What is Attention Deficit/Hyperactivity Disorder?
Attention Deficit/Hyperactivity Disorder, or ADHD, is a medical condition that makes it hard for people to regulate their attention, organize themselves, and control their impulses. For some people with the hyperactivity component of ADHD, keeping quiet, staying seated, or stopping all body movements is nearly impossible. While everyone may have occasional moments of daydreaming, fidgeting, or forgetfulness, someone with ADHD experiences these difficulties often, in multiple settings, such as home and school, over a period of at least 6 months.
The symptoms of ADHD are clustered into 3 main types of the disorder:
- inattentive type – characterized by forgetfulness, distractibility, and difficulty focusing and maintaining attention
- hyperactive/impulsive type – characterized by a tendency to act or speak before considering consequences, by restlessness, and by difficulty staying seated, keeping hands to self, or resisting the need to constantly move
- combined type – characterized by significant difficulties with both regulating attention and controlling hyperactivity/impulsivity
ADHD may significantly affect a child’s life by impairing academic activities, peer relationships, and home life. Estimates of the prevalence of ADHD among children range from 3 to 12 percent. The tendency to develop ADHD involves complex genetic and environmental factors. Although the disorder occurs more frequently in boys than in girls, its prevalence in girls is greater than previously thought. top
What Does Attention Deficit/Hyperactivity Disorder Look Like in Children and Adolescents?
During the toddler and pre-school years, difficulties with paying attention, staying still, and controlling impulses are expected in children. For example, children ages 2-3 are expected to be curious about their environment and to shift their attention from one toy to another. Similarly, young children are expected to move frequently as they explore their world. As children progress through childhood, however, most of them develop the ability to regulate their behavior and sustain concentration on tasks as needed. Children with ADHD, in contrast, do not attain age-appropriate levels of self-control, organization, and concentration. ADHD symptoms generally appear before age 7, although for a variety of reasons, some children are not diagnosed until later.
Children with the inattentive type of ADHD are often not identified until a pattern of concentration problems leads to lower academic performance. Yet they face a variety of challenges, including frequent forgetfulness and boredom, trouble remembering instructions and responsibilities, problems with focusing, and an aversion to mentally challenging tasks. The same child with significant difficulties sustaining attention, organizing tasks, and completing homework, however, may be able to focus attention for long periods of time on pleasurable activities that require focused attention, such as videogames or artistic pursuits.
Children with inattentive symptoms may be described as “daydreamers” or “spaced out.” Often, these children are more socially withdrawn and have more frequent problems with mild anxiety than children with the hyperactive/impulsive type of ADHD. Symptoms of inattentiveness may be difficult for others to detect, and many children – especially girls – with the inattentive type of ADHD are diagnosed much later or are never identified. Girls are more likely to have the inattentive type of ADHD, and, for a variety of reasons, girls are less likely to be diagnosed with ADHD or treated for their symptoms.
Children with hyperactive/impulsive symptoms of ADHD have difficulty controlling their actions. Their impulsive tendencies are often misunderstood as rudeness, disregard for others, or willful disobedience. These children tend to explore new settings with enthusiasm and touch objects without asking for permission. Their unrestrained behavior may lead to careless accidents (broken possessions or physical injury), the disapproval and irritation of others (due to difficulties waiting one’s turn or respecting others’ rules), and potentially dangerous situations (for example, darting across the street before looking both ways). Because this behavior is often disruptive to others, ADHD with hyperactivity and impulsivity is typically identified more easily than the inattentive type. The hyperactive type of ADHD appears to be more prevalent in boys than in girls.
All children with ADHD may struggle with low frustration tolerance and trouble following rules. Often they are “poor sports” in games, and they may seem intrusive or bossy in their play. As a result, children with ADHD face social challenges because their peers may perceive them as immature and annoying. They may be taunted by peers or tricked into getting into trouble with adults. Whereas older adolescents are able to describe their difficulties due to ADHD, children frequently have trouble identifying their underlying difficulties. Instead, children with ADHD are often only aware that they get into trouble more often than their peers, leading to self-doubt and low self-esteem.
