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Ask the Pediatrician: Does my child have ADHD, or is it something else?

The pandemic has exacerbated behavior issues. How to recognize and treat one such condition.

We’re back in school and so excited that our 5- to 11-year-olds can now be vaccinated against COVID-19. (Tips from Dr. Block on that here.) Kids have settled into school with masking and social distancing. We are also bringing back afterschool activities. While for some children the transition has been smooth, others are having difficulty with concentration, restlessness, and worry. Those behaviors can be symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) or they can have other causes. This is a great question from a reader; thank you so much. Let’s talk about it.

Is it ADHD or something else?
At the beginning of the school year, it seemed like all our kids were a little amped up with the excitement and nervousness. We are now reacquainted with in-person school and afterschool activity routines. What about the child who is still struggling with attention, performance in school, or impulsive behavior? If you are asking yourself if this is something more, you’re not the only one. We’re seeing increased requests for ADHD screenings for school-aged children. Early diagnosis and treatment can make a big difference, so recognizing possible ADHD is important.

Attention-Deficit/Hyperactivity Disorder

Let’s take a minute to talk about ADHD (Attention-Deficit/Hyperactivity Disorder). According to the American Academy of Pediatrics, approximately 9 percent of children have ADHD and it is twice as likely to be diagnosed in boys as girls. ADHD is considered a chronic condition of the brain. Children with ADHD have difficulty controlling their behavior and difficulty paying attention in school, have challenges getting along with other children, and are often impulsive. This is not the occasional outburst but rather a pattern of chronic behavior that impacts their ability to live regular lives.

Signs of ADHD

Children with ADHD have behavior challenges that fall into three categories, although many children have a combination of behaviors.

1. Inattentive: These children have a difficult time paying attention, appear to be daydreaming, and have challenges organizing themselves.
2. Hyperactivity: These children are in constant motion and have a very hard time sitting still.
3. Impulsivity: These children are noted to be very impulsive. They frequently interrupt, have a hard time taking turns and have impulsive behaviors, i.e., they might run into the street.



If you suspect your child has ADHD, what are the next steps?
If you notice your child having these impulsive, hyperactive, or inattentive behaviors on a regular basis for more than six months and the behaviors are impacting their success in school and at home, talk to your healthcare provider. Often times teachers are the first to notice these behaviors and will let parents know.

It is important that your child be seen by their provider in person. A physical exam and time for your provider to talk to you and your child are important to be sure that there are no other reasons for the behavior difficulties. Your provider will then ask you and your child’s teacher to fill out an ADHD behavior assessment. Your child may also be screened for other things including anxiety and depression.

ADHD treatment

ADHD treatment is individual, but it is important to have a long-term management plan with the goal of targeted behaviors. This can be better schoolwork, improved relationships, improved self-esteem, and safer behavior. It is important that the goals be realistic and observable. It is also important to have close follow up and ongoing monitoring. Education about ADHD and parent training in behavior management is helpful. Some patients and families benefit from individual and family counseling. Medication may also be part of the treatment plan. This is something you will discuss with your provider.

Will my child outgrow ADHD?
Most people with ADHD will have it into adulthood. By learning organizational skills, how to structure their environment, and on some occasions continuing medication, adults with ADHD can do well. I might say that for many fields having high energy behavior is a plus,

What if it’s not ADHD?
During your evaluation, the provider will check your child for symptoms that do not fit ADHD. Sometimes other disorders such as mood disorders (depression or anxiety), learning disorders, sleep problems, and certain types of seizures can have some symptoms that overlap with ADHD. It is also important to be sure there is nothing else going on including bullying at school or substance use.

Working with your healthcare provider and your child’s teacher is the best way to be sure you have the correct diagnosis.


More Ask the Pediatrician:

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About the Author

Susanna Block

Dr. Susanna Block, MD, MPH, is a pediatrician with Kaiser Permanente in Seattle and lives with her family in Queen Anne.