Kids Health Info

Attention deficit hyperactivity disorder (ADHD)

  • Attention deficit hyperactivity disorder (ADHD) is a chronic problem that results in poor concentration and control of impulses. It can affect a child's learning and social skills, and can have an impact on family functioning.

    It's estimated one in 20 children in Australia have ADHD. It is more common in boys than girls. 

    Some children have ADHD, but without the hyperactivity. These children have trouble focussing and paying attention, and can be forgetful and easily distracted. Sometimes the term ‘inattentive ADHD’ is used to describe this condition.

    The exact causes of ADHD are unknown, but it tends to run in families, so genes play some part. ADHD is not caused by poor parenting.

    With understanding, care and, in some cases, medical treatment, a child with ADHD can live a normal life. 

    Signs and symptoms of ADHD

    Common signs and symptoms of ADHD include:

    • inattention – difficulty concentrating, forgetting instructions, moving from one task to another without completion
    • impulsivity – talking over the top of others, losing control of emotions easily, being accident prone, acting without thinking
    • overactivity – constant fidgeting and restlessness.

    It is important to remember that all young children have a limited attention span and sometimes do things without thinking, but only a small number of children have ADHD. However, if your child has more than one of the symptoms of ADHD, the symptoms are causing problems for your child, and they have been ongoing for more than six months, you should have your child assessed for ADHD.  

    When to see a doctor

    A diagnosis of ADHD must be made by a trained and experienced health professional. If you are concerned about your child, see your GP. They can arrange a referral to a paediatrician or a child psychologist, who will be able to assess your child.

    It is important to make sure the symptoms are not caused by something else, which may need different treatment. There is no test for ADHD – the assessment is made using a wide range of information provided by both the family and your child’s school. Other health professionals, such as a speech therapist, may become involved in your child's assessment.

    Most children with ADHD also have other related problems, such as learning difficulties, sleep problems or anxiety. These need to be assessed and managed alongside the ADHD.

    Treatment for ADHD

    You can help your child manage their ADHD symptoms by using positive parenting strategies, along with a range of home and classroom strategies. These include sticking to a routine, building social skills and planning your child’s learning environment. Sometimes counselling for your child or the family is also needed. See our fact sheet ADHD – ways to help children at school and home.

    If after trying these strategies your child’s symptoms are still having a big impact on their life, your doctor may recommend medication.

    Stimulant medication

    The most effective treatment for the symptoms of ADHD is stimulant medication, and it has been the standard treatment for children with ADHD since the 1980s. About one to two per cent of children in Australia are prescribed stimulant medication.

    Stimulants act on the parts of the brain involved in controlling attention and arousal (being alert and awake). These medications greatly improve concentration, impulse control and hyperactivity in about 80 per cent of children with ADHD.

    The two most common stimulants used in Australia are methylphenidate (e.g. Ritalin) and dexamphetamine (e.g. Vyvanse). Both have similar actions and side effects. Stimulants can be short acting (e.g. Ritalin 10) or long acting (e.g. Ritalin LA, Concerta, Vyvanse). The short-acting forms usually last about three to four hours. Ritalin LA lasts six to eight hours, and Concerta and Vyvanse last around eight to 12 hours.

    In Australia, stimulant medications are regulated and can only be prescribed by paediatricians, child psychiatrists or neurologists (and GPs in certain situations).

    Stimulant medication is probably the most highly researched of any medication prescribed for children. They are not addictive in the doses used to treat ADHD. Some children only take them on school days, and don’t experience any withdrawal effects on weekends.

    Non-stimulant medications are also available, for example, atomoxetine (Strattera), clonidine and guanfacine (Intuniv). These medications can be helpful for some children with ADHD, such as those who experience side effects with stimulants.

    Side effects of stimulant medications

    The most common side effect of stimulants is decreased appetite (especially for lunch), which can sometimes affect weight gain. Less common side effects include:

    • stomach aches
    • headaches and dizziness
    • difficulty falling asleep
    • the child becoming irritable, withdrawn or highly emotional.

    Many children will have no side effects at all. If side effects do occur, they can often be managed by changing the dose or the time that the medication is given. If more severe side effects occur, stimulants can be stopped immediately without needing to slowly reduce the dose.

    It is possible that stimulants may have a minor effect on some children's growth (height), so this needs to be monitored along with their weight.

    Stimulant medication may cause a very small increase in heart rate and blood pressure. This is extremely unlikely to cause any problems for children with normal hearts. Your child may require tests before starting stimulant medication if they have a known heart or blood vessel abnormality, or a family history of heart problems.

    Follow-up

    Children taking stimulant medication need to be monitored by their treating doctor. This should happen regularly in the early phase of treatment, and at least every six months while the child is taking stimulants. In particular, height, weight, heart rate and blood pressure should be checked.

    Fish oils – what the research says

    Omega-3 fatty acids, which are found in fish and sea food, are important for parts of the brain used for memory, learning and reasoning. Children with ADHD have been found to have lower levels of omega-3 than children without ADHD.

    Increasing omega-3 levels may reduce the severity of ADHD-type behaviour, such as inattention, in some children. However, not all fish oil studies have shown improvements in ADHD-type behaviour, and there are not enough good-quality studies to be certain of its benefit.

    Your child should not take fish oils if they have a known hypersensitivity to fish oils, have a have a bleeding disorder, or are taking anti-coagulant or antiplatelet medicine. Otherwise, taking fish oil is considered safe and may help your child.

    Key points to remember

    • Children with ADHD are inattentive, impulsive and sometimes overactive, but not all children with these symptoms have ADHD.
    • Some children have ADHD, but without the hyperactivity – this is also known as inattentive ADHD.
    • No test can diagnose ADHD – assessment by a doctor or psychologist involves gathering information from families and schools.
    • Positive parenting strategies, school support and counselling can help most children with ADHD.
    • Stimulant medication is the most effective treatment for the symptoms of ADHD.

    For more information

    Common questions our doctors are asked

    My preschooler is very hyperactive and impulsive. Can I have him tested for ADHD?

    Usually, children must be at least about five years old to be assessed for ADHD. Many younger children show the signs of ADHD, but this is within the normal range of behaviour for their age. In some cases, especially when there is a strong family history of ADHD, a child may be assessed at a younger age. Discuss this with your child's doctor.  

    If my child doesn’t have ADHD, what else could be causing her behaviour?

    There may be a number of reasons for children being inattentive, impulsive or hyperactive, such as health or emotional problems, learning difficulties or lack of sleep. Talk to your GP if you are worried.

    Will my child grow out of his ADHD?

    Some adults have ADHD, and your child may still have ADHD symptoms when they are grown up. Most children manage their symptoms better as they get older, and many people no longer have symptoms by the time they are adults.     

    I've seen media reports about kids being on 'speed'. Is stimulant medication really the same as speed? Does my child really need this medication?

    The stimulant medications used to treat ADHD do not have the same ingredients as recreational drugs (such as speed). Stimulant medications are proven to be the best way to treat ADHD symptoms. The stimulants prescribed for children with ADHD are considered to be extremely safe, and they are probably the most highly researched of any medication prescribed for children. In the doses given to children to treat ADHD, stimulant medications are not addictive. If positive parenting strategies, school support and counselling haven’t helped, and your child’s symptoms are interfering with their social, emotional or school life, your doctor may recommend stimulant medication.


    Developed by The Royal Children's Hospital General Medicine department and Centre for Community Child Health. We acknowledge the input of RCH consumers and carers.

    Reviewed March 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit  www.rchfoundation.org.au.

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    Disclaimer
    This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.