Generally, as a person with ADHD goes through adolescence into adulthood, symptoms of hyperactivity and impulsivity decrease. Until recently it was therefore assumed that ADHD is outgrown in childhood, but it is now known that many children with ADHD continue to experience impairing symptoms into adulthood. When children are diagnosed with the disorder, it is not uncommon for parents to discover their own symptoms of ADHD that were never previously recognized or identified.
Early identification of the underlying disorder and a comprehensive treatment plan can help avert many difficulties. A trained clinician (such as a child psychiatrist, child psychologist or pediatric neurologist) should integrate information from home, school, and the clinical visit to make a diagnosis. top
► At Home
At home, children with inattentive symptoms of ADHD may have a combination of the symptoms listed below.
- Difficulty paying attention or shifting attention
- Difficulty ignoring distractions such as sounds or nearby activity
- Appearance of not listening to the person speaking to them. Children may appear to daydream often.
- Frequent careless mistakes in homework or activities
- Frequent forgetfulness of tasks and instructions. A child may forget instructions halfway through the chore (for example, when told, “Sweep up the leaves, put them in the garbage bags, and move the bags to the sidewalk,” a child may only sweep up the leaves before beginning another activity).
- Frequent misplacing and losing items such as toys or school materials
- Difficulty completing tasks due to problems staying focused. Tasks that are repetitive or tedious (for example, household chores, homework that requires a lot of copying or coloring) are often avoided altogether.
- Difficulty organizing tasks. Projects that require planning and carrying out multiple steps are particularly challenging.
- Avoidance of activities that demand continual concentration such as homework
At home, children with hyperactive and impulsive
symptoms may have a combination of the symptoms listed
- Frequent fidgeting with hands or feet and difficulty sitting still. Adolescents may feel constantly restless.
- Difficulty staying seated when sitting is expected, such as during meals or at school
- Running or climbing in inappropriate places
- Difficulty playing quietly. Children may constantly seek interactions with others.
- Talking more than is appropriate or difficulty providing a simple answer
- Seemingly “on the go” or “driven by a motor” in their activities or thoughts. These children sometimes just keep going, long after they should be tired, and seem unable to wind down.
- Blurting out answers before a question is completed
- Difficulty waiting in line. Children may want to be first in line, may become fidgety while waiting their turn in line, or may lose their patience.
- Interrupting others who are already involved in an activity
All young people with ADHD are at elevated risk for:
- Low self-esteem, because they are not able to control their attention and behaviors like other children, and because achieving academic success is likely more difficult than for most of their peers. Children with ADHD may continue to make mistakes frequently, despite their efforts to follow instructions. With peers and adults reminding them of their many errors, they may have difficulty seeing that they do anything well.
- Problems with peer relationships, because of low frustration tolerance, difficulty following rules, intrusive play, or bossiness. Other children may not want to play with them.
- Experimentation with alcohol or drugs as a way to reduce academic and social frustrations, especially if frequent and serious fights, arguments, or rule-breaking behaviors are involved. Drugs and alcohol can themselves produce or worsen ADHD symptoms.
- Depression or thoughts of not wanting to be alive, which may develop if children believe that nothing will help reduce their symptoms top
► At School
At school, children with ADHD may experience a combination of the symptoms listed below, in addition to those listed above.
- Difficulty paying attention, focusing on schoolwork, and listening to directions. A child with ADHD may be easily distracted by peers, sounds, or even artwork on classroom walls.
- Problems organizing schoolwork and remembering tasks. Multiple-part verbal directions, such as requesting a student “turn to page 133 in your math book, complete problems 1-6, then begin reading pages 20-25 in your history book,” may be confusing. Homework assignments and textbooks may be forgotten or misplaced frequently, and papers and notebooks may be quite cluttered.
- Inability to sit still and remain seated. Children with ADHD may not know why it is difficult for them to sit still. They may be unable to sit quietly, despite frequent reminders to do so.
- Difficulty waiting their turn in line, waiting to give an answer during class, or waiting their turn during games. These children may appear impatient or may insist upon being first. These behaviors can be misunderstood and can easily annoy others.
