ADHD in children and young people

Attention-deficit hyperactivity disorder (ADHD) is a condition that often becomes obvious in early childhood before 12 years of age. However, difficulties may become clearer in adolescence as the demands placed on young people increase. People with ADHD might struggle with:

• inattention – finding it hard to concentrate
• hyperactivity – feeling restless and struggling to sit still
• impulsivity – saying or doing things without thinking about the consequences first.

Some of these problems, such as hyperactivity, might be more obvious in younger children.

ADHD is a neurodevelopmental disorder. These are a group of conditions that become noticeable typically in childhood or adolescence. They can cause difficulty with day-to-day functioning in different areas. Other neurodevelopmental disorders include autism and dyslexia.

Many children, especially young children, can struggle to concentrate or sit still for long periods of time. This does not necessarily mean that they have ADHD. Some children are just more restless or excitable than others.

Our ability to focus naturally improves as we get older. For example, a 12-year-old can usually pay attention for much longer than a two-year-old. It can be helpful to think about how your child compares with children and young people the same age as them.

Children and young people with ADHD will find it much harder to focus, and will be more hyperactive and impulsive than their peers of the same age. These challenges can negatively affect their school or home life. In this resource, we look at what ADHD is and how it is different from more common challenges children can have with attention, hyperactivity or impulsivity.

Recent studies suggest around five in every 100 children have ADHD.

Boys are more likely to be diagnosed with ADHD than girls. For every two boys diagnosed with ADHD, one girl is diagnosed. However, in adults the diagnosis of ADHD in men and women is more equal. For every three men diagnosed with ADHD, two women are diagnosed.

This might be because, as children, boys are more likely to show hyperactive and impulsive symptoms. These are more noticeable than inattentive symptoms. Girls may be more likely to cover or mask their difficulties, such as by becoming withdrawn or anxious. This can make it more difficult to diagnose ADHD in girls. It can also lead to them and their families being less likely to seek treatment.

For most people, ADHD is caused by a combination of genetic and environmental factors. These are differences in the genes that make up someone’s body, and what happened when they were in the womb and after they were born.

Research has shown that ADHD is more common in children and young people who:

• have a sibling with ADHD
• have neurodevelopmental disorders like autism
• have epilepsy
• were born prematurely
• have been in care
• have had a brain injury.

This does not necessarily mean that these things cause ADHD.

No one is ‘to blame’ for ADHD, and it can’t be ‘prevented’ or ‘cured’. Instead, people with ADHD can benefit from support at school and at home.

The kinds of symptoms people with ADHD have will depend on their age and the environment they are in. For example, whether they are doing something they enjoy or not.

You can see a full list of the symptoms of ADHD in adults, but below we have explained how these symptoms might appear in children and young people:

Inattention

Children and young people who struggle to pay attention might:

• make simple or seemingly careless mistakes in schoolwork or activities. They might misread or skip questions
• forget to do something they have been asked to do like putting their clothes away or brushing their teeth
• have difficulty planning, managing and organising schoolwork
• lose or forget things, like their homework or house keys
• struggle to listen when being spoken to, and struggle to follow instructions properly
• not finish tasks or start lots of projects but not finish them
• seem forgetful, distracted or to be daydreaming.

Hyperactivity and impulsivity

Children and young people who are hyperactive and impulsive might:

• Struggle to sit still – This can be difficult at school, as they might find it very hard to sit in their chair quietly during a lesson. Or they might feel restless and uncomfortable when sitting still. 
• Be full of energy – Most young children can be energetic and excitable. However, children and young people with ADHD might struggle to calm down or to be quiet in settings where this is expected of them.
• Talk over others or struggle to wait their turn.
• Act without thinking even if something might be potentially dangerous or risky.

These challenges are experienced in multiple places such as in school and home life, and are likely to cause problems in each setting. How these problems appear in each setting may be different depending on how that setting is structured.

