Attention Deficit Hyperactivity Disorder Diagnosis & Treatments
In general, a diagnosis of attention-deficit/hyperactivity disorder is made if the core symptoms of ADHD start early in life — before age 12 — and create major problems at home and at school on an ongoing basis.
There’s no specific test for ADHD. An evaluation can help find out whether symptoms are related to ADHD or another problem. Making a diagnosis will likely include:
- A medical exam. This can help rule out other possible causes of symptoms.
- Information gathering. This includes reviewing any current medical conditions, personal and family medical history, and school records.
- Interviews or surveys. These may include information from family members, teachers or other people who know your child well, such as caregivers, babysitters and coaches. This information can show how your child behaves in different situations.
- ADHD rating scales. These help collect and evaluate information about your child.
Diagnosing ADHD in young children
Signs of ADHD can sometimes be noticed in preschoolers or even younger children. But diagnosing the condition in very young children is harder. That’s because developmental conditions such as language delays can be mistaken for ADHD.
Children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist, such as a psychologist or psychiatrist, speech pathologist, or developmental pediatrician.
Other conditions with symptoms like those of ADHD
Some medical conditions or their treatments may cause symptoms much like those of ADHD. Examples include:
- Learning or language delays.
- Mood disorders such as depression.
- Anxiety disorders.
- Seizure disorders.
- Vision or hearing conditions.
- Autism spectrum disorder.
- Medical conditions or medicines that affect thinking or behavior.
- Sleep disorders.
- Brain injury.
Treatment
Standard treatments for ADHD in children include medicines, behavior therapy, counseling and education services. These treatments can lessen many of the symptoms of ADHD, but they don’t cure it. Treatment also can help prevent some complications caused by ADHD. It may take some time to find what works best for your child.
Stimulant medicines
Stimulant medicines, also called psychostimulants, are currently the most prescribed medicines for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. The medicines help lessen the symptoms of inattention and hyperactivity. They can sometimes help in a short period of time.
Examples of stimulant medicines include:
- Amphetamines. These include dextroamphetamine (Dexedrine Spansule), dextroamphetamine-amphetamine (Adderall XR, Mydayis) and lisdexamfetamine (Vyvanse).
- Methylphenidates. These include methylphenidate (Concerta, Ritalin, others), dexmethylphenidate (Focalin) and dexmethylphenidate-serdexmethylphenidate (Azstarys).
Stimulant medicines are available in short-acting and long-acting forms. Long-acting patches of methylphenidate (Daytrana) or dextroamphetamine (Xelstrym) are available. They can be worn on the hip.
The right dose varies from child to child, so it may take time to find what works for your child. And the dose may need to be adjusted if side effects occur or as your child matures. Ask your healthcare professional about possible side effects of stimulant medicines.
Stimulant medicines and certain health risks
Some research suggests that using ADHD stimulant medicines with certain heart problems may be a concern. Weight and growth may be affected. Also, the risk of certain mental health symptoms may be higher when using stimulant medicines.
- Heart conditions. Stimulant medicines may cause a rise in blood pressure or heart rate. But the higher risk of serious side effects or sudden death is still not proved. The healthcare professional evaluates your child for any heart condition or family history of heart disease before prescribing a stimulant medicine. The healthcare professional also monitors your child when stimulant medicines are used.
- Appetite changes, weight loss and slowed growth. Stimulant medicines can affect appetite and cause weigh loss. These medicines also can slightly affect height growth.
- Mental health conditions. Stimulant medicines may rarely raise the risk for agitation or irritability. Uncommonly, manic symptoms or losing touch with reality can happen. Contact your child’s healthcare professional right away if your child has sudden new or worsening behavior or sees or hears things that aren’t real while taking stimulant medicine.
Other medicines
Medicines that are sometimes called nonstimulants have been approved by the U.S. Food and Drug Administration, also called the FDA, to treat ADHD. These include:
- Atomoxetine (Strattera).