- Learning disorders are common in people with ADHD. A child’s difficulties in school should not be presumed to be due entirely to ADHD. If the child still has academic difficulty after ADHD symptoms are treated, an educational evaluation for a learning disorder should be considered. A child’s repeated reluctance to attend school may be an indicator of an undiagnosed learning disability.
- Other mental health conditions, compounding any learning and behavioral challenges. Having one mental health condition does not “inoculate” the child from having other conditions as well. Children with ADHD commonly have co-existing mood and anxiety disorders.
- Speech and language problems that may need evaluation by specialists
- Side effects from medications. Medications
may have cognitive or behavioral effects or physically uncomfortable
side effects that interfere with school performance. After
a child begins receiving medical treatment for symptoms, any mood
changes or new behaviors should be discussed with parents, as
they can reflect medication side effects. top
► At the Doctor's Office
Symptoms of ADHD may be evident during an office visit when children
with hyperactivity and impulsivity have difficulty sitting
still. However, other children may not show symptoms at the doctor's
office if they are able to control their behavior for short periods
of time or appear to pay attention during the appointment. Clinicians
will benefit from talking with parents, school staff, and other
important caregivers to evaluate a child’s functioning in
each area to determine the underlying cause of the child’s
Clinicians may encounter some of the following challenges in diagnosing and treating a child or adolescent with ADHD.
- Symptoms vary over time and their appearance changes
as a child grows. A clinician may need to see a child over time
to determine the appropriate diagnosis.
- Other behavioral conditions may look like ADHD or may
co-exist with ADHD. Failure to follow rules and instructions
may be due to a behavior disorder such as conduct
disorder (a condition involving repeatedly breaking
societal rules or violating individual rights of others) or oppositional
defiant disorder (a condition causing argumentative
and defiant behavior with a number of different adults). Alternatively,
a child’s problems with breaking rules may be mistakenly
attributed to another behavior disorder when, in fact, the symptoms
are due to ADHD.
- Anxiety disorders may look like ADHD, because
a child’s anxiety can produce agitation or difficulty concentrating.
Anxiety conditions include generalized anxiety disorder
(constant anxiety in multiple settings), social
phobia, (anxiety triggered by social situations
and fear of embarrassment in front of others), specific
phobias (anxiety triggered by a particular object
or situation), separation anxiety disorder (anxiety triggered
by separation from a caregiver) and panic disorder
(unpredictable panic attacks sometimes occurring out of the blue
that may be triggered by stress).
- Mood disorders, such as depression
and bipolar disorder, can impair a child’s ability
to pay attention. Bipolar disorder may be present
or may emerge in a significant percentage of children with ADHD.
The onset of pediatric bipolar disorder (particularly
in very young children) is often preceded by the emergence of
ADHD. The two conditions can be initially hard to tell apart.
Medical treatment for ADHD with stimulants, however, can aggravate
mood instability, especially in a person vulnerable to developing
bipolar disorder. If bipolar disorder is in fact present, it is
important to stabilize the child’s mood prior to treating
- Physical trauma, abuse or neglect can cause
- Caffeine and other substances, such as stimulants, can
produce ADHD-like symptoms. Evaluation for caffeine use
and other substance use is especially important in adolescents.
- Medical conditions and prescribed medications can cause
problems with attention and hyperactivity. These conditions
include hyperthyroidism, hypothyroidism, seizure disorders, sleep
disorders, genetic conditions, head trauma, and toxic exposures.
Relevant laboratory tests and physical examinations may be helpful
when the child’s history raises concern about other underlying
medical conditions. Certain prescription medications can cause
side effects that look like symptoms of ADHD.
- Children may have difficulty talking
about their behavior. Phrasing questions
with particular sensitivity and compassion may allow a more complete
picture of symptoms to emerge. For example, inquiring about how
long the child can work on a task before it’s really difficult
to keep working may be preferable to asking how long the child
can sustain effort on a task. Specific and detailed questions
about symptoms are helpful. Parents and teachers often have more
accurate descriptions of behaviors in young children. Older children
may be more able to describe their symptoms than younger children.