Children and young people with ADHD can sometimes seem disruptive or rude in certain settings, like the classroom. However, they probably won’t be doing this on purpose. It is important that children and young people with ADHD get the support and understanding they need, and are not punished. Parents and teachers can make a positive difference to the lives of children and young people with ADHD by:

• encouraging their enthusiasm and creativity
• and helping them to engage positively in different environments.

Intellectual disabilities and ADHD

Children and young people with an intellectual disability (also known as a learning disability) can present with similar patterns of behaviour as those present in ADHD. For children who have both ADHD and an intellectual disability, one condition might disguise or emphasise behaviours of the other.

ADHD is not something that disappears as people grow up. However, it can become less noticeable with some people experiencing fewer symptoms as they get older. It can also get easier for children and young people to manage their ADHD as they get older. This will depend on the kinds of things that they struggle with.

Some children and young people struggle more as they get older, as they receive less support from family. For example, some people with ADHD manage well when they are younger. However, when they leave home for university or work they can struggle to organise themselves without help.

Read more about ADHD in adulthood.

If you think your child may have ADHD, start by speaking to your GP. They should ask you and your child:

• what challenges they are experiencing
• how significant these challenges are
• which situations and settings they happen in.

They may be able to refer you and your child to an ADHD-focused support group. This could be helpful if you are waiting for further support or an assessment. Your GP should then offer to review how things are after a few months. If the difficulties are still present, they may then refer your child to a specialist service for an ADHD assessment.

You can also speak with your child’s teacher or their school’s Special Educational Needs Coordinator (SENCo) about your concerns. They may be able to suggest changes in the classroom that could help your child in the meantime. They may be able to let you know of any local ADHD-focused support groups or parent training available. The SENCo may also be able to refer your child for an ADHD assessment.

If you are in Scotland, you can speak with someone in the Senior Leadership Team at your child’s school about your concerns.

We know that waiting lists for assessments can be very long, which means some people have to wait a long time for a diagnosis. How long you have to wait might depend on where you live.

There is no one test for ADHD. To make an ADHD diagnosis, a specialist with training in ADHD will need to assess your child and consider their:

• behaviour
• symptoms in different areas of their life, i.e. at school, home, etc.
• medical history, including any other current or previous conditions
• mental health.

An ADHD diagnosis is made by:

• recognising patterns of behaviour
• observing your child
• talking to you and your child, and their other parents or carers, about the challenges they are having
• understanding how they have grown and developed since birth
• looking at reports of their behaviour from school or other places.

Can I get a private assessment?

Some families choose to pay for a private ADHD assessment. It is important to check that this private assessment:

• is carried out by professionals with expertise in ADHD
• is of high quality
• meets standards such as NICE guidelines (National Institute for Health and Care Excellence)
• and includes detail on all the areas described above.

It’s also important to make sure the assessment will be accepted by your local NHS ADHD team or child and adolescent mental health service (CAMHS). They will need to know that the assessment was of a high quality so that they have the information to treat your child safely.

Speak with your local NHS ADHD team who may be able to give you guidance about what they need in an assessment. Your child’s GP should have their contact details. It’s important to bear in mind that the way this works does vary between services.

The person who diagnoses your child should have a conversation with you and your child about how this diagnosis could affect their life. Or, if your child is older, they might want to have this conversation on their own. The person making the diagnosis should provide you both with information about ADHD.

There can be positive impacts of receiving a diagnosis, such as:

• improving you and your child’s understanding of their symptoms
• identifying and building on individual strengths
• helping your child to access the services they need.

They should also talk with you about any things that could make your child’s ADHD easier or harder to manage, and what support is available. They might suggest that you attend an ADHD-focused parent support group or parent training group. The availability of these might depend on where you live.

Developing a treatment plan

Children and young people with ADHD should have a treatment plan that covers their:

• needs
• goals
• strengths
• any other conditions they have.

You and your child should be given the chance to discuss:

• the pros and cons of different treatments, including medication
• how changes to your child’s lifestyle like diet and exercise might help
• any concerns you or your child has
• preferences for treatment
• how the treatment might be affected by other conditions.