- Viloxazine (Qelbree).
- Guanfacine (Intuniv).
- Clonidine (Onyda XR).
Antidepressants, such as bupropion (Aplenzin, Wellbutrin XL, others), are not specifically approved by the FDA to treat ADHD. But they may be effective if other medicines haven’t worked or have too many side effects.
Atomoxetine and antidepressants work slower than stimulant medicines do and may take several weeks to show a full effect. These may be good options if your child can’t take stimulant medicine because of health conditions or severe side effects.
Suicide risk
Although not proved, concerns have been raised that there may be a slightly higher risk of suicidal thinking in children and teenagers taking atomoxetine, viloxazine or antidepressants. Contact your child’s healthcare professional right away if you notice any signs of depression or suicidal thinking.
Give medicines safely
It’s very important to make sure your child takes the right amount of the prescribed medicine. Parents may be concerned about stimulant medicines and the risk of misuse and addiction. Stimulant medicines are considered safe when your child takes the medicine as prescribed by the healthcare professional. Your child should see the healthcare professional regularly to decide if the dose of the medicine needs to be adjusted.
There is concern that other people might misuse stimulant medicines prescribed for children and teenagers with ADHD. To keep your child’s medicine safe and to make sure your child is getting the right dose at the right time:
- Give medicines carefully. Supervise children and teens when they take ADHD medicines rather than letting them be in charge on their own.
- At home, keep medicine in a childproof container. Also store medicine out of the reach of children. An overdose of stimulant medicine is serious and could result in death.
- Don’t send supplies of medicine to school with your child. Deliver any medicine yourself directly to the school nurse or health office.
ADHD behavior therapy
Children with ADHD often benefit from behavior therapy, social skills training, parent skills training and counseling. These may be provided by a psychiatrist, psychologist, social worker or other mental health professional. Some children with ADHD also may have other mental health conditions such as anxiety or depression. Counseling may help both ADHD and the other condition.
Examples of therapy include:
- Behavior therapy. Teachers and parents can learn behavior-changing strategies, such as token reward systems and timeouts, for dealing with difficult situations.
- Social skills training. This can help children learn proper social behaviors.
- Parenting skills training. This can help parents develop ways to understand and guide their child’s behavior.
- Talk therapy. Also called psychotherapy, this allows older children with ADHD to talk about issues that bother them, explore negative behavior patterns and learn ways to deal with their symptoms.
- Family therapy. Family therapy can help people find ways to overcome challenges that may arise when a family member has ADHD.
The best results happen when a team approach is used. Your child’s team may include teachers, parents, therapists and healthcare professionals working together. Learn about ADHD and available services. Work with your child’s teachers and refer them to trusted sources of information to support their efforts in the classroom.
Medical devices
The FDA has approved two devices for ADHD. They both need a prescription.
- Monarch external trigeminal nerve stimulation (eTNS) system. This is a medical device to treat children with ADHD who are 7 to 12 years old and not taking ADHD prescription medicine. The device creates low-level electrical pulses that move through a wire to a small patch placed on the child’s forehead. Signals are sent to areas of the brain that relate to attention, emotion and behavior.
- EndeavorRx. This is a game-based digital therapeutic device. The game is designed to improve attention in children with predominately inattentive- or combined-type ADHD who are 8 to 17 years old.
These devices have FDA approval, but they are new and have limited evidence and data to guide treatment. If you’re considering these devices, it’s important to talk with your healthcare professional about precautions, expectations and possible side effects. Get complete information and instructions from your healthcare professional.
Ongoing treatment
Your child should see a healthcare professional regularly while being treated for ADHD. If symptoms are much better and stable, visits usually take place every 3 to 6 months.
Contact the healthcare professional if your child has any medicine side effects, such as loss of appetite, trouble sleeping or worse irritability. Also contact the healthcare professional if your child’s ADHD symptoms are not getting better with the current treatment.
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