Attention-Deficit/Hyperactivity Disorder (ADHD) in Children - An Overview

Attention-Deficit/Hyperactivity Disorder (ADHD) in children is a common condition affecting many across the United States, and the number of diagnoses has been steadily growing. It’s common for parents to feel uncertain about ADHD and how they can support their child.

We’ll walk you through the most common symptoms, possible causes, risk factors, coexisting conditions, and the range of treatment options available.

Overview

ADHD is one of the most common neurodevelopmental disorders found in children and teens. Many kids show signs early on, and the condition can continue as they grow older into adulthood [*]. In fact, about 6.5 million children in the United States currently have ADHD [*].

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes ADHD as a pattern of behaviors that can get in the way of life. These challenges can affect how a child learns, makes friends, and feels about themselves.

It’s important to note that ADHD is a real condition that’s rooted in how the brain develops, and not a sign of laziness or poor parenting.

Children with ADHD have genuine strengths, such as creativity, enthusiasm, and the ability to focus deeply on topics that interest them. They are just as intelligent and capable as their peers, but may struggle to show it due to their symptoms.

Symptoms

ADHD can present differently in each child, but the most common signs include trouble focusing, excessive activity, and impulsive behaviors.

These behaviors usually start in early childhood, between ages 3 and 6, although they may become more obvious when a child starts school. However, some people aren’t diagnosed until adulthood, meaning their symptoms went unrecognized or untreated during childhood.

Inattentive symptoms

Inattentive symptoms involve challenges with focusing, sustaining attention, and finishing tasks. Children displaying these symptoms may seem absent-minded or prone to distraction.

Look out for these common inattentive symptoms:

• Difficulty staying focused - The child may struggle to pay attention during school lessons, conversations, or while completing homework.
• Easily distracted - Even small noises, movements, or thoughts can pull their attention away from the task at hand.
• Forgetfulness - They may frequently forget assignments, chores, or daily routines (like brushing their teeth or washing their face).
• Trouble following instructions - Children may miss steps or make careless mistakes when asked to complete tasks.
• Disorganization - Keeping track of belongings, schoolwork, or schedules can be challenging.
• Avoiding tasks that require sustained mental effort - Activities like reading, homework, or detailed projects may feel overwhelming.

Hyperactive and impulsive symptoms

Hyperactive-impulsive symptoms involve having extra energy or restlessness and acting quickly without thinking. A child finds it difficult to sit still or control their impulses.

Look out for these common hyperactive and impulsive symptoms:

• Fidgeting or squirming - The child may have trouble staying seated, tap their hands or feet, or move around constantly.
• Trouble waiting - Waiting in line or taking turns can feel impossible.
• Excessive talking - They may interrupt conversations, share thoughts as soon as they arise, or talk nonstop even when it’s time to listen.
• Impulsive actions - Children with ADHD may do things without thinking first, such as running into situations that could be risky.
• High energy at inappropriate times - They may stay active or talk even in situations where being calm or quiet is expected.

Combined symptoms

Some children have combined type ADHD, which means they show both inattentive and hyperactive-impulsive symptoms. This type is actually the most common form of ADHD.

Children with combined ADHD may have trouble focusing on tasks, staying organized, and remembering routines, while also having difficulty sitting still, controlling impulses, or managing their energy.

For example, a child with combined ADHD might have trouble completing homework because they get distracted easily, while also frequently getting up during class or interrupting others.

Symptoms in boys vs. girls

ADHD often looks different in boys and girls. Boys are more likely to show hyperactive and impulsive behaviors, while girls more often show quieter symptoms like daydreaming, disorganization, or anxiety. These signs are less disruptive, so girls are more likely to be underdiagnosed or diagnosed later in life.

Causes

Scientists haven’t found one exact cause of ADHD. Instead, it seems to develop from a mix of genetics, brain differences, and environmental factors. ADHD tends to run in families, and studies show that genes play a big role. A child is more likely to develop ADHD if a parent or sibling also has it [*].

Still, there isn’t one “ADHD gene.” Instead, many genes work together and influence attention, impulse control, and brain development.

Risk Factors

Several factors can increase the likelihood that a child may develop ADHD. While family history plays a major role, other prenatal and early-life factors have also been linked to higher risk [*]:

• Maternal smoking or alcohol use during pregnancy - Children whose mothers smoked or drank alcohol while pregnant may be more likely to develop ADHD.
• Exposure to lead - Coming into contact with lead at a young age can affect brain development and increase risk.
• Prenatal exposure to air pollution - Children exposed before birth to certain air pollutants, called polycyclic aromatic hydrocarbons (PAHs), may have differences in brain development, especially in areas that help with attention and self-control.
• Brain injuries - Trauma to the brain during early childhood may contribute to ADHD symptoms.
• Low birth weight - Being born smaller than average has been associated with a higher chance of developing ADHD.

