Attention Deficit and Hyperactivity Disorder (ADHD)

  • Overview

    Is your son a constant bundle of energy … always moving, unable to sit still, even for a few moments? Is your daughter easily distracted and forgetful, tending to frequently “have her head in the clouds”?

    Maybe you’ve tried to calm your child down, or urged him to focus. You may have attempted to increase his nightly hours of sleep, adjusted his diet or encouraged him to get more physical exercise—yet nothing appears to be working. 

    It’s normal for all kids to have trouble focusing (and behaving) at one time or another. For children with attention-deficit/hyperactivity disorder (ADHD), however, these symptoms seem to be constantly present and can cause ongoing problems at home, at school and with friends. 

    If your child has ADHD, you might feel frustrated and at a loss for what to do. It may seem like she’s always losing homework or having trouble following teachers’ instructions, or she may have difficulty making friends and getting along with other family members. Learning as much as you can about ADHD is a great first step to identifying the methods that will allow your child work to her full potential—at home, in school and with peers. 

    Here are some key facts about ADHD: 

    • ADHD is classified by the Diagnostic and Statistical Manual (a standard reference) as a behavior disorder.
       
    • However, ADHD is also considered a neurodevelopmental disorder because it is stems from biological problems with the brain functions that control emotions and learning.
       
    • ADHD is the most common neurodevelopmental disorder in childhood, affecting an estimated 5 to 7 percent of all school-age children according to many studies which go back 50 years or more.
       
    • ADHD affects different kids in different ways: some children may be able to function relatively well with minimal treatment, while others may need more extensive care to manage their symptoms.
       
    • If left untreated, ADHD can lead to significant problems, including:
    • While the symptoms of ADHD may change—and in some instances, improve— as your child grows, the most recent research suggests that up to 40 percent of children with ADHD continue to experience problems into adulthood.
       
    • The good news is that ADHD responds well to a combination of behavioral modification and medication. Early detection and intervention will enhance your child's growth and development, and improve her quality of life in the long term.

    How Boston Children’s Hospital approaches attention-deficit/hyperactivity disorder (ADHD)

    If you are a parent seeking essential information about treatment for ADHD—as well as guidance in helping your child live an active, healthy life while managing this disorder—you’re in the right place. The expert clinicians in Children’s Division of Developmental Medicine, Department of Neurology and Department of Psychiatry have many years of experience caring for children and adolescents with ADHD. 

    The Developmental Medicine Center within Boston Children’s Division of Developmental Medicine:

    • provides neurodevelopmental assessments for children, ages 3 to 6, with mild to severe attentional problems through the Preschool Age Program
    • offers comprehensive evaluations for children, between the ages of 7 and 10, with attention difficulties through the School-Age Program
    • conducts multidisciplinary, neurodevelopmental assessments for children, between the ages of 11 and 17, with attentional challenges through the Adolescent Program
    • provides ongoing, comprehensive treatment for children with ADHD through it’s ADHD Program 

    In addition, the Department of Neurology at Boston Children’s is home to a Learning Disabilities Program that:

    • brings together Boston Children’s experts in pediatric neurology, neuropsychology, speech/language pathology and psychology, as well as in language (written and oral) and mathematics education
    • performs comprehensive evaluations of school-aged children who are experiencing academic, cognitive and behavioral challenges
    • educates parents, teachers and other physicians about understanding and working with children who have ADHD and other conditions that impact learning
    • has published an in-depth guide for families

    Meanwhile, Boston Children’s Department of Psychiatry:

    • has a specialized Neuropsychology Program that assesses children to determine if a medically- or biologically-based problem is contributing to their thinking, learning or behavioral issues
    • offers psychotherapy, counseling and other non-medication-based behavioral health interventions through the Psychosocial Treatment Clinic
    • has a devoted Psychopharmacology Clinic to help clinicians and families decide whether psychiatric medication might be a beneficial addition to a child’s treatment plan

    Having convenient access to multiple specialists across Boston Children’s—all working together to design the treatment plan that best fits your child—ensures that you, your child and your entire family will receive the medical, emotional and educational support you need. 

    Better information means better treatment for ADHD

    Routine and systematic monitoring of your child is a must for effective treatment of ADHD, but it's often difficult for doctors to track a child's progress both at home and at school. In response to this dilemma, Boston Children's physicians have developed a web-based ADHD symptom tracker and medication side-effect assessment tool.

    ADHD:
    Reviewed by William Barbaresi, MD; Leonard Rappaport, MD, MS; and David Urion, MD
    © Children’s Hospital Boston, posted in 2011

  • In-Depth

    Understanding the basics of attention-deficit/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

    What causes attention-deficit/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

      What are the symptoms of attention-deficit/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?

      FAQ

      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.

