Attention Deficit and Hyperactivity Disorder (ADHD) Symptoms & Causes in Children

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In-Depth

Understanding the basics of Attention Deficit and Hyperactivity Disorder (ADHD) will give you the tools to help your child live—and thrive—with her condition. 

What is attention-deficit/hyperactivity disorder (ADHD)?


ADHD is a behavior disorder that is neurodevelopmental in origin—meaning it is caused by a biological problem with the brain functions that control emotions and learning.

ADHD usually develops before age 7. Sometimes, though, symptoms are not noticeable until a child is somewhat older and has entered more challenging academic and social environments.

Is ADHD common?

Yes. ADHD is the most common behavioral disorder in childhood, affecting an estimated 5 to 7 percent of all school-age children.

What are the different ways ADHD can present in a child?

There are three ways in which ADHD can present: 
  • ADHD, predominantly inattentive type
    • A child with this type of ADHD suffers from inattention and distractibility without hyperactivity.
    • Children with this form typically display a persistent pattern of inattention, especially when sustained mental effort is required (for example, when participating in a classroom exercise or completing homework).
       
  • ADHD, predominantly hyperactive/impulsive type
    • A child with this type of ADHD suffers from impulsive and hyperactive behaviors during times when it's necessary to behave quietly.
    • Children with this kind of ADHD are frequently impatient and do not stop to think before acting.
    • This is the least common type of ADHD.
       
  • ADHD, combined type
    • A child with this type of ADHD suffers from impulsive and hyperactive behaviors, as well as inattention and distractibility.
    • This is the most common type of ADHD.

Does ADHD run in families?

Many parents of children with ADHD report that they experienced symptoms of ADHD when they were younger. ADHD is also commonly found in brothers and sisters within the same family.

Are some kids more prone to developing ADHD than others?

Boys are two to three times more likely to have ADHD than girls. However, girls are believed to be somewhat more likely to have the inattentive subtype of ADHD—increasing the likelihood that their symptoms might go undiagnosed, preventing them from getting necessary treatment.

What sorts of behaviors do kids with ADHD tend to exhibit?

Children with ADHD often:
  • have a hard time paying attention
  • daydream a lot
  • seem like they’re not listening
  • are easily distracted from schoolwork or play
  • forget things
  • seem to be in constant motion or unable to stay seated
  • squirm or fidget
  • talk too much
  • cannot play quietly
  • act and speak without thinking
  • have trouble taking turns
  • interrupt others

My child is impulsive and hyperactive, inattentive and easily distracted. Does he have ADHD?

It’s possible. Children with ADHD:
  • usually, but not always, first begin demonstrating behavioral problems before age 7
  • are prone to more frequent and severe behavioral episodes (especially when they’re bored) than most children in the same age range
  • display problematic behavior for at least six months
  • engage in the problematic behaviors in two or more different settings (for example, at home and at school)
  • have difficulties at home, at school or with friends because of their behavior

However, in order to confirm that your child definitely has ADHD, you will need an official diagnosis from a qualified health professional. 

Can ADHD lead to other problems down the line?

Kids with ADHD often have other problems, which can worsen their symptoms and make navigating daily life and school even harder. Children with ADHD are at particular risk for:

For these reasons, early diagnosis and intervention are very important.

Causes of Attention Deficit and Hyperactivity Disorder (ADHD)

While no single cause has been conclusively identified, doctors and researchers believe that ADHD symptoms are linked to neurodevelopmental problems—issues with the brain functions responsible for emotional control and learning.   

  • Research has suggested that children with ADHD have lower levels of dopamine, a neurotransmitter that acts as a chemical messenger in the brain.
  • Studies have also revealed that children with ADHD have a lower than normal metabolism in the areas of the brain responsible for attention, social judgment and movement.

There is clear evidence that ADHD has a genetic component and tends to run in families. However, scientists are also studying other possible causes and risk factors, including:

Giving kids with ADHD a voice

Boston Children's psychiatrist-in-chief David DeMaso, MD, and members of his team have created the ADHD Experience Journal, an online collection of thoughts, reflections and advice from kids and caregivers dealing with ADHD.

    Signs and symptoms of Attention Deficit and Hyperactivity Disorder (ADHD)

    Your child’s exact symptoms will depend on what type of ADHD he has. In general, a child with ADHD will show some of the following warning signs: 

    Inattention problems

    • has a short attention span for his age (difficulty sustaining attention)
    • makes careless mistakes
    • often does not seem to listen when spoken to
    • often does not follow instructions
    • often has trouble organizing activities
    • often loses things
    • has difficulty attending to details
    • is easily distracted
    • is forgetful
    • has poor study skills for his age

    Impulsivity problems

    • often interrupts others
    • has difficulty waiting for his turn in school and/or games with friends
    • tends to blurt out answers instead of waiting to be called on
    • takes frequent risks, and often without thinking before acting

    Hyperactivity problems

    • seems to be in constant motion; runs or climbs at times with no apparent goal except moving around
    • has difficulty remaining in his seat, even when it is expected or instructed
    • fidgets with hands or squirms when seated
    • talks excessively
    • has difficulty engaging in quiet activities
    • loses or forgets things repeatedly and often
    • inability to stay on task; shifts from one task to another without finishing any of them

    ASK: Boston Children's advocacy program for kids with ADHD, other learning and behavioral disorders

    The Advocating Success for Kids (ASK) Program at Boston Children's Hospital works with children under the age of 14 who are experiencing learning, developmental, emotional or behavioral problems in school or at home. Learn more about ASK.

