility more than peers.

How is ADHD diagnosed?

Most children with ADHD are diagnosed and managed by the child’s pediatrician or family doctor. Children with problematic levels of inattention, hyperactivity, or impulsivity, low school achievement for the child's IQ, and/or behavior problems should be evaluated. This will generally take a few visits and require gathering information about school performance, school/daycare behavior, functioning within the family and with friends, and other medical or mental health concerns. Evidence of functional problems in at least 2 settings (usually at home and at school) is needed to make the diagnosis. If the child only struggles in 1 setting, it likely isn’t ADHD. Developmental delays, low IQ, or other chronic problems such as sensory deficits (such as vision or hearing problems), other behavioral health or psychosocial problems, and/or features of autism make it harder to diagnose ADHD. Sometimes specialized educational testing or a neuropsychological evaluation may be needed to help understand if someone has ADHD and/or other conditions that can overlap.
More information about diagnosing ADHD can be found at Symptoms and Diagnosis of ADHD (CDC) and The ADHD Diagnostic Process. Guidelines for diagnosis, published by the American Academy of Pediatrics (AAP), can be found at [Wolraich: 2019].

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. Not all children or adults will need medication to manage ADHD.

Does ADHD run in families?

ADHD tends to run in families; the parents and the primary care doctor should be aware of this possibility in siblings. Sometimes during their child’s ADHD evaluation, parents realize that they have had lifelong symptoms, and then they can work with their doctor to get an adult evaluation.

What is the treatment for ADHD?

Stimulant medications are medications that increase attention and focus. They are currently considered the most effective treatment for ADHD symptoms. They are controlled substances because some people abuse stimulant medications to get more energy and focus even though they don’t have a diagnosis of ADHD. A variety of other medications may be considered, especially if stimulants have too many side effects or don’t work well enough. Long-term medication use may be needed to help manage the symptoms of ADHD because it is a chronic condition.
Behavior therapy (also called behavior modification or psychosocial treatment) is the most effective non-medication therapy for children. Behavior therapy may include helping parents and teachers improve structure and communication. Parent-training therapy, a specific kind of therapy that works well for many kids with ADHD, coaches parents on how to structure the child’s environment and manage expectations so that the child can develop better self-regulation and adaptive skills.
Occupational therapy can help children manage executive function skills, like organizing and planning, that will help them be more successful at school and home. An occupational therapist may be found through the school system, or the child can be referred to private occupational therapy. There are some newer treatments, including games and virtual reality available for certain children. These are rarely covered by insurance or Medicaid.

How will my family’s life be changed?

While a child’s ADHD may greatly affect the family, there are many treatments available. ADHD symptoms and related behaviors can be managed to help the child lead a normal and productive life. Effective management of ADHD can really improve the quality of life for the child and family. Getting a diagnosis and good treatment plan with regular follow-up can make a huge difference in the quality of life and long-term success for the child and, therefore, the family too.

I don't want to get my child addicted to drugs by starting him on stimulants.

Children with ADHD rarely get addicted to (or dependent upon) stimulants. In fact, the evidence suggests that careful use of stimulants in the early years decreases the risk of adolescent drug use and cigarette smoking. The reasons are not well understood, but one study found that reduced self-esteem due to school problems and impulsivity may contribute to drug use among children who are not treated for their ADHD. [Wilens: 2008] Another study suggests that stimulant use for ADHD does not affect later illicit substance abuse. [Shaw: 2012]

I have heard that stimulants are associated with heart problems. Is there another safer remedy, such as a diet, which will help my child?

Research to date has not clearly shown a higher risk of serious heart problems in children using stimulant medication. [Wolraich: 2019] Behavioral therapy is an important part of the management of ADHD, but for many children, it is not enough to manage their symptoms. The risk of heart problems with stimulants, which are the most common class of medication used to treat ADHD, is very small. The medical home doctor should talk with you about specific concerns based on your child and family’s health history.

How long will my child need to be on medication?

ADHD medications do not cure ADHD; they help manage the symptoms of ADHD. Those symptoms will improve over time in most people, but some will continue to benefit from medication even in adulthood. The length of treatment will depend on the child and whether she has associated learning problems. Your primary care doctor will regularly check progress to determine with you and your child when to consider stopping medication.

I've heard about medication holidays. What does that mean?

You, your child, and your primary care doctor can discuss if there are times that stimulants are not needed (such as prolonged school holidays or even weekends). This would not apply to children on atomoxetine (Strattera) or extended-release preparations of guanfacine and clonidine.

What are side effects of stimulant medications?

Common side effects are decreased appetite, insomnia, anxiety or nervousness, stomachache or headache, increased heart rate and blood pressure, and irritability (most often as the medication wears off in the afternoon/evening). Often, raising the dose slowly over time can avoid many of these side effects. Adding a small dose in the afternoon can sometimes get rid of irritability. Since one stimulant may work better than another for your child, try a different kind before giving up.

Will my child be shorter if he takes stimulants?