- Children may be unaware, or unwilling to admit,
that their difficulties or behavior may indicate symptoms of a
disorder. Consideration of observations by others (including parents,
caregivers, and teachers) may clarify the magnitude of particular
- Families may need to be coached about what
they can reasonably expect from their child. Children with ADHD
will benefit if their family understands that therapy and medicines
may reduce, but may not cure, symptoms. top
How is Attention Deficit/Hyperactivity Disorder Treated?
Children with ADHD generally respond well to structured environments, to stimulation well-matched to their activity level and need for novelty, and to one-on-one time with an attentive adult. These supports in the child’s environment help the child to stay interested but not overwhelmed.
ADHD is treatable through ongoing interventions provided by a child’s medical practitioners, therapists, school staff, and family. These treatments include a combination of psychological interventions (counseling), biological interventions (medicines), and interventions at home and at school to reduce distractions and other sources of stress for the child. Open, collaborative communication between a child’s family, school, and treatment professionals optimizes the care and quality of life for the child. top
► Psychological Interventions (Counseling)
Counseling can help children with ADHD, and everyone around them, to understand that their symptoms are caused by a disorder with complex genetic and environmental origins--not by flawed attitude or personality. Counseling also can reduce the impact of symptoms on daily life. A variety of psychological interventions can be helpful, and parents should discuss their child’s particular needs with their clinician to determine which psychological treatments could be most beneficial for their child.
- Parent training in behavior therapy
can provide parents with key tools to encourage desired behaviors
and reduce undesired behaviors. This training teaches parents
how to use small rewards -- positive reinforcement
-- to promote preferred behaviors. Parents learn that attention
to negative behaviors may unintentionally reinforce those problem
behaviors in a way that encourages those behaviors to occur even
more frequently. Parent training in behavior therapy has been
found by researchers to be effective with behavioral symptoms
of ADHD and generally more effective than teaching cognitive strategies,
such as cognitive behavior techniques, to the children.
Behavior therapy is especially helpful with younger children when
used in combination with medication. These interventions do not
“cure” ADHD and consequently are most successful when
employed on an ongoing basis so that parent responses can be “fine
- Parent guidance sessions can help parents to
manage their child’s symptoms, identify effective parenting
skills, learn how to function as a family despite the disorder,
and address complex feelings that can arise when raising a child
with a disorder like ADHD. Educating family members about the
features of ADHD and effective interventions is key to successful
treatment. Family therapy may be beneficial when issues are affecting
the family as a whole.
- ADHD coaching is an emerging approach for
parents that provides guidance and practical
strategies for setting goals, getting organized, establishing
healthy routines, and tackling the daily logistical challenges
of living with ADHD. Coaches can help children and their parents
develop strategies to compensate for ADHD and focus on the children’s
- Individual psychotherapy may be useful for
children and adolescents with ADHD. Children with ADHD may carry
a sense of failure, as if the disorder was their fault, and they
may be troubled by their problems with peers. Individual psychotherapy
does not reduce symptoms of ADHD but may be helpful with related
problems such as low self-esteem and social challenges.
- Group psychotherapy can be valuable to a child
by providing a safe place to talk with other children who face
adversity or by allowing a child to practice social skills or
symptom-combating skills in a carefully structured setting. Social
skills training groups teach children to assess their behaviors
in social settings and to learn appropriate social behaviors.
These groups rely on modeling and contingency
management (small rewards for good behaviors) to
encourage effective social skills.
- School-based counseling can be effective in
helping a child with ADHD navigate the social, behavioral, and
academic demands of the school setting. top
► Biological Interventions (Medicines)
Medication usually plays an important role in treating a child’s ADHD symptoms, in conjunction with the counseling interventions described above.
The U.S Food and Drug Administration (FDA) has approved Adderall, Concerta, Dexedrine, Focalin, Metadate, Ritalin, and Strattera for treating children and adolescents with ADHD. Medications approved by the FDA for other uses and age groups are also prescribed for young people with ADHD. The FDA allows doctors to use their best judgment to prescribe medication for conditions for which the medication has not specifically been approved.