    Questions to ask your doctor

    You and your family play an essential role in your child’s treatment for attention-deficit/hyperactivity disorder (ADHD). It’s critical that you share your observations and ideas with your child’s treating physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations. 

    You’ve probably thought of many questions to ask. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you and can make notes to take home. (If your child is old enough, you can encourage him or her to write down questions for the doctor, too.)
     
    Initial questions to ask your doctor might include:

    • What criteria did you use to reach this diagnosis?
    • Is there any other condition my child may have instead of, or in addition to, ADHD?
    • What type of ADHD do you believe my child has?
    • What are the goals of treatment for my child?
    • What role should I play in my child’s treatment?
    • Will you be working with my child’s other medical caregivers?
    • How can I tell if my child is making progress?
    • How should I involve my child's teacher and school in the treatment plan?
    • How should I explain my child's condition to other members of the family?
    • Will you prescribe medication for my child? If so, what are the possible side effects of this medication?
    • What other resources can you point me to for more information?

    Keep in mind that your doctor will want to ask you some questions, too. These might include the following:

    • Can you describe your child’s daily routine?
    • How long has your child had these symptoms?
    • How do your child’s symptoms affect him at school? At home? With friends?
    • Have you tried any behavioral modification approaches already?
    • Have you tried any medications?
    • Is there a history of ADHD in the family?
    • Is there anything in particular that seems to make your child’s symptoms better or worse?

    Frequently Asked Questions about Attention Deficit and Hyperactivity Disorder (ADHD)

    Q: Can our family pediatrician help treat my child’s attention-deficit/hyperactivity disorder (ADHD)?
    A: Primary care pediatricians play a significant role in caring for children with ADHD. Early diagnosis and management can help improve your child’s main symptoms, and allow him to build and maintain healthier friend and family relationships.

    Once a child has been diagnosed with ADHD and has started treatment, pediatricians should remain involved in follow-up care by performing complete medical, family, social and educational evaluations on a routine basis.

    Interviews or questionnaires completed by parents, teachers and counselors can provide valuable information for your family pediatrician. Your child’s primary care pediatrician can also help answer questions and concerns about possible side effects from medication, and can guide you in the process of obtaining and collecting information about your child’s behavior at home and at school.
     

    Q: How do I know if my child needs to be referred to a specialist for her ADHD?
    A:
    Whether your child needs more involved care from an ADHD specialist depends on your relationship with your primary care doctor. The American Academy of Pediatrics has published guidelines for the diagnosis and treatment of ADHD; these guidelines can serve as a useful tool for your pediatrician, ensuring that he or she recognizes the symptoms of ADHD and understands how best to treat it.

    Successful treatment for ADHD requires a substantial time investment and long-term commitment—not only from your family, but also from all the medical professionals involved in your child’s care. If your child’s pediatrician is not comfortable or experienced in providing this level of care—or if you feel like you might need a second opinion—you should always feel free to ask for a referral to a specialist.
     

    Q: Is there a simple test to diagnose ADHD?
    A: Unfortunately, no. ADHD is diagnosed after an extensive evaluation that may include one or more of the following components:

    • a thorough physical exam
    • a complete medical, family and academic history
    • neuropsychological tests to measure the child’s thinking, learning and behavioral functions
    • interviews with you, your child, other family members and teachers
       

    Q: Does behavioral therapy work for treating kids with ADHD? How can I take part in this therapy?
    A: Behavioral therapy is very helpful in managing ADHD for many children. In fact, research has suggested that medication for ADHD is more effective when combined with behavioral modification therapy. 

    As a parent, you can be involved in your child’s behavioral modification therapy by:

    • praising her efforts to improve behavior
      • ignoring outbursts that seem to beg for attention
      • listening and responding to her needs
      • rewarding positive changes in her behavior, even if the behavior is not perfect
      • using the “right” discipline for the “wrong” behavior
      • using the right language when talking about behavior (for example, saying “appropriate” and “inappropriate” instead of “good” and “bad”)
         

    Q: His classroom teacher says my child has ADHD; what should I do?
    A: ADHD is a medical condition, and only a qualified medical professional can diagnose your child. If a teacher or other school staff member is telling you they believe your child has ADHD, they are most likely expressing concern about the impact of his symptoms on his education or interactions at school.

    If you, other family members, teachers or other adults in your child’s life believe your child may be showing signs of ADHD, it’s important to talk to your family pediatrician or to another licensed health professional who is trained in diagnosing and treating ADHD.
     

    Q: How will having ADHD affect my child’s life in the long term?
    A: ADHD responds well to both behavioral modification therapy and medication, but early detection and intervention are vital.

     If left untreated, ADHD can lead to many problems, including:

    • poor performance or failure at school
    • injuries and accidents
    • substance abuse and other risky behaviors
    • difficult relationships with parents and peers
    • poor self-esteem 

    While the symptoms of ADHD may change—and in some instances improve considerably— as your child ages, current scientific research suggests that up to 40 percent of children with ADHD will continue to experience problems into adulthood without proper treatment.

    Getting the right diagnosis and care early on will enhance your child's personal, emotional and educational development and optimize her quality of life as she grows.

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    - Sandra L. Fenwick, President and CEO

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