While stimulants can lead to weight loss in some children, this doesn’t happen in all children (some even gain weight). Stimulants may slow height growth for a while, but then kids generally catch up over time. Some studies have shown a slight decrease in projected height with long-term stimulant use, but more research is needed to confirm this finding. [Harstad: 2014] [Troksa: 2019] Your primary care doctor will track weight and height before, during, and after stimulant use to identify any concerns about growth while your child is growing.

Will my insurance cover behavior therapy for ADHD?

Many insurers don’t cover behavior therapy for ADHD because they prefer to cover some stimulant medications, which are often considered the most effective treatment for ADHD symptoms. Insurers may cover behavior therapy for related conditions such as depression, substance abuse, or anger management, so if any of those concerns exist, the behavior therapy should list those as the primary focus of treatment. Some behavioral approaches can be provided through the public school system, such as social skills training, depending on the availability of skilled staff and the needs of the child. Insurers may cover occupational therapy to work on executive function skills, organization, and fine motor skills like writing.

Resources

Information & Support

Related Portal Content
Attention-Deficit/Hyperactivity Disorder (ADHD)
Assessment and management information for the primary care clinician caring for the child with ADHD.
Care Notebook
Medical information in one place with fillable templates to help both families and providers. Choose only the pages needed to keep track of the current health care summary, care team, care plan, health coverage, expenses, scheduling, and legal documents. Available in English and Spanish.
Books for Children:
  • Otto Learns about His Medicine: A Story About Medication for Children With ADHD [Galvin: 2001]
  • Being in Control: Natural Techniques for Increasing Your Potential and Creativity for Success in School [Alster: 2001]
  • Shelley, the Hyperactive Turtle [Moss: 1989]
  • Learning to Slow Down and Pay Attention [Nadeau: 2004]
  • Putting on the Brakes: Understanding and Taking Control of Your ADD or ADHD [Quinn: 2009]
  • Cory Stories: A Kid’s Book About Living with ADHD [Kraus: 2004]
  • The Adventures of Phoebe Flower: Stories of a Girl with ADHD [Roberts: 2010]
  • The Survival Guide for Kids with ADHD [Taylor: 2012]
Although the books aren’t about ADHD, the popular young adult Percy Jackson series by Rick Riordan features young heroes who all have ADHD. [Riordan: 2014]
Books for Parents:
  • Smart but Scattered [Dawson: 2009]
  • ADHD: What Every Parent Needs to Know (2nd ed.) [Reiff: 2011]
  • Taking Charge of ADHD (3rd ed.) [Barkley: 2013]
  • You and Your A.D.D. Child: How to Understand and Help Kids With Attention Deficit Disorder [Warren: 1995]
See ADHD Information Library (National Resource Center on ADHD) for more titles.

For Parents and Patients

The Diet Factor in ADHD (AAP)
A comprehensive overview of the role of dietary methods for treatment of children with ADHD when pharmacotherapy has proven unsatisfactory or unacceptable; American Academy of Pediatrics.

ADHD Information (healthychildren.org)
List of publications for parents of children with ADHD; American Academy of Pediatrics.

ADHD: Parents Medication Guide (AACAP) (PDF Document 1.1 MB)
Forty-five page booklet that helps youngsters and their families better understand the treatments for ADHD; prepared by the American Academy of Child & Adolescent Psychiatry and American Psychiatric Association (2013).

Studies

Clinical Trials in ADHD (clinicaltrials.gov)
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.

Authors & Reviewers

Initial publication: March 2012; last update/revision: January 2023
Current Authors and Reviewers:
Author: Maggie Moore
Reviewer: Jennifer Goldman, MD, MRP, FAAP
Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.
Authoring history
2020: update: Jennifer Goldman, MD, MRP, FAAPA
2015: update: Jennifer Goldman, MD, MRP, FAAPR; Robyn Nolan, MDR
2012: first version: Lynne M. Kerr, MD, PhDA
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Harstad EB, Weaver AL, Katusic SK, Colligan RC, Kumar S, Chan E, Voigt RG, Barbaresi WJ.
ADHD, stimulant treatment, and growth: a longitudinal study.
Pediatrics. 2014;134(4):e935-44. PubMed abstract / Full Text

Riordan R.
Percy Jackson and the Olympians.
Disney-Hyperion; 2014. 978-1484707234 http://www.amazon.com/Jackson-Olympians-Paperback-covers-poster/dp/148...

Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, Arnold LE.
A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment.
BMC Med. 2012;10:99. PubMed abstract / Full Text

Troksa K, Kovacich N, Moro M, Chavez B.
Impact of Central Nervous System Stimulant Medication Use on Growth in Pediatric Populations with Attention-Deficit/Hyperactivity Disorder: A Review.
Pharmacotherapy. 2019;39(6):665-676. PubMed abstract
This article review the newer data surrounding the effects of central nervous system stimulants on growth parameters in children with ADHD.

Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, Biederman J.
Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents.
Arch Pediatr Adolesc Med. 2008;162(10):916-21. PubMed abstract / Full Text

Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W.
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.
Pediatrics. 2019;144(4). PubMed abstract / Full Text
This guideline revision provides incremental updates to the 2011 guideline on ADHD, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations; American Academy of Pediatrics (AAP).