Many children who have attention-deficit/hyperactivity disorder (ADHD) have other concerns or disorders. Recognizing symptoms of different disorders and finding ways to help children can be a challenge for families. Learn more about how to help children who have ADHD and other disorders.

Is it ADHD?

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Could it be something else?

Many other disorders or conditions can also have symptoms that look like those of ADHD. For example, a child with a sleep disorder might have trouble focusing or remembering. A child with a learning disorder might make seemingly careless mistakes. A child with a behavior disorder might have difficulty getting along with others or resisting temptation. A child with anxiety might squirm or fidget often. For some children, symptoms that look like ADHD can be better explained by another diagnosis, but many children with ADHD also have another condition.

Sometimes symptoms that might look like ADHD or other conditions can be temporary. Having difficulties with behavior or emotions might be a reaction to stress and change. For example, coping with stress from significant life changes, such as loss of a loved one, can be a challenge, particularly for children who are already struggling with managing their behavior and emotions. Changes in routines like moving to a different home or school can be stressful and can make children more easily distracted or fidgety. If children do not settle quickly into a new situation, it can be hard for parents to understand whether their child is reacting to temporary stress, or if there is a problem that needs treatment. A thorough evaluation may be needed to learn what causes the problems.

For some children, having ADHD without getting the right treatment and support can cause problems that lead to other disorders, such as behavior problems, anxiety, or depression. These issues stem from challenges brought on by ADHD symptoms. An evaluation might be needed if a child with ADHD develops other problems over time.

When ADHD is “Complex” – Sorting out the Symptoms

When a child has difficulty with paying attention, being overly active, or acting without thinking, there is not a single test to find out if it is ADHD. Experts recommend a thorough evaluation using information from the child, parents, teachers, and other adults who know the child well. Primary care providers evaluate and diagnose ADHD based on the best available evidence which usually include these steps:

• Rule out any other possible conditions that can cause similar symptoms.
• Screen for other conditions that might coexist with ADHD, including
  • emotional or behavioral disorders,
  • developmental, learning, or language disorders), and
  • other health conditions (such as sleep disorders, or apnea).

Some children have “complex” ADHD symptoms. This means they might have symptoms beyond those that fit the typical description of ADHD. Experts recommend that primary care providers refer children to a specialist if the providers detect other conditions that they are not experienced in treating or diagnosing.

Children with complex ADHD may need treatment that is specific to their needs. Among the most common disorders that coexist with ADHD are

• Anxiety
• Autism spectrum disorder
• Depression
• Disruptive behavior disorders
• Substance use disorders
• Tic disorders

Having complex ADHD can also mean not fitting the typical age description, such as having ADHD symptoms earlier than age 4 years or not showing any ADHD symptoms until adolescence. Children who develop ADHD symptoms at younger or older ages than typical may also need more detailed diagnosis and treatment.

What Parents Can Do

When children experience behavior or emotions that are severe or that last a long time, parents may want to talk with their healthcare provider to get a complete and accurate diagnosis and treatment. The healthcare provider might refer the family to a specialist such as a child psychologist, child psychiatrist, or developmental pediatrician for a detailed assessment. Doctors might also recommend a developmental and educational evaluation most often done at a local early intervention agency (for children under age 3 years), or public school (for children age 3 years and older).

For ADHD and many other developmental disorders, treatment options involve behavior therapy, and specifically parent training in behavior management, as part of the child’s treatment. In parent training, parents get advice and gain skills for helping their child with the specific symptoms that cause difficulties.

Parents can also talk with their child’s teachers about how to help their child succeed in school. Accommodations and special education services can be tailored to address the different symptoms that the child may experience.

Children occasionally act angry or defiant around adults or respond aggressively when they are upset. When these behaviors persist over time, or are severe, they can become a behavior disorder. Children with ADHD are more likely than other children to be diagnosed with a behavior disorder such as Oppositional Defiant Disorder or Conduct Disorder.

Oppositional Defiant Disorder

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD is one of the most common disorders occurring with ADHD. ODD usually starts before 8 years of age, but can also occur in adolescents. Children with ODD may be most likely to act oppositional or defiant around people they know well, such as family members or a regular care provider. Children with ODD show these behaviors more often than other children their age.

Examples of ODD behaviors include

• Often losing their temper
• Arguing with adults or refusing to comply with adults’ rules or requests
• Often getting angry, being resentful, or wanting to hurt someone who they feel has hurt them or caused problems for them
• Deliberately annoying others; easily becoming annoyed with others
• Often blaming other people for their own mistakes or misbehavior

Conduct Disorder

Conduct Disorder (CD) is diagnosed when children show a behavioral pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These behaviors can lead to breaking the law and being jailed. Having ADHD makes a child more likely to be diagnosed with CD. Children with CD are more likely than other children to get injured, and to have difficulties getting along with peers.

