What are the main symptoms of ADHD in children?
The main symptoms of ADHD are difficulties controlling attention, behaviour and emotions, as expected for age.
Difficulty controlling attention
A child who has difficulty controlling attention may make careless mistakes or fail to pay attention to detail, not seem to listen when spoken to, have trouble organizing tasks and activities and be easily distracted. Sometimes they may focus very well (over-focus) on tasks of high interest such as video games but not on tasks that may be difficult, require more effort or be less interesting to them, such as school work.
Difficulty controlling behaviour and emotions
A child who finds it difficult to control their behaviour might show symptoms of hyperactivity. They may often fidget, have trouble playing quietly, be "on the go" or talk too much. If a child has symptoms of impulsivity, they may have trouble waiting for their turn and frequently interrupt others.
What is the difference between ADHD and normal inattention or high energy in children?
It is not unusual for most children to have one or two symptoms of ADHD now and then. For a diagnosis of ADHD, however, the symptoms must cause problems for the child at home, play and school. In particular, they must be:
- excessive
- persistent
- pervasive
Excessive
This means a child must experience more frequent and/or more severe symptoms than other children of the same age.
Persistent
ADHD symptoms have continued for many months and are not a response to a temporary stressful situation such as divorce, trauma or starting a new school or grade.
Pervasive
When symptoms are pervasive, they occur in several different settings such as at school, at home, restaurants, church, shopping malls, after-school activities and so on.
Does a child with ADHD show symptoms all the time?
ADHD symptoms may not be present all the time. Usually, they become more obvious in more demanding situations. For instance, obvious symptoms appear to be minimal when a child with ADHD is watching TV or playing a videogame but more noticeable when they need to sit still and focus on a long or difficult task.
Do ADHD symptoms change over time?
Symptoms of ADHD may look different at different ages.
Hyperactive and impulsive symptoms are more easily noticed by parents and teachers in early childhood. They may first appear when a child is in kindergarten or primary grade school. Children may act without thinking or seem "driven by a motor". These symptoms often become less obvious as a child grows and may disappear by the teen years. However, while teens and adults may appear calmer, they may still feel restless, make rash decisions without thinking and talk in sudden bursts.
Difficulties controlling attention often last from childhood into adulthood. They are less obvious to other people than hyperactivity and impulsivity and tend to emerge later in childhood, when school work and expectations for following classroom routines increase. The symptoms of inattention include forgetfulness, disorganization and problems concentrating, especially when the material is not interesting.
How ADHD appears in school-age children
One of the key times for diagnosing children is when they are aged seven to nine years old. At this age, parents/caregivers and teachers often start to notice problems with the child's school work and friendships.
School performance
Many children with ADHD may also have more difficulties than their peers with learning to read, spell or do math. But even without any specific learning difficulty (such as dyslexia), ADHD can interfere with a child’s ability to learn, follow classroom routines and complete school work. They may have trouble understanding how the classroom works and may find it hard to give focused, organized answers to a teacher's questions. Homework can also be a challenge, as ADHD may make it difficult for a child to write down homework, remember to take the necessary books home and start or complete homework by themselves.
CADDAC (Centre for ADHD Awareness Canada) offers more information on how ADHD affects children at different ages and provides suggestions and strategies for educators.
Social emotional abilities
Children with ADHD often have more social and emotional problems than other children. This is true for both boys and girls. For instance, ADHD is linked with being a victim of bullying and being rejected by peers.
In terms of emotions, children with ADHD can experience sudden mood swings, which may appear as over-reactions to small issues or becoming frustrated very quickly. They may also have a strong need for instant satisfaction.