The following medications are commonly prescribed for treatment of ADHD in children and adolescents.
- Stimulants. Adderall, Concerta, Dexedrine,
Focalin, Metadate, and Ritalin are all stimulants that are prescribed
for use in children and adults with ADHD.
- Strattera. Strattera works on brain chemicals related to ADHD symptoms, but it works differently than stimulants. This is the first non-stimulant medication approved by the FDA for treating children and adults with ADHD.
- Antidepressants such as bupropion (Wellbutrin, Zyban) and desipramine (Norpramin) can effectively treat symptoms of ADHD in some children and adolescents.
- Antihypertensive medications such as clonidine (Catapres) and guanfacine (Tenex) are sometimes helpful in treating behavioral symptoms such as impulsivity or hyperactivity.
- Antinarcolepsy medication. Modafinil (Provigil) is a medication occasionally used to enhance the effect of another ADHD medication.
In most cases, stimulants, antihypertensive medications, and antinarcolepsy medication begin to be effective in reducing symptoms after the child or adolescent has taken them for 1-2 weeks. Strattera and antidepressants usually begin to be effective after 2-4 weeks. For Strattera and antidepressants, fully 12 weeks may be required in order to determine whether the medication is going to be effective for a particular individual. Medications should only be started, stopped, or adjusted under the direct supervision of a trained clinician.
There is no “best” medicine to treat ADHD, and it is important to remember that medicines usually reduce rather than eliminate symptoms. Different medicines or dosages may be needed at different times in a child’s life or to address the emergence of particular symptoms. Successful treatment requires taking medicine daily as prescribed, allowing time for the medicine to work, and monitoring for both effectiveness and side effects. The family, clinician and school should maintain frequent communication to ensure that medications are working as intended and to monitor and manage side effects.
The following caution should be observed when a child or adolescent is treated with a stimulant.
- Stimulants can be misused. Misuse of stimulants
is not a significant concern in young children or in adolescents
without a history of alcohol or drug abuse. Young people with
histories of alcohol or drug abuse require careful evaluation
and monitoring when prescribed stimulants to ensure that they
are taking the medication as prescribed. The longer-acting agents
such as Concerta or Adderall XR appear to be abused less frequently
than the short-acting, immediate-release formulations, so clinicians
now more commonly start adolescent patients on larger doses of
The following cautions should be observed when any child or adolescent is treated with antidepressants.
- Benefits and risks should be evaluated. Questions have arisen about whether antidepressants can cause some children or adolescents to have suicidal thoughts. The evidence to date shows that antidepressants, when carefully monitored, have safely helped many children and adolescents. The latest reports on this issue from the U.S. Food and Drug Administration can be found on its web site at www.fda.gov. Consideration of any medicine deserves a discussion with the prescribing clinician about its risks and benefits.
- Careful monitoring is recommended for any child receiving medication. Though most side effects occur soon after starting a medicine, adverse reactions can occur months after medicines are introduced. Agitation, restlessness, increased irritability, or comments about self-harm should be addressed immediately with the clinician if any of these symptoms emerge after the child starts an antidepressant. Frequent follow-up (weekly for the first month) is now advocated by the FDA for children starting any antidepressant.
- Some children who have ADHD may also have bipolar disorder. In some individuals with bipolar disorder, antidepressants may initially improve depressive symptoms but can sometimes worsen manic symptoms. While antidepressants do not “cause” bipolar disorder, they can unmask or worsen manic symptoms.
Helpful information about specific medications can be found at www.medlineplus.gov (click on “Drug Information”) and in the book Straight Talk About Psychiatric Medications for Kids (Revised Edition) by Timothy E. Wilens, MD. top
► Interventions at Home
Families can help reduce the impact of ADHD symptoms with interventions such as the following:
- Understand the disorder. Understanding the nature of ADHD and how the child experiences it will help parents sympathize with a child’s struggles.
