Attention deficit hyperactivity disorder (ADHD) is a long-term problem that results in poor concentration and control of impulses. It can affect a child's learning and social interactions, and can have a big impact on family functioning.
It's estimated one in 20 children in Australia have ADHD. It is more common in boys than girls.
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 good supports at home and school, and, in some cases, medication treatment, a child with ADHD can live a successful life.
Signs and symptoms of ADHD
The main signs and symptoms of ADHD include:
- inattention – difficulty concentrating, forgetting instructions, moving from one task to another without completion
- impulsivity – acting without thinking, talking over the top of others, losing control of emotions easily, being accident prone
- overactivity – constant fidgeting and restlessness.
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.
It is important to remember that all young children have a limited attention span and sometimes do things without thinking, but only a few have ADHD. However, if your child has symptoms of ADHD, which are causing problems for your child, you should have your child assessed for ADHD and related problems.
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 initially. 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 pathologist, may also 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.
The most effective treatment for the symptoms of ADHD is stimulant medication, which has been the standard treatment for children with ADHD since the 1970s. 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 and dexamphetamine. Both have similar actions and side effects. Stimulants can be short acting or long acting. The short-acting forms usually last about three to four hours while long acting forms can last between six 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.
Some 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. There are no withdrawal effects.
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.
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
There are many non-medication treatments that may have some benefits for some children with ADHD, such as fish oil. Exclusion diets are not usually helpful, but good nutrition is important.
Key points to remember
- Children with ADHD are inattentive, impulsive and sometimes overactive, but not all children with these symptoms have 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.
- Most children with ADHD also have other problems that need to be addressed, such as learning difficulties, anxiety and sleep problems.
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
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.
Does my child really need medication? Is it 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. 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.
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 February 2021.
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