    • Tests

      Determining whether your child has attention-deficit/hyperactivity disorder (ADHD) is a process with several steps. There is no single test that can definitively diagnose ADHD, and many other conditions—including anxiety disorders, depression and certain learning disabilities—create symptoms that closely mimic ADHD.

      Doctors use criteria established by the American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision to reach a diagnosis of ADHD. This set of standards ensures that all kids who may have ADHD are appropriately evaluated and treated.

      Is there any lab test that can screen for ADHD?
      No; there are no blood tests or other kinds of medical tests that can diagnose ADHD.

      How does Boston Children’s Hospital begin the process of diagnosing ADHD?
      Here at Boston Children’s, a developmental pediatrician, child neurologist, child and adolescent psychiatrist or other qualified medical professional will typically diagnose ADHD after an extensive evaluation with you and your child. 

      • We will usually start by compiling a detailed history of your child's overall health, academic performance, family life, social interactions and behavior. This process will involve talking to you and other family members, your child, her teachers and her primary care pediatrician.
      • Next, we will observe your child’s behavior and ask her questions about how she’s feeling at home, at school and with her friends.
      • Specific tests may then be used to rule out other potential causes of attention problems (for example, another kind of learning disability or psychiatric disorder), and other tests may be used to measure your child’s learning ability and skills in particular areas.

      Because ADHD is characterized by a group of symptoms, getting a final diagnosis often depends on combining and balancing results from several different types of evaluations—including physical, neurological and psychological assessments. 

      Here at Boston Children’s, you and your child will have access to all of the necessary specialists through our comprehensive, multidisciplinary approach. We are here to advise and support you at every step of the way.

    • Boston Children's Hospital's clinicians are regarded as world leaders in diagnosing and treating attention-deficit/hyperactivity disorder (ADHD). Your child is always treated as an individual, and never “just a patient.”

      Our compassionate, family-centered care model considers you and your family central members of the treatment team, and you are involved in your child's care from beginning to end. 

      What are the first steps in treating ADHD at Boston Children's Hospital?
      When you come to Boston Children's for an initial appointment, your child's treating clinician will:

      • give your child a thorough physical exam
      • go over your child's medical, family and school history with you
      • talk to you (and your child) about his behaviors, symptoms, feelings and concerns
      • in some cases, give your child a comprehensive neuropsychological assessment—a sophisticated evaluation of his thinking, learning and behavioral functions

      Because Boston Children's is a multidisciplinary center with experts in all relevant fields, your child's treatment plan will involve much more than medical care to manage his ADHD symptoms. You (and he) will also have access to an assortment of educational, emotional and psychosocial support services to meet all of your family's needs.

      What treatment options does Boston Children's normally prescribe for kids with ADHD?
      There are three major components of treatment for kids with ADHD here at Boston Children's:

      • medication
      • behavioral modification therapy
      • educational intervention

      For some children, it may be appropriate to start with behavioral modification therapy and move to medication only if behavioral treatments don't work well enough. (As an example, if you have attended a behavioral parent training class, the teacher has worked for several months on classroom interventions and your child has received focused treatment—but you still see considerable room for improvement in his behavior and rate of progress—you and your child's treating clinician might consider starting him on medication.)

      For many kids with ADHD, the combination of medication and behavioral approaches should be considered from the very start.


      Medication

      Stimulant medications (drugs that enhance the activities of the brain and nervous system) have been used to treat ADHD and related childhood disorders since the 1930s. These medications have proven to be very effective in improving the basic symptoms of ADHD—including inattention, impulsivity and hyperactivity—in up to 90 percent of children.

      Stimulant medications work well for ADHD because they are able to “balance out” the brain chemicals that make it hard for kids with the disorder to maintain attention and control their impulses.

      There two families of compounds commonly used for ADHD:

      • methylphenidate and its derivatives (Ritalin, Ritalin LA, Ritalin SR, Concerta, Metadate, Focalin)
      • amphetamine derivatives (dextroamphetamine, mixed amphetamine salts/Adderall)

      These medications are available in different preparations under various brand names. The drugs will differ in how they're administered (for example, in tablets or capsules) and in how long they are effective (short-acting or long-acting).

      Considerations before beginning medication

      There are a few considerations involved when stimulant medications are prescribed for ADHD:

      • duration — Your doctor will likely want to prescribe the longest-acting preparation to control your child's symptoms throughout the day, both in and out of school.
      • side effects — Different kids respond to these medications in different ways. If your child has negative side effects when taking a certain medication, the doctor may recommend trying a different one.

