Evaluating and managing your child’s ADHD

Young children often exhibit hyperactive behavior or impulsivity, but when this behavior becomes detrimental to their daily functioning, parents might consider evaluating their child for ADHD. A Baylor College of Medicine developmental-behavioral specialist offers guidance for parents navigating their child’s ADHD diagnosis.

“ADHD is a disorder where a child exhibits hyperactivity and impulsivity or inattention difficulties across multiple settings and to a degree that is beyond what would be expected for their age,” said Dr. Holly Harris, assistant professor of pediatrics and developmental pediatrician at Baylor and Texas Children’s Hospital.

The earliest time to make a diagnosis or start recognizing ADHD is usually around 4 years of age. Any young child around 2 or 3 years old is not expected to have a long attention span and might have some degree of hyperactivity at baseline, which is developmentally normal at that age.

Signs and symptoms of ADHD might include a degree of hyperactivity and impulsivity that is almost impairing a child’s safety, for example, a child who cannot stop themselves from darting away in a parking lot or continuously jumps on furniture. A child experiencing symptoms of ADHD might struggle with staying on task without excessive reminders, such as cleaning up or getting dressed in the morning.

“It’s harder to recognize that in a 4-year-old because some of these things are developmentally appropriate,” Harris said. “When a child hits 5, 6, 7 years old is when it becomes easier to recognize some of the symptoms because you usually have information from the child’s school environment as well.”

Parents should be on alert if a teacher reaches out about their child being fidgety, not staying seated, acting impulsively in class or being unable to focus on work. Sometimes ADHD is more subtle, particularly if it is the inattentive subtype, and thus it appears in later elementary years. This can manifest with symptoms such as:

Older elementary or middle school-aged kids might have a hard time starting a big project because they have difficulty breaking down a big idea into smaller chunks. As they enter their teenage years, they might continue to experience problems with executive functioning – a term that encompasses how they plan for future events, how they inhibit impulses and how they organize their thoughts, among other things.

Many kids with ADHD have social difficulties with their peers because they might not pay attention well in the group setting. They might say or do something impulsively, since children with ADHD will have trouble with inhibition. This can affect their social skills, and Harris recommends parents look out for this as this can be supported by explicitly teaching social skills.

If parents want to investigate these behaviors further, start with the primary care provider as pediatricians are comfortable diagnosing and managing ADHD. The pediatrician will take the patient’s history, perform a physical examination and ask questions to assess whether or not they have suspicion for ADHD. They will typically give the parent and teacher a rating scale to rate the different symptoms of ADHD. One common scale used is the NICHQ Vanderbilt Assessment Scales.

“For an ADHD diagnosis, the hyperactivity/impulsivity and inattention have to be detrimental in some fashion. A lot of kids might have a tendency to be active or inattentive, but it has to be impairing your functioning,” she said.

There are behavior strategies parents can easily implement in the home to address behavioral difficulties that stem from impulsivity and hyperactivity. Parents and caregivers can also consider parent management training (PMT), an evidence-based therapy for ADHD. Pediatricians can also recommend behavior strategies and helpful books. Harris also suggests praising the positives.

“A lot of kids with ADHD engage in behaviors that are negative. If the parent catches them doing something good, really emphasizing that and building those positive behaviors and focusing on the child’s strengths is important,” she said.

Provide a token economy with a sticker chart or token jar that they can fill if they follow through on good behavior. Parents can decide what the child’s reward will be for earning stickers or tokens, such as picking where the family goes to dinner or having a movie night. Parents should also be consistent with their consequences for negative behavior. Set up home “ground rules” so the child knows what to expect.

Checklists or visual schedules are helpful for children as well. If they have trouble getting ready in the morning, a visual, such as Velcro board or check chart, where they can mark off their morning tasks will help them remember what comes next.

Comprehensively evaluating a child for ADHD is important if they portray symptoms. If a child is hyperactive and inattentive, parents and schoolteachers might think they are having trouble in school because of their ADHD, but it could also be another learning disability, such as dyslexia.

“If a child is still having difficulties in school despite treatment, we do recommend children with ADHD undergo a comprehensive educational evaluation because there is a high rate of co-occurring learning disabilities that can be masked,” Harris said. “It is important to have a low threshold to pursue evaluation for learning issues if difficulties persist even after you’re addressing the ADHD.”

By Homa Shalchi