Examples of CD behaviors include

• Breaking serious rules, such as running away, staying out at night when told not to, or skipping school
• Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals
• Lying and stealing, or damaging other people’s property on purpose

Treatment for disruptive behavior disorders

Starting treatment early is important. Treatment is most effective if it fits the needs of the child and family. The first step to treatment is to have a comprehensive evaluation by a mental health professional. Some of the signs of behavior problems, such as not following rules, are also signs of ADHD, so it is important to get a careful evaluation to see if a child has both conditions. For younger children, the treatment with the strongest evidence is behavioral parent training, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child’s behavior. For school-age children and teens, an often-used effective treatment is combination training and therapy that includes the child, the family, and the school. Sometimes medication is part of the treatment.

Many children with ADHD also have a learning disorder (LD). This is in addition to other symptoms of ADHD, such as difficulties paying attention, staying on task, or being organized, which can also keep a child from doing well in school.

Having a learning disorder means that a child has a clear difficulty in one or more areas of learning, even when their intelligence is not affected. Learning disorders include

• Dyslexia – difficulty with reading
• Dyscalculia – difficulty with math
• Dysgraphia – difficulty with writing

The combination of problems caused by having ADHD and LD can make it particularly hard for a child to succeed in school. Properly diagnosing each disorder is an important part of getting the right kind of help for the child.

Treatment for learning disorders

Children with learning disorders often need extra help and instruction that is specialized for them. Having a learning disorder can qualify a child for special education services in school. Because children with ADHD often have difficulty in school, the first step is a careful evaluation to see if the problems are also caused by a learning disorder. Schools usually do their own testing to see if a child needs intervention. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

Anxiety

Many children have fears and worries. However, when a child experiences so many fears and worries that they interfere with school, home, or play activities, it is an anxiety disorder. Children with ADHD are more likely than those without to develop an anxiety disorder.

Examples of anxiety disorders include

• Separation anxiety – being very afraid when they are away from family
• Social anxiety – being very afraid of school and other places where they may meet people
• General anxiety – being very worried about the future and about bad things happening to them

Depression

Occasionally being sad or feeling hopeless is a part of every child’s life. When children feel persistent sadness and hopelessness, it can cause problems. Children with ADHD are more likely than children without ADHD to develop childhood depression. Children may be more likely to feel hopeless and sad when they can’t control their ADHD symptoms and the symptoms interfere with doing well at school or getting along with family and friends.

Examples of behaviors often seen when children are depressed include

• Feeling sad or hopeless a lot of the time
• Not wanting to do things that are fun
• Having a hard time focusing
• Feeling worthless or useless

Children with ADHD often have a hard time focusing on things that are not very interesting to them. Depression can make it hard to focus on things that are normally fun. Changes in eating and sleeping habits can also be a sign of depression. For children with ADHD who take medication, changes in eating and sleeping can also be side-effects from the medication rather than signs of depression. Talk with your healthcare provider if you have concerns.

Treatment for anxiety and depression

The first step to treatment is to talk with a healthcare provider to get an evaluation. Some signs of depression, like having a hard time focusing, are also signs of ADHD, so it is important to get a careful evaluation to see if a child has both conditions. A mental health professional can develop a therapy plan that works best for the child and family. Early treatment is important, and can include child therapy, family therapy, or a combination of both. The school can also be included in therapy programs. For very young children, involving parents in treatment is very important. Cognitive behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking. Consultation with a health provider can help determine if medication should also be part of the treatment.

ADHD can make peer relationships or friendships very difficult. Having friends is important to children’s well-being and may be very important to their long-term development.

Although some children with ADHD have no trouble getting along with other children, others have difficulty in their relationships with their peers; for example, they might not have close friends, or might even be rejected by other children. Children who have difficulty making friends might also more likely have anxiety, behavioral and mood disorders, substance abuse, or delinquency as teenagers.

How does ADHD interfere with peer relationships?

Exactly how ADHD contributes to social problems is not fully understood. Children who are inattentive sometimes seem shy or withdrawn to their peers. Children with symptoms of impulsivity/hyperactivity may be rejected by their peers because they are intrusive, may not wait their turn, or may act aggressively. In addition, children with ADHD are also more likely than those without ADHD to have other disorders that interfere with getting along with others.

Having ADHD does not mean a child won’t have friends.

Not everyone with ADHD has difficulty getting along with others. For those children who do have difficulty, many things can be done to help them with relationships. The earlier a child’s difficulties with peers are noticed, the more successful intervention may be. Although researchers don’t have definitive answers on what works best for children with ADHD, some things parents might consider as they help their child build and strengthen peer relationships are:

• Pay attention to how children get along with peers. These relationships can be just as important as grades to school success.
• Regularly talk with people who play important roles in your child’s life (such as teachers, school counselors, after-school activity leaders, healthcare providers, etc.). Keep updated on your child’s social development in community and school settings.
• Involve your child in activities with other children. Talk with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
• Peer programs can be helpful, particularly for older children and teenagers. Social skills training alone has not shown to be effective, but peer programs where children practice getting along with others can help. Schools and communities often have such programs available. You may want to talk to your healthcare provider and someone at your child’s school about programs that might help.

