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It can be challenging to know whether your child needs help from a doctor.

Most kids are energetic, fidgety, and lost in their own world from time to time. You may wonder if it’s a phase or stage of life, or if trying something different in your parenting will help.

The hyperactive and impulsive symptoms of ADHD appear by age 7. Inattentive symptoms are usually present as well, though they may not be noticed until middle school or high school place further demands on attention. The American Academy of Pediatrics recommends well-child checkups throughout these early years. As a parent, you know the most about how your child behaves and is developing. Talking over these details with your child’s doctor is the best way to find out if there’s an underlying problem. 

Primary features of ADHD

There are three primary features of ADHD: inattention, hyperactivity, and impulsive behavior. Each of the symptoms taken by itself can be part of normal childhood behavior from time to time. For a diagnosis of ADHD, multiple symptoms must be extreme or excessive for a child that age; they must persist for many months; and they must occur across settings, such as home and school.

A publication of the National Institute of Mental Health on ADHD sums up the symptoms in each of the three areas of inattention, hyperactivity, and impulsivity.

Children who have symptoms of inattention may:

  • Be easily distracted, miss details, forget things, and frequently switch from one activity to another
  • Have difficulty focusing on one thing
  • Become bored with a task after only a few minutes
  • Have difficulty focusing attention on organizing and completing a task or learning something new
  • Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
  • Not seem to listen when spoken to
  • Daydream, become easily confused, and move slowly
  • Have difficulty processing information as quickly and accurately as others
  • Struggle to follow instructions

Children who have symptoms of hyperactivity may:

  • Fidget and squirm in their seats
  • Talk nonstop
  • Dash around, touching or playing with anything and everything in sight
  • Have trouble sitting still during dinner, school, and story time
  • Be constantly in motion
  • Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:

  • Be very impatient
  • Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
  • Have difficulty waiting for things they want or waiting their turns in games
  • Often interrupt conversations or others' activities.

ADHD can appear in children as one of three types, depending on the pattern of symptoms and behaviors listed above: predominantly inattentive type, predominantly hyperactive-impulsive type, or combined type. In combined type, children have symptoms of both inattention and hyperactivity and impulsivity.

Diagnosing ADHD

The symptoms of ADHD typically appear between the ages of 3 and 6. Parents may notice that their child loses interest in activities sooner than other children his age, or that he seems “out of control” much of the time.

Teachers may be the first to notice

In some cases, teachers may be the first to notice the signs of ADHD, as many symptoms may be more apparent in a school setting. Because ADHD runs in families, parents may not realize that what seems typical to them has an underlying disorder. In some cases, adults realize for the first time that they have struggled with ADHD themselves at the time that their child is diagnosed.

Steps of a comprehensive evaluation

Diagnosing ADHD requires a thorough, comprehensive evaluation of your child’s health and behavior. There is no simple test for ADHD. A good first step to find out if your child has a disorder is a visit to a pediatrician. The process may also begin with a school psychologist. If needed, you may choose to work with a mental health specialist with experience in ADHD.

A doctor will begin with a thorough checkup to identify whether there are other medical problems, such as hearing or vision problems, undetected seizures, allergies, thyroid problems, or other health issues that may look like ADHD.

The next steps are taking a thorough history of your child’s health and behavior by talking with you and your child and, importantly, teachers and others closely involved in your child’s life. The doctor will also observe your child closely, preferably in multiple settings, and work with you to rate your child’s behavior on several scales in order to understand the severity and frequency of the symptoms. Once your doctor has a complete view of your child’s health and behavior, he will be able to determine whether to diagnose your child with ADHD.

Coexisting disorders

ADHD is often accompanied by other problems. Some of these problems may be related to ADHD. Other problems may grow when ADHD has not been adequately managed. Many of these problems, including disruptive behavior disorders, can be prevented by early intervention.

Some children with ADHD also have a specific learning disability. It is common for children with ADHD to experience anxiety disorders or mood disorders at some point. Many children with Tourette's syndrome also have ADHD. And teens and adults with ADHD are more likely than their peers to have substance abuse problems.

Children with ADHD are also likely to develop more severe disruptive behavior disorders, such as oppositional defiant disorder or conduct disorder. These behavior disorders are characterized by aggressive, defiant, disruptive, and even antisocial or destructive behavior.

Although it may seem tempting to see if your child will simply “grow out of it,” getting help can prevent or treat these other conditions and give your child every chance to be her best and succeed.

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