Support at school

It might be helpful for you to share your child’s diagnosis and treatment plan with school staff if they aren’t already aware of it. Depending on how old your child is, you might want to involve them in this decision.

Informing the school about your child’s diagnosis and treatment can help them to understand:

• how ADHD affects your child
• why this should be taken seriously
• what they can do to support your child
• how they can feed back to you and your child’s medical team.

With the right support at school, children and young people with ADHD can succeed academically and socially. The kind of support your child needs will depend on their unique needs. It might also depend on what your child’s school is able to offer.

Schools and workplaces are legally required to make reasonable adjustments to support people with disabilities. This includes ADHD. We have included some examples of what these adjustments might look like in the next section.

The kind of support your child needs at school can be recorded in an individual education plan. This should be reviewed regularly with the teacher, SENCo or other support staff. Open communication between parents and teachers is crucial for supporting children and young people with ADHD. Parents and teachers can work together to develop a consistent approach to managing the child or young person’s symptoms. This can support their academic and social development.

Reasonable adjustments at home and school

Making changes to your child’s environment can be one of the most effective things you and their school can do. These changes can support them with their ADHD and improve how they are able to manage day-to-day.

There are many examples of reasonable adjustments, and these will depend on what is helpful for your child and what you and your child’s school can reasonably provide. Any changes introduced should be reviewed regularly. However, they might include:

• Changes to the physical environment – When your child is in challenging environments, such as school or exams, they might find some of the following things helpful:
  • Listening to music or wearing noise-cancelling headphones.
  • Having brighter or lower lighting.
  • Having access to a clear desk space without distractions, or something to play with to help with focus.
• Changes to routine – They might find it helpful to:
  • Take frequent short breaks when revising.
  • Receive written instructions as well as verbal instructions when you are asking them to do something.

They might also benefit from the support of a teaching assistant.

Here are some tips for home:

• Be understanding and patient. Children and young people with ADHD are not trying to be difficult. They simply have different ways of processing information and responding to their environment.
• Create a consistent and structured environment. This will help children and young people with ADHD feel more secure and help them regulate their behaviour.
• Set realistic expectations. Don't expect children and young people with ADHD to perform perfectly all the time. Celebrate their accomplishments, no matter how small.
• Teach them self-management skills. Help children and young people with ADHD learn how to plan, organise, and manage their time.
• Encourage them to participate in regular physical activity and keep a balanced, nutritious diet. Exercise can help children and young people with ADHD to focus, and reduce their symptoms.
• Be kind to yourself. Being a parent of a child or young person with ADHD can feel challenging at times. Parent support groups locally or online can be helpful spaces to share experiences and get advice.

Medication

Medication should only be offered to children and young people if:

• their ADHD symptoms are causing significant challenges and
• environmental modifications have been tried and reviewed.

Children under the age of five should not be prescribed ADHD medication without a second specialist opinion from an ADHD service with expertise in managing ADHD in young children.

Before starting medication

Before starting medication, the person treating your child should:

• check their mental and physical health
• inform you and your child about the risks associated with taking stimulant medications if they have any other health conditions
• support you to monitor for any side-effects.

Once your child is taking a medication that is working for them, it should be reviewed every year. They should have physical check-ups every three to six months depending on their age.

Different medications

There are several different medications available for treating ADHD. These fall into two groups:

Stimulant medications:

• methylphenidate
• dexamfetamine

Non-stimulant medications:

• atomoxetine
• guanfacine

These medications are known by different brand names.

Stimulant medications increase the availability of neurotransmitters (chemicals in the brain). Two neurotransmitters, dopamine and noradrenaline are found in in areas of the brain that help to control attention and behaviour.

Many people wonder why simulant medications are used to treat a condition that causes hyperactivity. These medications strengthen a part of the brain that can help to control the areas of the brain that drive hyperactivity. They do not cure ADHD. They help to control the symptoms of poor attention, overactivity or impulsivity.