      The most common side effects of stimulants include:

      • insomnia (inability to fall or stay asleep)
      • decreased appetite
      • stomachaches
      • headaches
      • “jittery” feelings
      • tics (sudden, repetitive movements or sounds that are difficult to control)
      • re-emergence of symptoms when the medication wears off in the evening (unfortunately, this is usually the very time you want your child to be “winding down” for the day)

      Most side effects associated with stimulant medications:

      • are mild
      • decrease with regular use
      • respond well to changes in the particular drug, dose and preparation

      Before starting your child on a stimulant, your treating clinician will obtain a thorough medical and family history and perform a physical examination, including checking your child's pulse, blood pressure and heart rate. Electrocardiograms (EKGs) and further heart tests are not usually necessary, unless an abnormality shows up in your child's medical or family history or during a physical exam.

      An important note: If your child has any type of heart problem, she should always be examined and cleared by a cardiologist before beginning any new medication.

      Learn more about medications used to treat ADHD.


      Behavioral modification therapy

      Kids with ADHD can also benefit from some common behavioral modification therapies, including:

      • point systems — rewarding your child through a system of “earning points” for positive behaviors
      • contingent attention —responding to your child with positive attention when she displays desired behaviors, and withholding attention when she takes part in undesired behaviors
      • teaching healthy life skills — working with your child to master skills in studying, setting goals, planning ahead and rewarding herself for positive behaviors

      A combination of behavioral modification therapy and medication is usually more effective than either approach alone, at least in the short term. Your child's treating clinician is the best source of information in determining what treatment methods to try, when to implement them and for how long.

       


      Educational intervention

      A structured educational setting can be an especially difficult place for a child with ADHD. That's why the federal government has put some special rules in place to help kids with ADHD and other learning and behavioral conditions succeed in school.

      It is critical to understand, however, that a formal diagnosis of ADHD does not automatically mean your child will qualify for either an Individual Education Program Plan (IEP) or accommodations under Section 504 of the Rehabilitation Act of 1973, which guarantees certain rights to individuals with disabilities (including ADHD). 

      • In order to qualify for special educational services through an IEP, your child must have demonstrated proof of either significant behavior problems in school that require special services or an associated, diagnosed condition, such as another learning disability
         
      • Eligibility for Section 504 is based on the confirmed existence of an identified physical or mental impairment that substantially limits a major life activity. In other words, a diagnosis of ADHD is not enough; your child's ADHD must also significantly—and demonstrably—affect his learning and/or behavior. 
         
      • If your child is deemed eligible under Section 504 and attends a public school, you can request that his teachers provide accommodations for his inattention and/or hyperactive and impulsive symptoms, such as:
        • giving him frequent reminders to stay on task
        • reducing distractions
        • rewarding persistence
        • prompting him to double-check work, complete assignment books and turn in homework
        • giving him extra time to complete work
        • providing opportunities for physical activity or "boredom breaks" during the day
        • providing a variety of interesting approaches to learning
        • giving rewards for good control of behavioral impulses
        • giving consequences for failing to control behavioral impulses 

      Support and education for parents

      Raising and caring for a child with ADHD can be very stressful at times, and may often present challenges for the entire family. In these circumstances, parent support and education about ADHD can make a big difference.

      Boston Children's Hospital offers classes in behavior management skills for parents. Training in these skills usually occurs in a group setting, which encourages parent-to-parent sharing and the brainstorming of ideas. Contact our Department of Psychiatry to learn more.

      Coping and support

      The ups and downs experienced by a child—and family—living with attention-deficit/hyperactivity disorder (ADHD) can feel overwhelming sometimes. In addition to the information provided here, you may find comfort and support from the following resources: 

      Patient and family resources at Boston Children's
       

      • Boston Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.
         
      • The Advocating Success for Kids (ASK) Program at Boston Children's provides multidisciplinary evaluation, referral and advocacy services for children under age 14 who have behavioral, emotional, learning or developmental problems that affect them at home or at school. ASK works with children who receive their primary care either at Boston's Bowdoin Street Community Health Center, Martha Eliot Health Center or Joseph M. Smith Community Health Center or at Boston Children's Primary Care Center. For more information about ASK, please call 617-355-4690.
         
      • The ADHD Experience Journal was designed by Children's psychiatrist-in-chief David DeMaso, MD, and members of his team. This online collection features thoughts, reflections and advice from kids and caregivers dealing with ADHD.
         
      • Boston Children's International Center is a dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the International Center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu.



       

      Helpful links

      Please note that Boston Children's Hospital does not unreservedly endorse all of the information found at the sites listed below. These links are provided as a resource.

       Helpful links for parents

      Helpful links for teens

      Helpful links for younger children

    • Research & Innovation

      Much of today’s research on attention-deficit/hyperactivity disorder (ADHD) focuses on genetics. Here at Boston Children’s Hospital, our researchers are also looking closely at the structural and functional differences between the brains of children and adults with ADHD and the brains of people not affected by the disorder.

      In addition, Boston Children’s physicians and scientists are engaged in several innovative studies designed to increase understanding of how ADHD affects children, and how best to diagnose and treat it.