Complications

Children with ADHD may struggle in school, which can lead to lower grades or needing extra help. Studies show that they have difficulties in reading, math, and spelling, and these challenges can continue or get worse as they grow older, especially without treatment [*].

ADHD can also affect a child’s social life and psychological well-being. Their difficulty controlling impulses can cause conflicts and make it more difficult to form friendships. On top of academic struggles, repeated negative feedback from teachers, parents, or peers can lower a child’s self-esteem.

Furthermore, ADHD can continue into adulthood and increase the risk of several health problems. These may include obesity, high blood pressure, and diabetes.

Research also suggests that ADHD may increase the risk of heart and blood vessel problems, including heart attacks and strokes [*]. These risks are likely linked to behaviors and lifestyle factors, such as smoking, poor sleep, and diet, as well as the effects of long-term stress on the body.

Early diagnosis and support can help children manage symptoms and improve long-term outcomes.

Conditions Often Linked to ADHD

Children with ADHD may experience other challenges. These may involve behavioral, learning, and emotional difficulties:

• Behavioral disorders - These include Oppositional Defiant Disorder (ODD), which shows up as frequent arguments, defiance, or temper outbursts, and Conduct Disorder (CD), which may involve aggression, breaking rules, or stealing.
• Learning disorders - These include dyslexia (difficulty with reading), dyscalculia (challenges with math), and dysgraphia (difficulty writing and organizing thoughts). These conditions can make academic tasks more challenging and affect a child’s confidence.
• Emotional challenges - Children with ADHD are also more likely to experience anxiety or depression, which may show up as excessive worry, persistent sadness, or withdrawal from activities. These symptoms can appear as early as the preschool years [*].

Diagnosis

There’s no single test for ADHD, so the first step is usually talking with a healthcare provider. They can help figure out whether your child’s behavior is due to ADHD, another condition, or a combination of both.

A thorough evaluation considers the whole child. It will involve looking at their school performance, emotional health, relationships, and development [*]. For an ADHD diagnosis, symptoms must be present in at least two settings, such as home and school, and must clearly affect the child's daily functioning.

Treatment

Managing ADHD usually involves a mix of behavioral strategies and, when appropriate, medication.

Behavioral approaches help children learn new skills and manage daily routines, while medications can improve focus, reduce impulsivity, and calm hyperactivity. Stimulants are the most commonly prescribed and usually very effective, while non-stimulant options are available for children who need alternatives.

For preschool-aged children (4-5 years), the American Academy of Pediatrics recommends behavior therapy as the first line of treatment before trying medication. For children 6 years and older, combining medication with behavior therapy is the preferred approach [*].

Children benefit most when behavior therapy and medication are used together. Of course, it’s important to discuss any questions or concerns with your healthcare provider, who can help determine the best plan for your child’s needs.

Prevention

There is currently no way to prevent ADHD, but the good news is that children diagnosed with ADHD can absolutely thrive with the right support.

Professional guidance, along with understanding and consistency from parents, caregivers, and the people around them, can help them succeed.

While ADHD itself cannot be prevented, we do know there are certain risk factors linked to its development. This means parents and caregivers can still be proactive. For example, during pregnancy, avoiding tobacco, alcohol, and other substances can help reduce risks related to brain development.

Supporting a healthy pregnancy, minimizing exposure to harmful substances, and making sure a mother receives good prenatal care all help create the best possible start for a child.

Outlook/Prognosis

ADHD is a lifelong condition for many children. About 7 out of 10 children continue to have symptoms into their teen years and early adulthood. This doesn’t mean the future is bleak — it simply means that ADHD is something many people learn to manage over time.

Most children with ADHD do very well in the long run. As they grow, many learn strategies that help them stay focused, manage responsibilities, and handle school, work, and relationships successfully.

Resources

If you’d like to learn more about ADHD in children, these resources offer reliable information for families and caregivers:

• American Academy of Pediatrics (AAP)
• American Psychiatric Association (APA)
• Centers for Disease Control and Prevention (CDC)
• Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
• ADDitude: ADHD Science & Strategies
• Mental Health Center Kids: ADHD Worksheets for Children