Teen

Attention deficit hyperactivity disorder (ADHD) is a nervous system disorder that can present itself in different ways. Learn about the different symptoms and types of ADHD and its treatment options.

What Is ADHD?

ADHD is a behavioral health condition more commonly found in boys than in girls. Most people with ADHD are diagnosed as children, but adults can be diagnosed with ADHD as well.

ADHD can affect how well your child does in school, both academically and socially. It can also cause conflict at home.

Children with untreated ADHD have more emergency department visits and are more likely to have self-inflicted injuries, according to the Centers for Disease Control and Prevention. Teens with untreated ADHD have twice as many car accidents than those with ADHD who do receive treatment.

There are three subtypes of ADHD. They are:

Predominantly inattentive ADHD

Predominantly inattentive ADHD was once known as attention deficit disorder (ADD). Kids with this subtype of ADHD may:

  • Have trouble focusing or paying attention in school or at play.
  • Have trouble finishing tasks, such as schoolwork or chores.
  • Seem like they’re not listening when spoken to directly.
  • Make careless mistakes or miss details in schoolwork or other activities.
  • Fail to meet deadlines.
  • Start tasks but get easily distracted by other thoughts or things going on around them.
  • Have trouble following instructions or doing things in order.
  • Have trouble keeping supplies and schoolwork neat and in order.
  • Have poor time management skills.
  • Often arrive late to activities.
  • Avoid tasks that require concentration or attention to detail.
  • Lose or misplace schoolbooks and supplies, keys, eyeglasses, and cell phones.
  • Forget what they’ve heard.

Predominantly hyperactive and impulsive ADHD

Symptoms for those with predominantly hyperactive and impulsive ADHD include:

  • Fidgeting, squirming in their seat, or tapping their hands or feet.
  • Trouble remaining seated when asked.
  • Trouble playing or engaging in activities quietly.
  • Talking nonstop.
  • Frequently interrupting or intruding on what others are saying or doing.
  • Trouble waiting their turn.
  • Running around or climbing about when it’s not appropriate.
  • Feeling restless.
  • Being constantly on the go.
  • Blurting out answers before the question is over.

Combined type ADHD

Those with combined type ADHD have symptoms of both inattentive ADHD and hyperactive and impulsive ADHD.

ADHD Diagnosis

The following criteria are used to determine ADHD subtypes:

  • Children up to 16 years of age must have six or more symptoms of hyperactive and impulsive ADHD, or six or more symptoms of inattentive ADHD.
  • Adolescents age 17 and older must have five or more symptoms of hyperactive and impulsive ADHD, or five or more symptoms of inattentive ADHD.

To receive an ADHD diagnosis, a child’s symptoms must meet the following criteria:

  • The child has several inattentive or hyperactive impulsive symptoms before age 12.
  • The child has several symptoms in two or more settings, such as at home, school, or work, or with family, friends, or community members.
  • There is clear evidence that their symptoms interfere with, or affect the quality of, their social, school, or work life.
  • The symptoms have been present for at least six months.
  • The symptoms are inappropriate for the child or adolescent’s developmental level.
  • Another mental disorder — such as an anxiety disorder, mood disorder, dissociative disorder, or personality disorder — doesn’t explain the symptoms.
  • The symptoms don’t happen only during a psychotic disorder, such as schizophrenia.

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How Your Pediatrician Can Help

If you suspect your child has ADHD, it’s important to talk to your pediatrician. They will follow the recommendations from the American Academy of Pediatrics (AAP) clinical practice guidelines. This means your child’s doctor should:

  • Evaluate any child or adolescent ages 4 to 18 who present academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.
  • Gather information from parents or guardians, teachers, school staff, and mental health clinicians involved in the child or adolescent’s care.
  • See if the child meets the standard criteria for ADHD. This includes reports of symptoms and impairment in more than one major setting (social, academic, or occupational).
  • Screen for emotional or behavioral disorders, such as anxiety, depression, oppositional defiant disorder, conduct disorders, sleep disorders, and substance use.
  • Screen for developmental conditions, such as learning and language disorders and autism spectrum disorders.
  • Screen for physical conditions, such as tics and sleep apnea.
  • Rule out other causes that have similar symptoms.
  • Refer children and adolescents to a specialist if they have co-occurring mental health conditions that need additional diagnosis or treatment, or if their ADHD symptoms are not responding to initial treatment.