These social and emotional issues can occur because of a child’s:
- difficulty reading social cues, for example failing to read facial expressions accurately or interpreting neutral behaviour or comments as negative
- problems with conversation skills, problem-solving or other social skills
- trouble controlling behaviour, for instance interrupting or not taking turns, which may irritate other children
- difficulty controlling their emotions, for example reacting angrily or inappropriately when they are upset
How ADHD appears in teens
While a diagnosis of ADHD is usually confirmed by age 12, some older children may not be diagnosed until they transition to high school. This is because the transition and adjustment to high school usually place new demands on a child's organizational skills and reveal difficulties with controlling attention that might have been hidden previously.
School performance
Many of the school difficulties experienced by younger children with ADHD continue into the teen years. Compared with their peers, teens with ADHD are three times more likely to drop out of school. However, many students with ADHD do graduate from high school and go on to higher education, which is encouraging. They may still face challenges with learning and academic performance, however, so proper supports remain essential.
Social emotional abilities
Teens with ADHD may have:
- more negative moods, such as anger, anxiety and stress
- fewer positive moods, such as happiness, alertness and a sense of wellbeing
ADHD may contribute to risky behaviours such as gambling and addictions, including substance abuse and video addiction. In addition, it is more likely to be associated with obesity, depression, anxiety, suicide and self-harm, and eating disorders such as anorexia, bulimia and binge eating. For older teens, there is increased risk of driving offences and accidents.
How is ADHD diagnosed?
There is no specific test for ADHD. Usually, a qualified health-care professional will examine your child and ask questions about:
- your child’s developmental history
- how your child behaves at home and in other situations
- how long your child has had symptoms and whether they cause problems
- whether your child is experiencing problems at school or with school work
The health-care professional will usually ask you to fill in some structured questionnaires so they can learn about your child’s general behaviour at home. If you have other concerns, such as problems with your child’s nutrition or sleep, make sure to discuss them. It might help to write down your questions before your child’s appointment.
Often families seek advice from their health-care provider after they and/or the child’s teacher have expressed concerns about the child’s symptoms.
Once your child is in school, the health-care professional can find out if they are inattentive, impulsive or hyperactive in that setting as well as at home. Your child’s teacher will likely be asked to fill in structured questionnaires or rating scales as well as report cards to provide the information the health-care professional needs. A child will be diagnosed with ADHD only if their symptoms are excessive and persistent and cause difficulties at home and at school.
Will a diagnosis be made right away?
It will probably take two or three visits to a health-care professional to diagnose ADHD, as they will need time to collect information from your child's teacher and consider all the information that has been gathered.
What happens after a diagnosis of ADHD?
Once your child is diagnosed with ADHD, treatment can begin. You, your child's health-care provider or psychologist and the school will need to work together on a plan to manage your child’s ADHD.
This plan will begin with a thorough discussion about ADHD and possible treatments and supports for parents and for your child or teen. Next, a treatment plan is developed based on a clear discussion with you and your child about your needs and preferences.
Medication is often an important part of treatment, but it may not be enough to help a child do their best. Before starting a child on medication, many parents and caregivers prefer to engage with other forms of treatment, such as adapting their parenting style for challenging behaviour and working with the child’s school to develop an individual education plan (IEP).
Further information
For more information on ADHD, please see the following pages:
ADHD: How to help your child at home
ADHD: Communicating with your child's school
ADHD: Treatment with medications
Resources
The following resources offer support and additional information on ADHD.
Websites
Learning Disabilities Association of Ontario
Centre for ADHD Awareness, Canada - CADDAC
Journal articles
Cortese, S. & Tessari, L. (2016). Attention-Deficit/Hyperactivity Disorder (ADHD) and Obesity: Update 2016. Current Psychiatry Reports 19 (4) doi: 10.1007/s11920-017-0754-1.
Heinonen, K. et al (2010). Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: A longitudinal study. BMC Pediatrics. Dec 15 2010 10:91. doi: 10.1186/1471-2431-10-91.
Sucksdorff, M. et al (2015). Preterm Birth and Poor Fetal Growth as Risk Factors of Attention-Deficit/ Hyperactivity Disorder. Pediatrics Sept 2015 136 (3) e599-e608. doi:10.1542/peds.2015-1043.