Children and adolescents with ADHD are likely to get hurt more often and more severely than peers without ADHD. Research indicates that children with ADHD are significantly more likely to

• Get injured while walking or riding a bicycle
• Have head injuries
• Injure more than one part of their body
• Be hospitalized for unintentional poisoning
• Be admitted to intensive care units or have an injury resulting in disability

More research is needed to understand why children with ADHD get injured, but it is likely that being inattentive and impulsive puts children at risk. For example, a young child with ADHD may not look for oncoming traffic while riding a bicycle or crossing the street, or may do something dangerous without thinking of the possible consequences. Teenagers with ADHD who drive may take unnecessary risks, may forget rules, or may not pay attention to traffic.

There are many ways to protect children from harm and keep them safe. Parents and other adults can take these steps to protect children with ADHD.

• Always have your child wear a helmet when riding a bike, skateboard, scooter, or skates. Remind children as often as necessary to watch for cars and to teach them how to be safe around traffic.
• Supervise children when they are involved in activities or in places where injuries are more likely, such as when climbing or when in or around a swimming pool.
• Keep potentially harmful household products, medications, and tools out of the reach of young children.
• Teens with ADHD are at extra risk when driving. They need to be extra careful to avoid distractions like driving with other teens in the car, talking on a cell phone, texting, eating, or playing with the radio. Like all teens, they need to avoid alcohol and drug use, and driving when drowsy.
• Parents should discuss rules of the road, why they are important to follow, and consequences for breaking them with their teens. Parents can create parent-teen driving agreements that put these rules in writing to set clear expectations and limits. 

Children with ADHD have increased risk of injury to the mouth and teeth, as well as cavities (also known as caries or tooth decay). Learn about protecting children’s oral health.

The core symptoms of ADHD, like impulsivity and inattention, might lead children to behave in ways that can put their health at risk or cause them to forget healthy and protective behaviors. Over time, if not addressed, these risks can lead to injury, disease, or even an earlier-than-expected death. In addition to injuries, children with ADHD are at increased risk for being overweight or having obesity. Healthy habits for children include:

• Developing healthy eating habits, such as eating plenty of fruits, vegetables, and whole grains, and choosing lean protein sources.
• Participating in daily physical activity based on age.
• Limiting the amount of daily screen time from TVs, computers, phones, and other electronics.
• Getting the recommended amount of sleep each night based on age.

Being healthy is important for all children and can be especially important for children with ADHD. The core symptoms of ADHD, like impulsivity and inattention, might lead children to behave in ways that can put their health at risk or cause them to forget healthy and protective behaviors. Over time, if not addressed, these risks can lead to injury, disease, or even an earlier-than-expected death.

Having a healthy lifestyle can help children with ADHD deal with stress and difficulties in their daily lives. In addition to recommended treatments like behavior therapy and medication, a healthy lifestyle can help children with ADHD manage their ADHD symptoms. Parents and healthcare providers can learn more about health risks associated with ADHD and about healthy habits that can help protect children from long-term health risks.

Ways to Protect Children with ADHD From Different Health Risks

Preventing Unintentional Injuries

Impulsivity and inattention can put children at risk for injuries, such as:

• Unintentional injuries including falls, drowning, burns, and poisoning. Learn how to keep children safe from injuries.
• Brain injuries. Learn how to recognize, respond to, and minimize the risk of concussion.
• Car crashes, particularly as teenagers and young adults.

Supporting Mental Health

Children with ADHD are at increased risk for mental, behavioral, and emotional concerns and disorders, such as:

• Behavior disorders, which may increase the risk of interpersonal violence and delinquent behavior.
• Mood disorders, including anxiety and depression. 
• Being the victim of bullying. 
• Using tobacco and other high-risk substances. 
• Suicide. Learn about youth suicide prevention.
• Sexual risk behavior. 

Supporting Oral Health

Children with ADHD have increased risk of injury to the mouth and teeth, as well as cavities (also known as caries or tooth decay). Learn about protecting children’s oral health.

Promoting Physical Activity, Nutrition, and Sleep

Children with ADHD are at increased risk for being overweight or having obesity. Healthy habits for children include:

• Developing healthy eating habits, such as eating plenty of fruits, vegetables, and whole grains, and choosing lean protein sources.
• Participating in daily physical activity based on age.
• Limiting the amount of daily screen time from TVs, computers, phones, and other electronics.
• Getting the recommended amount of sleep each night based on age.

Talk With a Healthcare Provider

Every child with ADHD is different, and experts can’t predict whether or how individual children will be affected by these risks. Talk with your provider about the best way to protect your child’s health.

Additionally, some treatments for ADHD, such as stimulant medication, may have side effects that could affect your child’s health, such as difficulty sleeping and loss of appetite. Talk with your child’s healthcare provider about these side effects.