- Listen to the child’s feelings. Isolation
can foster low self-esteem and depression in young people with
ADHD. The simple experience of being listened to empathically,
without receiving advice, may have a powerful and helpful effect.
- Establish consistent routines. Children with ADHD are more likely to succeed in completing tasks when they occur in a predictable pattern. Setting a time for homework, for dinner, and for relaxation (for example, story time or game time as a reward for successful homework completion) helps the child understand and meet expectations. These times should be clearly explained to the child and even written down in a visible place. Timers may be helpful reminders for children.
- Simplify the child’s schedule. A child with ADHD may become more distracted and “wound up” if there are many after-school activities. This may require parents to make adjustments to the child’s after-school commitments based on the individual child’s abilities, and the demands of particular activities.
- Identify special places for homework. A child may need a “special spot” or quiet place where distractions are reduced, such as a place away from the front door. Parents may need to remove distracting items for the area to be effective. Turning off televisions and telephones can assist in reducing distractions.
- Enlist the help of other family members. Siblings deserve praise for staying away from the child during homework time or for providing helpful assistance to the child. Encouraging family members to assist in the process will foster a positive experience for everyone.
- Reduce the possibility of accidents. Remove fragile items from the child’s reach. Ensure that the path for putting away one’s bicycle does not require careful navigation between breakable or “scratchable” objects.
- Supervise social activities to monitor peer interactions. Sometimes social activities with only 1-2 peers are most successful. Expand very gradually to a larger group of peers in order to build on success.
- Prepare for academic transitions. The transition from elementary school to middle school or from middle school to high school can be challenging for children with ADHD, due to decreased supervision, increased class size, and greater expectations for independence. Anticipating these times and preparing for them may be helpful for the child and parents.
- Praise the child’s efforts to address symptoms. Young people often feel like they only hear about their mistakes. Even if improvements are small, every good effort deserves to be praised.
- Behavioral plans may be useful to reinforce a child's successful efforts. Children tend to benefit from behavioral plans that reward good behaviors (rather than punish misbehaviors) because they may otherwise feel as though they get feedback only about their mistakes. Suggestions for effective behavioral plans are shown below.
Provide frequent acknowledgements of success. Experts encourage doing this six times per hour at home. This pattern may not be one parents grew up with, but it is an easy and effective means to help a child develop new habits. For example, tell the child, "Great job getting the table cleaned off with no sticky spots at all," rather than, "I've told you twice already to go pick up your clothes once you get the table cleaned off."
Reward the child for making efforts to reduce problem behaviors. Avoiding a tantrum, demonstrating flexibility in a potentially difficult situation, or increasing times without a rageful episode can all improve daily life and warrant reward or acknowledgment.
Develop meaningful incentives with the child. Praise, gold stars on a calendar, or sitting beside a parent in the car can all be effective rewards. Parents will need to determine with their child what the reward is, and will need to be consistent with the plan for it to be effective. Tangible reminders help children learn that they can be responsible for their actions and will be recognized for their good efforts. Parents can look to the school psychologist or guidance counselor or to their child's treatment professionals for help in developing behavioral plans for the home.
A chart system is often effective,
in which a certain number of stars per day may be "cashed
in" for the reward (an extra story with parent, a trip
for ice cream, etc.). It is essential that these rewards not
become the source of additional conflict. If the child doesn't
have the required "points" for a reward, rather
than saying, "No, you don't get your treat because you
didn't pick up all your clothes today like we asked,"
parents report more success when they say, "You picked
up all your clothing for six days so farjust one more
day and you'll earn that ice cream we talked about for picking
up for a whole week." Parents need to set appropriate
limits, such as saying "no" to an extravagant toy
as a reward. On the other hand, the reward needs to be something
the child enjoys and will be motivated to earn.
► Interventions at School
There are many ways that schools can help a child with ADHD succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifications, and school strategies include the following options.
For children with inattentive symptoms:
- Assign the child a seat that limits distractions. Sitting at the front of the class may be helpful.
- Reduce distracting sounds. Noisy classroom chairs can be quieted with tennis balls or padding at the end of the legs. Headphones may help a child’s concentration.