      Staying on top of ADHD
      Proper treatment of ADHD requires consistent monitoring of a child's symptoms, medications, behaviors and side effects. Paper-based questionnaires given to parents have often been used for this purpose. 

      However, since the pen-and-paper process does not always (or entirely) capture the information necessary for monitoring children with ADHD, Boston Children’s has helped design a web-based data entry tool for parents—one that regularly updates doctors about a child’s ADHD.

      This online program guides parents through each step of reporting the relevant information, with a built-in mechanism to ensure that questions aren't skipped over. Eugenia Chan, MD, MPH, an ADHD specialist in Children’s Division of Developmental  Medicine, helped develop the tool. She hopes that teachers will also use it to provide input on a child's behavior at school.


      Studying the outcomes of kids with ADHD
      In collaboration with doctors and researchers at the Mayo Clinic, William Barbaresi, MD, associate chief of the Division of Developmental Medicine at Boston Children’s, is finalizing the largest-ever population-based study of the natural history and outcomes of ADHD.

      Over the course of this 15-year study, Barbaresi and his colleagues have followed approximately 700 children—more than 200 of whom were diagnosed with and treated for ADHD as kids—from early childhood through adulthood.

      In an attempt to understand how ADHD affects different facets of life, the researchers have compared the lives of people who had ADHD as children to the lives of those who did not. These comparisons cover a number of areas, including:

      • median annual income
      • educational attainment (e.g., reading scores, math scores and highest level of education completed)
      • career paths, including the number of job changes over time
      • marital status
      • history of and treatment for substance abuse
      • criminal activity
      • other psychiatric conditions

      Barbaresi and his colleagues are now analyzing the data from this landmark study.


      Using neuroimaging to improve the diagnosis of ADHD in younger children
      How does knowledge about typical variation in executive functions, and the impact of environment on the developing brain, inform clinical practice in terms of diagnosis and treatment of ADHD?

      To address this question, Margaret Sheridan, PhD, researcher in Developmental Medicine at Boston Children's, and members of her Sheridan Laboratory are conducting a longitudinal study of very young children with ADHD to identify ways that neuroimaging can contribute to better diagnostic techniques between the ages of 3-5 years.

      Learn more about research projects at Boston Children’s.

      Is it really ADHD? Brain activity may provide an objective measure

      Last month, the American Academy of Pediatrics released new guidelines on attention-deficit hyperactivity disorder (ADHD), lowering the minimum age at which physicians should consider drug treatment from 6 years to 4 years.

      But here’s the problem. “Current behavioral criteria for ADHD are most effective only after age 8 or 9,” says Margaret Sheridan of the Laboratories of Cognitive Neuroscience at Boston Children’s Hospital. “If you use them at age 3 to 6, then you’re wrong about half the time, and the child will stop meeting the criteria by age 8.”

      Sheridan wants to avoid these problems by finding an objective, measurable pattern of brain activity that reliably predicts ADHD in children as young as 3. Does that difference persist over time? Does it correlate with behavioral measures? Does treatment change the brain activity?

      To date, she’s enrolled about 40 children in a study that is measuring both EEG activity and metabolic activity on functional MRI (fMRI) scans in children 3 to 7 –both typical children and children meeting research criteria for ADHD. (The fMRI studies start at age 5, when most children can hold still in the scanner). The study will ultimately enroll 200 children (for information, and to enroll a child, call Kelly Khem at 857-218-5220 or email adhd.at.chb@gmail.com).

      Read more about the study.


      Clinical trials

      Boston Children’s is known worldwide for pioneering some of the most effective diagnostic tools, therapies and preventive approaches in pediatric medicine. A significant part of our success comes from our commitment to research—and to advancing the frontiers of health care by conducting clinical trials.

      Boston Children’s coordinates hundreds of clinical trials at any given time. Clinical trials are studies that may involve:

      • evaluating the effectiveness of a new drug therapy
      • testing a new diagnostic procedure or device
      • examining a new treatment method for a particular condition
      • taking a closer look at the causes and progression of specific diseases 

      Boston Children’s is involved in several multi-site clinical trials and studies focusing on pediatric neurology, psychiatry and developmental medicine. While children must meet strict criteria in order to be eligible for a clinical trial, your child may be a candidate for participation in a study. Before considering this option, you should be sure to:

      • consult with your child’s treating physician and treatment team
      • gather as much information as possible about the specific course of action outlined in the trial
      • do your own research about the latest breakthroughs relating to your child’s condition

      Taking part in a clinical trial at Boston Children’s is entirely voluntary. Our team will be sure to fully address any questions you may have, and you may remove your child from any medical study at any time.

      Search current and upcoming clinical trials at Boston Children’s.                                                                    

      Search the National Institute of Health’s list of clinical trials taking place around the world.

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