There is good scientific evidence for using stimulants to treat ADHD. In most people these drugs are effective, safe, and have few side-effects. You will usually be able to tell quickly if they are helpful or not. You can read more about this in the next section.

Non-stimulant medications increase the availability of noradrenaline or mimic its effects. They tend to take longer to start having an effect than stimulant medications. They are generally used if stimulant medications haven’t worked for your child or if they find them difficult to take. 

The medication needs to be built up gradually to minimise any side-effects and to find the right dose for your child. Most people get noticeable benefits from the first medication they try. Other people might need to try a different medication to get the best results.

How do I know medication is working?

If ADHD medication is working, you will find that:

• your child’s concentration is better
• their feelings of restlessness or over-activity are less
• they find it easier to control themselves.

Sometimes school or teachers notice the improvement before you do. You might want to let your child’s teacher know if they are starting a new medication.

Many children and young people with ADHD who use medication find it very helpful. However, there are also young people who, with the support of their parents or carers, choose not to take medication or are unable to. All medications have side-effects, and some people find these more noticeable than others.

If you are a parent or carer of a child or young person with ADHD, the person who diagnosed your child should:

• ask you how ADHD affects you and your family
• discuss any concerns you have
• encourage you to seek a parent carer’s assessment of your needs. This should be provided by your local social care authority, usually the ‘children with disabilities team’
• encourage you to join self-help groups
• offer you advice about parenting methods that could help both you and your child. For example:
  • structuring your child’s day
  • setting rules and managing behaviour
  • having positive contact with your child.

Advice about your parenting doesn’t mean that you are a bad parent. This advice should be given to all parents to help support them with this diagnosis, and the enhanced needs of their children.

If you’re a young person and have ADHD, there are some things you can do to support yourself and to get the best support possible from the people around you.

1. Talk about it

If you’ve just found out you have ADHD, you might find it helpful to talk to a trusted friend. Being given a diagnosis can bring up lots of emotions – you might feel confused, upset, or relieved. Remember, receiving an ADHD diagnosis doesn’t mean you are a different person than the person you were before. It just means that you can now get support for some of the challenges you have been having.

2. Stay active

Regular exercise is good for everyone. If you have ADHD, exercising can help to improve your mood, and this can also help to improve your ADHD symptoms. Take a look at our resource on activity and mental health. It explains why exercise is important and suggests some easy ways you can stay active.

3. Get enough good-quality sleep

Not sleeping well can make ADHD symptoms worse. Developing good sleeping habits can be challenging, but there are some things you can try:

• Develop and maintain a comforting bedtime routine, e.g. having a bath, listening to music.
• Go to bed and get up at the same time each day, including at weekends.
• Avoid screen time for at least an hour before bedtime.
• Avoid having sugar or caffeine in the evening, especially in the couple of hours before bed.
• Get enough exercise during the day.
• Keep the bedroom dark and quiet. If you can, leave a window open for fresh air.

4. Aim for a regular and balanced diet

ADHD isn’t caused by eating certain foods, but studies have shown that there is a link between certain foods and some of the symptoms of ADHD. Try to have a balanced diet that includes lots of different kinds of foods. Avoid eating a lot of highly processed food or foods that contain a lot of sugar. You can find out more about what makes a healthy diet in our resource on weight, exercise and eating disorders.

Young Minds - Young Minds is a charity that provides mental health support to children and young people. They offer advice and support for parents of children with ADHD, as well as a range of other services.

ADHD Foundation - The ADHD Foundation is a charity that provides information, support, and research into ADHD. They offer a range of services, including information and advice on ADHD and support groups.

ADHD reading list - Jessica Kingsley Publishers provides reading lists of books related to neurodiversity. This reading list includes books for children and young people and their parents on ADHD.

This information was produced by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB). It reflects the best available evidence at the time of writing.

Expert author: Dr Jenny Parker

Sections of this resource are based on the College’s ADHD in adults information resource, which was written by Dr Dietmar Hank and Dr Kate Franklin.

Full references available on request.