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Pediatric Mental Health Institute
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Identifying and Treating ADHD in Children

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition typically diagnosed in childhood, with symptoms often continuing into adulthood. According to the Centers for Disease Control’s National Survey of Children’s Health, approximately 9.4% of children and adolescents ages 2 to 17 in the United States have a diagnosis of ADHD. This survey also revealed that children living in rural areas were diagnosed with ADHD more often than those in suburban or urban areas. Those children were also less likely to receive evidence-based treatments, such as behavioral therapy.

The American Psychiatric Association identifies three subtypes of ADHD:

  • Predominantly Inattentive Subtype: Often referred to as “ADD,” children are diagnosed with this subtype if they predominantly exhibit symptoms such as inattention, disorganization, forgetfulness and a tendency toward distraction. Parents often report that their child can focus very well on desired activities, such as video games. This is not uncommon in children with ADHD, who typically can focus intently on activities of interest to them.
  • ADHD, Predominantly Hyperactive/Impulsive Subtype: Children with this subtype of ADHD predominantly exhibit symptoms such as impulsivity and hyperactivity.
  • ADHD, Combined Subtype: Children diagnosed with this subtype exhibit both inattentive and hyperactive/impulsive symptoms.

What causes ADHD in children?

A variety of factors can place children at-risk for ADHD. These include:

  • Having a first-degree biological relative with ADHD
  • Prematurity or low birthweight
  • Maternal smoking, alcohol use or drug use during pregnancy
  • Exposure to environmental toxins

Who gets ADHD?

Boys are twice as likely to have an ADHD diagnosis. However, girls are more likely than boys to present primarily with inattentive symptoms. Nearly 64% of children diagnosed with ADHD have a comorbid emotional or behavioral disorder such as:

  • Learning disabilities
  • Anxiety
  • Depression
  • Behavior difficulties such as oppositional defiant disorder or disruptive mood dysregulation disorder

Screening for ADHD in children

Timely identification of children with ADHD is critical, as poorly controlled symptoms can negatively impact a child’s academic performance, peer relationships and self-esteem.

Children with concerns of possible ADHD should first undergo a medical exam, including hearing and vision tests, to rule out other health conditions that can present similarly to ADHD. Although there is no single test to diagnose ADHD, the most common screening measures when a provider suspects ADHD are the Vanderbilt Assessment Scales.

ADHD treatment recommendations for children

For children under the age of 6, the American Academy of Pediatrics recommends parent management training as the first-line treatment, before medication. The “gold standard” for treatment in children ages 6 and older is a combination of medication and behavior therapy.

Behavior therapy typically focuses on working with parents and teachers to develop strategies aimed at strengthening the child’s positive behaviors and eliminating problematic behaviors. These strategies may include use of strategic attention, development of reward systems, implementing effective punishment procedures and other evidence-based strategies.

Collaboration with the child’s school is critical. Providers can work with school personnel to develop effective behavior management strategies in the classroom and provide additional supports, such as a 504 Plan or Individualized Education Plan. Child-focused treatment typically involves teaching children to become more aware of their thoughts and feelings and learning ways to more effectively manage them. Social skills training can also be helpful.

Children’s Hospital Colorado’s Pediatric Mental Health Institute provides evidence-based, family focused, comprehensive mental health services, including psychiatric evaluation and treatment for ADHD. For more info, call 720-777-6200. Additionally, providers can connect with many mental health services throughout Colorado on Colorado.gov.

Additional ADHD Resources

  • Children and Adults with ADHD, or CHADD, offers great content, activities and support for kids, parents, teachers and providers.
  • ADHDChildhood is another good resource for ADHD tools and tips.
  • Russel Barkley, PhD, a widely recognized ADHD expert, has a website full of great ADHD information. His books Taking Charge of ADHD: The Complete Authoritative Guide for Parents and Your Defiant Child: 8 Steps to Better Behavior, co-authored with Christine Benton, are an excellent resource for parents with a new or existing diagnosis.
  • The American Academy of Child and Adolescent Psychiatry’s ADHD Resource Center offers an ADHD overview with links to ADHD content for families and professionals.
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