Behavior is one of the main things under review when diagnosing attention deficit hyperactivity disorder (ADHD) in children. The mental health disorder is estimated to affect at least 6.1 million U.S. children, according to the Centers for Disease Control and Prevention (CDC), which reports that boys are more likely to be diagnosed with the disorder than girls.
It can be challenging for parents to tell the difference between ADHD and normal child behavior. Children cycle through a great deal of changes as they develop, so their behavior changes as a result of that. They also can experience changes due to a medical or mental health condition they have.
Some may characterize ADHD behavior as impulsive or being unable to sit still, but those characterizations do not tell the whole story or present the whole picture. Parents who are working to determine if their child has ADHD need to know that there are three subtypes of ADHD and that they each have their own symptoms, according to Everyday Health.
A child can have inattentive subtype, hyperactive-impulsive type, or a combined type of both, the website says.
Inattentive ADHD includes being easily distracted or an inability to keep up with homework assignments or school supplies. A child with inattentive ADHD could also struggle with paying attention to details or not following directions. They may also have trouble completing their assignments before moving on to others. Other signs include:
Hyperactive-impulsive ADHD fits more closely with what comes to mind when ADHD is mentioned. Children with this condition are often unable to sit still and exhibit impatience. They also may struggle with staying in line and waiting to take their turn, and they may be unable to avoid speaking out loud or blurting things out, according to Everyday Health. Other signs include:
If a child exhibits behaviors of the first two types, then they may be dealing with a combination of both types of ADHD.
Tiffany R. Farchione, M.D., a child psychiatrist who reviews ADHD drugs for the Food and Drug Administration (FDA), shares that boys are more likely to have the hyperactive-impulsive type. This ADHD type is easier to notice in children than the quieter children who are having problems paying attention.
Parents concerned about their child having ADHD should first seek a formal diagnosis from a licensed mental health professional, such as a psychologist, pediatrician, or other professional who is qualified to make it.
Having a professional’s opinion can also help rule out other causes for the child’s behavior. For example, they may have behavioral problems because they are having trouble with seeing or hearing. They also may have other or additional mental health disorders that need to be addressed. It is possible to have co-occurring disorders or have a disorder that mirrors the symptoms of another one unrelated to ADHD.
As the CDC notes, this is important because it ensures a proper diagnosis and treatment for the affected child. It also can help professionals determine how many children are affected by ADHD, which, in turn, affects how public health is affected by the condition.
The professional will ask questions about the child’s behavior and condition and consult with the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) before making an official diagnosis. Confirming the symptoms with the criteria in the manual can help parents and the mental health professional they are working with to determine how to go about treatment for the affected child.
After a diagnosis is made, the next big task is determining how to approach treatment and what treatment will involve the child.
The American Academy of Pediatrics (AAP) offers guidance in this area. It recommends that preschool students enter behavior therapy. When it comes to children who are older than preschool age, guidance is not specific enough, according to the AAP. This could mean parents and mental health professionals will have to join forces in figuring out the best therapy path for the affected child.
When it comes to using prescription medications for the child, AAP’s guidance is the same. It recommends using stimulant medications, methylphenidate, and amphetamines in their various forms. AAP writes that “atomoxetine and the extended-release alpha-2 agonists guanfacine and clonidine remain the secondary alternative medications.” It also mentions that treatment medications also include extended-release alpha-2 agonists, which are Food and Drug Administration (FDA)-approved.
Generally, the FDA has approved stimulants and non-stimulants that can be used to treat ADHD ADHD in children as young as age 6. Stimulants speed up the central nervous system, and they are the most widely used medications for this condition. These drugs can stay in the body at varying lengths of time.
Non-stimulant drugs to treat ADHD were first approved by the FDA in 2003. They do not work as fast as stimulants do, but they stay in the body for up to 24 hours, and they could be a better treatment approach for children who cannot handle stimulant drugs. These drugs include Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine).
The medical or mental health professional treating your child could recommend that you use bupropion for ADHD. It is not an FDA-approved medication, but HealthyChildren.org, an AAP website, reports that the medication was studied for use during ADHD treatment. Check with the medical professional you are working with to see which set of medications would benefit your child.
There are side effects to medications in both groups, even the non-stimulant drugs. According to HealthyChildren.org, side effects are minimal, but they include irritability, decreased appetite, insomnia, and others. In the case of bupropion, higher doses could bring on seizures and hallucinations in some people.
It is possible for a child to age out of needing medication for the ADHD symptoms. The American Academy of Child and Adolescent Psychiatry advises that you should consult with your doctor before taking your child off medication. The academy lists the following signs that indicate it may be time to reduce your child’s medication or take them off it altogether.
It is important to follow up if you suspect your child has ADHD. It is also important to follow up with treatment if your child has been formally diagnosed with a mental health disorder. According to the American Academy of Child and Adolescent Psychiatry, leaving the mental health disorder untreated can bring serious consequences. Some of the difficulties that can result include:
According to the FDA, research shows that children with untreated ADHD are taking to the emergency room more often. They also are said to be more likely to inflict harm on themselves than children who have received treatment.
ADHD can follow people into adulthood. Thirty to 60 percent of people diagnosed with the condition during childhood must continue to manage it. A person who does not know they have ADHD can make it to adulthood and struggle with many areas of life without knowing why. They may:
Failing to get treatment for a person can also lead to them using drugs or alcohol to self-medicate to deal with the symptoms. This is discouraged as it can also put someone on the path to dealing with a substance use disorder in addition to dealing with ADHD.
If they do develop a SUD while coping with ADHD, there is treatment and hope. People with co-occurring disorders are encouraged to enter a professionally run substance use treatment program that focuses on treating the addiction and the mental health disorder at the same time.
Using an integrated approach to treatment gives dually diagnosed people the best chances to learn how to use healthy coping strategies and tools and the proper medications they need to manage both conditions.
In conclusion, there are ways to tell the difference between ADHD and normal behavior. It starts with observation and following up on any concerns you have for your child. Seek a professional opinion and start professionally guided treatment as soon as possible to improve your child’s mental health and well-being.
U.S. Centers for Disease Control and Prevention. from https://www.cdc.gov/ncbddd/adhd/index.html
U.S. Centers for Disease Control and Prevention. from https://www.cdc.gov/ncbddd/adhd/data.html
Rothman, J., Orenstein, B., Bowers, E., Rauf, D., & By. (n.d.). Unruly behavior vs. symptoms of adhd: How can you tell?: Everyday health. from https://www.everydayhealth.com/adhd/distinguishing-bad-behavior-from-symptoms.aspx
Commissioner, Office of the. “Dealing with ADHD: What You Need to Know.” U.S. Food and Drug Administration, FDA. from https://www.fda.gov/consumers/consumer-updates/dealing-adhd-what-you-need-know
“Non-Stimulant Medications Available for ADHD Treatment.” HealthyChildren.org. from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Non-Stimulant-Medications-Available-for-ADHD-Treatment.aspx
Wolraich, M., & Jr., J. (2021, March 14). Updated ADHD GUIDELINE addresses evaluation, diagnosis, treatment from Ages 4-18. from https://www.aappublications.org/news/2019/09/30/adhd093019
American Academy of Child & Adolescent Psychiatry. (n.d.). Frequently asked questions. from https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/FAQ.aspx#question6
ADDitude Editors Medically reviewed by Sharon Saline, Editors, A., & Saline, S. (2021, February 05). Adhd statistics: New add facts and research. from https://www.additudemag.com/the-statistics-of-adhd/