ADHD in children: signs, support and next steps

Maybe your child seems to run on a different setting from other children, or a teacher has said something. It’s hard to tell what’s simply part of being young and what might be more. Wanting to understand your child better is a good reason to read on. A pattern that lasts tells you far more than one difficult week.

What are the symptoms of ADHD in kids?

The symptoms of ADHD in kids affect attention, energy levels and impulse control [1]. Most children with ADHD show signs of both the inattentive and the hyperactive-impulsive kind, though some show only one [1]. Clinicians call these groupings presentations. Some children seem mostly dreamy and hard to reach, while others are rarely still.

Symptoms usually start before the age of 12 [1]. What you’re really looking for is a pattern across attention, activity and impulses, rather than a single habit. It helps to think about how your child copes across a whole ordinary week. A few notes each evening, on mornings, homework and bedtime, make that week easier to describe later.

What are the signs of ADHD at home and at school?

The signs of ADHD tend to show up in ordinary moments, like getting dressed or doing homework [1]. A teacher and a parent may describe the same child quite differently, so comparing notes is worth the effort.

Attention

• gets distracted easily, even halfway through a task.
• finds it hard to listen or follow instructions.
• forgets everyday jobs, such as brushing teeth.
• starts things and doesn’t finish them.
• loses homework, PE kit or water bottles.

Activity and impulses

• fidgets, taps or can’t sit still.
• gets up when meant to stay seated.
• talks a lot, or loudly.
• finds it hard to wait their turn.
• interrupts or acts before thinking.

For a diagnosis, the signs need to show in two or more important settings, such as home and school [2]. They also need to cause real difficulty, not just the odd hard day [2].

ADHD in girls: what are the signs, and why are they missed?

ADHD is thought to be recognised less often in girls, perhaps because their inattentive signs are harder to spot [1]. A girl who drifts off quietly in class rarely holds up the lesson. NICE notes that girls are less likely to be referred for an assessment, and may get a different diagnosis first [2].

A 2002 review pooling earlier studies found girls with ADHD had less hyperactivity than boys, and more anxiety and low mood [3]. Signs you might notice in your daughter include:

• daydreaming or drifting off in class.
• forgetting or losing things.
• chatting or blurting things out, rather than being physically busy.
• worry or low mood alongside struggles at school.

A 2020 expert consensus statement describes a quieter, more inward picture of ADHD as common in girls [4]. A girl who copes on the surface can look as if she’s doing fine. The statement adds that some girls become good at hiding their difficulties behind coping strategies [4].

Can toddlers and young children have ADHD?

A busy, distractible child under 5 doesn’t necessarily have ADHD [1]. Plenty of children are impulsive and full of energy at this age. Restlessness at nursery or in reception can also be a sign of being tired, anxious or stressed [1]. If the signs are strong and last for months, talk to your GP or health visitor.

Where a young child does have ADHD, NICE’s first step is a group training programme for parents, focused on ADHD [2]. Medication isn’t offered under 5 without a second opinion from a specialist service with expertise in young children [2]. AuDHD Psychiatry assesses children from the age of 6.

What else could it be, and how is ADHD diagnosed in children?

Other conditions can look like ADHD, and some can sit alongside it. A GP may check whether anxiety, Tourette’s or signs of autism in children explain the behaviour better [1]. Anxiety, depression or a learning difficulty such as dyslexia can also come alongside ADHD [1]. Sorting out which is which takes time and more than one view of your child.

NICE says a diagnosis shouldn’t rest on a rating scale or an observation alone [2]. Tools such as the Conners’ rating scales still add useful detail, and a school observation helps when there’s doubt [2]. The usual route starts with your child’s teacher, who will often bring in the school’s special educational needs co-ordinator (SENCO) [1]. A GP can then refer your child to a specialist [1].

What treatment helps children with ADHD?

Treatment for children aged 5 and up starts with parent support, not medicine [2]. The support covers information about ADHD and can run in a group, sometimes over just one or two sessions [2]. Changes to your child’s surroundings, at school and at home, are part of this first stage too.

Medication is offered only if symptoms still cause a persistent, significant difficulty after those changes have been made and reviewed [2]. An ADHD specialist starts and monitors any medicine, such as methylphenidate [1]. Some children need to try more than one before one suits them [1]. Our guide to ADHD medication for children sets out each step.

Later on, some young people who’ve been helped by medication still find things hard. For them, NICE suggests a course of cognitive behavioural therapy (CBT), covering social skills, problem-solving and self-control [2].

How can you support your child at home and at school?

Classroom changes are among the first kinds of support NICE describes [2]. Examples include:

• a different seat, or changes to lighting and noise.
• fewer distractions around the desk.
• shorter spells of focus, with breaks to move.
• instructions written down.
• help from a teaching assistant.

In England, the SENCO at your child’s school or nursery can look at their needs with you [5]. Bring notes on what you see at home, because they help the school see the whole picture. SEN support is help given in school [5]. Children and young people up to 25 with more complex needs may get an education, health and care (EHC) plan [5]. The other UK nations run their own school support systems.

Support for parents shouldn’t wait for a formal diagnosis, according to NICE [2]. At home, regular sleep, physical activity your child enjoys and clear instructions, one at a time, all help [1].

When is it time to get your child checked?

It’s worth a closer look when home and school support hasn’t been enough. A referral can be raised by your GP or the school’s SENCO [1].

An assessment may help if:

• the signs have lasted a long time, at home and in class.
• support so far hasn’t made enough difference.
• your child is aged 6 to 17.

It might not be right today if:

• your child needs urgent help now. Call NHS 111 and choose the mental health option, or in Northern Ireland call Lifeline free on 0808 808 8000, any time. In an emergency, call 999 or go to A&E [6].
• your child is under 6, because our child assessment starts at age 6.

At AuDHD Psychiatry, the ADHD assessment for children is one online appointment, with no GP referral. A parent can be present, and we send the outcome letter the next day. The full report follows within two weeks. You could start with the free ADHD test for children, which doesn’t diagnose. A free 15-minute call can help you work out which assessment or support fits your child.

Questions people ask

In short

ADHD in children shows up across attention, activity and impulses, and the signs begin early and appear in more than one place. Girls are easier to miss, because their signs are often quieter. Changes in the classroom and support for parents come first, and medication is weighed up later by a specialist. If the signs have lasted and the changes haven’t been enough, gather your notes from home and school. AuDHD Psychiatry can then help you think through what to do next.