- Clarify the expectations for classroom behaviors. If children understand, ahead of time, what is expected of them and what the consequences are if expectations are not met, they will have a better chance at succeeding.
- Clearly draw attention to instructions that are given (for example, “Peter, this is a direction”). A child with ADHD often misses basic social cues.
- Ask the child to repeat instructions before carrying them out. Repetition reinforces the directions in the child’s mind and makes evident whether the child understood the instructions.
- Provide information in small chunks that will allow the child to follow each step
- Provide frequent check-in points during a lesson.
Children with ADHD will respond well to supervision and encouragement
that help keep them on track.
- Develop simple, discreet visual cues to help a child return to on-task behaviors. Children respond well to helpful reminders that do not embarrass them.
- Adjust to the child’s learning style. Untimed tests may be needed. For other tasks, a timer may help a child track the time needed to complete an assignment.
- Develop motivating strategies to complete assignments.
By pairing easier tasks that a child prefers with more difficult
tasks, a child will have more enthusiasm for all tasks.
- Help the child remember and retain important class materials. Write a list of needed class materials and develop a means for getting the list home (for example, tape it to a book or help the child place it in a backpack). Having a complete set of classroom materials at home and at school reduces time lost tracking down items such as pencils, erasers, paper, and textbooks. Taping important items such as pencils to the desk may reduce lost items.
- Help the child keep track of assignments by emailing assignments home
For the child with hyperactive or impulsive symptoms:
- Identify appropriate times/places when the child can move (for example, ask the child to bring the attendance sheet to the office). Children with ADHD may need to move more frequently than other children.
- Provide an alternative, less distracting source of activity, such as a squeezeball or fabric to rub.
- Develop cues to help students stop talking out of turn.
Nonverbal cues can be powerful and effective for all students.
Identify when the child will be able to talk again. For students
who blurt out answers, encourage them to write down answers before
raising their hands to give answers.
- Before an activity, clarify expectations. Identifying the expected volume level and activity level before unstructured activities will help reinforce desired behaviors.
- Design interventions that interrupt the behaviors. For a child with trouble standing in line, assign the child to a specific place to stand in line, or a specific student to stand beside. For a child with difficulty with taking turns, develop a routine for waiting, such as counting to 5, and then raising a hand.
For all children with ADHD:
- Provide assistance with peer interactions. An adult’s help may be very beneficial for both the child and his or her peers.
- Encourage small group interactions to develop increased areas of competency. Children with ADHD may put forth better efforts in more contained groups.
- Encourage the child to help develop interventions. Enlisting the child in the task will lead to more successful strategies and will foster the child’s ability to problem-solve.
- Develop a behavior plan that is a true incentive to the student, as described above in Interventions at Home. Rewards may be given at school by a teacher or school counselor or at home by a parent. Teachers, school counselors, and parents can collaborate to use similar reward systems at school and home.
- Reward a child’s efforts. Every good effort deserves to be praised.
- Please click on School-Based Interventions for a more complete list of school accommodations
for children with ADHD.
Flexibility and a supportive environment are essential for a student with ADHD to achieve success in school. School faculty and parents together may be able to identify patterns of difficulty and develop remedies to reduce a child’s challenges at these times. top
Many online resources and books are available to help parents, clinicians, and educators learn more about children and adolescents with ADHD. Click here
for a wide selection of resources. top
Information provided above on ADHD draws from sources including:
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition. Washington, DC: American Psychiatric Association, 1994
Bostic, JQ and Bagnell, A. “School Consultation.” In Comprehensive Textbook of Psychiatry, 8 th Edition. Kaplan, BJ and Sadock, VA. Philadelphia: Lippincott Williams and Wilkins, 2004
Dulcan, MK and Martini, DR. Concise Guide to Child and Adolescent Psychiatry, 2nd Edition. Washington, DC: American Psychiatric Association, 1999
Lewis, Melvin, ed. Child and Adolescent Psychiatry: A Comprehensive Textbook, 3rd Edition. Philadelphia: Lippincott Williams and Wilkins, 2002 top