This post was written by Dr. Reshma Khatri, PPG – Pediatrics.
Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurobehavioral disorder in children. The major components of this disorder are developmentally inappropriate levels of inattention and hyperactivity/impulsivity, which result in functional impairment in one or more areas of academic, social and emotional function. In addition to the propensity for children to have some compromise of academic and emotional function, children with ADHD also have a higher frequency of co-occurring learning, cognitive, language, motor and mental health disorders. In adolescence, hyperactivity often wanes but impulsivity and inattentiveness may persist.
ADHD has a polygenetic inheritance (runs in families). Intrauterine exposure to alcohol, smoke or opioids increases the chance of developing ADHD. Children with genetic, neurologic and neurodevelopmental disorders, have a higher chance of developing symptoms of ADHD.
Why are ADHD diagnoses increasing?
With advancements in social media, there is more awareness of ADHD among parents and schools leading to increased testing rates in younger children.
When should parents seek evaluation?
The Connors and Vanderbilt Questionnaires are easy tools for an initial evaluation. The diagnosis of ADHD is behaviorally defined and derived from history. To make a diagnosis, the child needs to display symptoms for more than six months and in at least two settings (home and school or place of occupation). Symptoms also need to have started before 12 years old. Your primary care provider will evaluate the forms from the parent and the teacher(s) and make a diagnosis based on the history and evaluation in the office.
If symptoms of inattention or hyperactivity are persistent, occur in multiple settings and/or interfere with functioning, it’s worth seeking evaluation. Start with the Connors and Vanderbilt forms and your pediatrician, and escalate to neuropsychology if there’s concern for dyslexia, a learning disability, diagnostic uncertainty or an inadequate response to treatment, if needed. Many conditions overlap with ADHD, so a careful medical evaluation is essential.
Are there other medical conditions that may cause signs and symptoms like ADHD?
The following conditions can present with symptoms like ADHD:
- Sleep apnea, sleep deprivation or poor sleep hygiene
- Language delay, hearing issues, dyslexia or any other learning disabilities
- Oppositional or conduct disorder
- Anxiety or depression
- Substance use disorder
- Undiagnosed seizure disorder (absence seizures)
- Undiagnosed anemia
- Family stressors (domestic violence), PTSD or unrealistic expectations
How important is it to involve children in their own care plan?
Involving children in their ADHD care plan is essential. It empowers them, improves treatment outcomes and ensures a smoother transition to adult independence.
Practical strategies
- Younger children: Parents remain primary managers. Keep the routines simple (pills with breakfast, time reminders).
- Tweens: Introduce alarms, pillboxes or visual checklists. Start monitoring eating and sleep routines.
- Adolescents: Encourage independent tracking of medication timing, effect and side effects, including appetite and sleep. Have them report back at appointments.
- Transition to adulthood: By late high school, teens should be able to describe their treatment plan, recognize medication effects and schedule refills with parental oversight.
Managing ADHD: An overview
Young children
- Primary approach: Behavioral therapy first, then add medication, only if needed.
- Read to or with the child. This helps increase attention span.
- Therapy: Focus on organization, sleep and behavior. Parental involvement is key.
- Medication: Work with the child’s provider to decide if they would benefit from stimulants or non-stimulants (some aid sleep). These should be used only when therapy isn’t enough.
Middle school/adolescents
- Combined approach: Medications, behavioral therapy and school support.
- Therapy: Helps with organization, focus, anxiety and depression.
- Medication: Usually needed. Teens should learn to notice when it wears off.
- Ensure good sleep hygiene.
- School support (504/IEP), which may include:
- Extra time on tests/assignments
- Preferential seating
- Visual/memory aids
- Note-taking tools
- Regular home-school communication
Adolescents into adulthood
- Symptoms: Hyperactivity may fade. Impulsivity/inattention often persist.
- Focus: Continued medication and 504 as needed. Build self-awareness (when medication wears off) and organization skills.
- Support: Therapy, self-help material (books, audiobooks, podcasts) and tools for time and focus management.
- Activity: Daily physical activity balanced with time dedicated to homework and sleep.
Re-evaluate the progress and efficacy of treatment every few months.
What is the correlation between screens/technology and ADHD?
A 2018 systematic review found a statistically small relationship between screen media use and attention-deficit/hyperactivity disorder (ADHD)–related behaviors. This association is theorized to be stronger for video games than traditional TV.
It’s also known that the use of screens close to bedtime decreases both quantity and quality of sleep and could affect memory the next day. Fast paced games and violent games may increase the chance of developing attention issues, especially in younger children. There is continued research in this area.
Sources
Attention-Deficit/Hyperactivity Disorder
Meghna Rajaprakash, MSc, MD, Mary L. Leppert, MB, BCH
Pediatr Rev (2022) 43 (3): 135–147.
Published: March 2022
Articles| January 01, 2023 – The Health Effects of Video Games in Children and Adolescents Daniel Alanko, MD
Pediatr Rev (2023) 44 (1): 23–32.