Treatment for ADHD

The AAP recommends the following treatments for children and adolescents with ADHD based on age.

For children ages 4 to 6

First-line treatment includes:

  • Parent or caregiver training in behavior management for ADHD. Behavior therapy usually involves eight to 12 sessions with a therapist to learn strategies to help your child.
  • Classroom interventions, which can include behavioral management and organizational training. Your child can also receive special education services and accommodation. This could be through an individualized education program (IEP) or a 504 Plan.

If behavioral interventions don’t work to reduce symptoms, your child’s doctor may prescribe medicine. Ritalin® (methylphenidate) is a stimulant medicine and is one of the primary medicines used to treat ADHD. Ritalin is the only ADHD drug approved by the Food and Drug Administration (FDA) to treat children under the age of 6.

For children and adolescents ages 6 to 18

The same parent training and classroom help apply to this age group as for children ages 4 to 6. In addition, older children and adolescents may benefit from learning skills to manage their ADHD. For many children, behavioral help often isn’t enough.

For this age group, there are many different FDA-approved medicines for ADHD. These include medicines that are both stimulants and nonstimulants.

Stimulants

Stimulants work to calm symptoms of hyperactive ADHD by increasing levels of dopamine and norepinephrine. This can help with executive functioning, such as attention and planning. There are many different types of stimulant medicines. Common ones include:

  • Adderall XR® (amphetamine and dextroamphetamine).
  • Concerta® (methylphenidate).
  • Focalin XR® (methylfenidate hydrochloride).
  • Ritalin (methylfenidate).
  • Vyvanse® (lisdexamfetamine).

There are other forms of stimulants that your child’s doctor may prescribe. Your child’s doctor will work with you and your child to choose the best medicines.

Nonstimulants

Sometimes doctors may recommend a nonstimulant medicine for ADHD. This could be because a child has not received enough benefit from stimulants, has experienced side effects, or has other conditions in addition to ADHD. The three FDA-approved nonstimulants for ADHD treatment in children include:

  • Strattera® (Atomoxetine)
  • Kapvay® (Clonidine)
  • Intuniv® (Guanfacine)

How to Find Help

There are different ADHD treatment options available. Your health care provider will work with you to help decide the best options for your child. It’s important to seek treatment if you suspect your child has ADHD. Left untreated, ADHD can negatively impact your child’s well-being and development.

To learn more about ADHD services at UPMC Western Psychiatric Hospital and UPMC Western Behavioral Health, call 412-235-5444.

For immediate counseling and support, call the resolve Crisis Services hotline at 1-888-796-8226. Trained crisis clinicians answer the phone 24/7, 365 days a year.

Sources

ADD vs. ADHD: What's the Difference in Symptoms. ADDITUDE Magazine. Link.

What Are The 3 Types of ADHD? ADDITUDE Magazine. Link.

Symptoms and Diagnosis of ADHD. Centers for Disease Control and Prevention. Link.

ADHD Treatment Recommendations. Centers for Disease Control and Prevention. Link.

Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. American Academy of Pediatrics. Link.

Parent Training in Behavior Management for ADHD. Centers for Disease Control and Prevention. Link.

ADHD in the Classroom: Helping Children Succeed at School. Centers for Disease Control and Prevention. Link.

ADHD Medications for Children. ADDitude Magazine. Link.

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. UPMC Western Psychiatric is the hub of UPMC Western Behavioral Health, a network of nearly 60 community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors throughout western Pennsylvania.