Have you noticed that your child or teen finds it hard to pay attention? Do they often move around during times when they shouldn’t, act impulsively, or interrupt others? If such issues are ongoing and seem to be impacting your child’s daily life, they may have attention-deficit/hyperactivity disorder (ADHD).

ADHD can impact the social relationships and school performance of children and teens, but effective treatments are available to manage the symptoms of ADHD. Learn about ADHD, how it’s diagnosed, and how to find support.

Learn about the symptoms of ADHD and what to do if you’re concerned that your child might have this disorder.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood.

Signs and Symptoms

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:

• have a hard time paying attention
• daydream a lot
• not seem to listen
• be easily distracted from schoolwork or play
• forget things
• be in constant motion or unable to stay seated
• squirm or fidget
• talk too much
• not be able to play quietly
• act and speak without thinking
• have trouble taking turns
• interrupt others

Diagnosis of ADHD

Deciding if a child has ADHD is a process with several steps. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, sleep problems, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Treatment for ADHD

ADHD can be successfully managed. Treatment options for ADHD include:

• Behavior therapy, including training for parents
• Medications
• School accommodations and interventions

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy, particularly training for parents, is recommended as the first line of treatment. What works best can depend on the child and family. Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Get Help!

If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency (for children under age 3 years) or public school (for children age 3 and older).

Attention-deficit/hyperactivity disorder (ADHD) is a biological disorder that causes hyperactivity, impulsiveness, and attention problems. Parents do not cause ADHD, but parents can play a key role in treatment. Behavior therapy is an effective treatment that improves ADHD symptoms without the side effects of medicine. It is an important first step for young children with ADHD and most effective when delivered by parents. With the support of healthcare providers and therapists, parents can learn specific ways to improve their child’s behavior and keep their relationships strong. Clinical guidelines for ADHD treatment recommend that healthcare providers first refer parents of young children for training in behavior therapy before prescribing ADHD medicine. However, more young children are taking medicine for ADHD than receiving psychological services, which may include behavior therapy. Most families will benefit from behavior therapy and there are instances where medicine may be appropriate. Healthcare providers and families can work together to make sure children with ADHD are receiving the most appropriate treatment.

Healthcare providers can:

• Follow the clinical guidelines for diagnosis and treatment of ADHD in young children.
• Discuss with parents the benefits of behavior therapy and why they should consider getting training.
• Identify parent training providers in their area and refer parents of young children with ADHD for training in behavior therapy before prescribing medicine.

• About 2 million of the more than 6 million children with ADHD were diagnosed as young children aged 2-5 years.

• About 75% of young children with ADHD received medicine as treatment.

• Only about 50% of young children with ADHD in Medicaid and 40% with employer-sponsored insurance got psychological services, which may have included behavior therapy, the recommended first-line treatment.

Problem

The recommended first treatment for young children with ADHD is underused.

• The American Academy of Pediatrics recommends healthcare providers first refer parents of young children with ADHD for training in behavior therapy before trying medicine.
• With the support of healthcare providers and therapists, parents can become trained in behavior therapy. Behavior therapy can work as well as medicine. Both behavior therapy and medicine work for about 70-80% of young children with ADHD.
• However, only about 40-50% of young children with ADHD received psychological services.* This percentage has not increased over time.
• ADHD medicine can cause side effects, such as poor appetite, stomach aches, irritability, sleep problems, and slowed growth. The long-term effects of ADHD medicine on young children are not known.
• Behavior therapy can take more time, effort, and resources than medicine and can be longer lasting.

Parents may need support in accessing behavior therapy in their area

• Healthcare providers and parents may not be aware of the recommendations for and benefits of behavior therapy for young children with ADHD.
• It may be difficult to find therapists who train parents in behavior therapy in some areas of the country. Visit this page for more help:

What Can Be Done

The Federal government is

• Offering coverage and Federal Medicaid reimbursement for recommended ADHD services that states seek to add to their Medicaid state plan.
• Helping states evaluate the impact of state-level programs to improve treatment for young children with ADHD.
• Evaluating new and existing state Medicaid and other insurance policies on their impact on treatment rates.
• Monitoring the number of children diagnosed with ADHD and the treatments they receive.
• Conducting research to better understand and treat ADHD.
• Sharing materials through the National Resource Center on ADHD.
  http://www.help4adhd.org/NRC.aspx

Healthcare providers can

• Follow the clinical guidelines for diagnosis and treatment of ADHD in young children. http://bit.ly/1nCUenn, http://bit.ly/1UYugZ8
• Discuss with parents the benefits of behavior therapy and why they should consider getting training.
• Identify parent training providers in your area and refer parents of young children with ADHD for training in behavior therapy before prescribing medicine.

Parents can

• Talk with their child’s healthcare provider about the benefits of being trained in behavior therapy for their young child with ADHD.
• Learn and use these strategies to support their young child with ADHD.

Health professional organizations can

• Inform healthcare providers about the reasons for and benefits of parent training in behavior therapy.
• Train and support new and existing providers to deliver parent training in behavior therapy to fill service gaps.
• Include content about proven treatments for ADHD in graduate or professional curricula, training, and certification.

States can

• Encourage health plans and provider organizations to support reimbursement for behavior therapy services.
• Work to make sure that families have access to behavior therapy training.
• Evaluate ADHD medicine prescribing policies such as getting prior authorization and other policies that may affect ADHD treatment.
  http://bit.ly/1SQQfN0
• Support scale up of proven parent training programs and other promising programs for children with ADHD.

Researchers are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other disorders, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors that might raise the risk of developing ADHD and are studying how brain injuries, nutrition, and social environments might play a role in ADHD.

What are learning and attention problems?

Many children have trouble with learning and paying attention every now and then. However, for some, learning or attention differences are significant and do not go away. These children might have difficulty with classwork or homework, they might not follow directions at home or at school, and they might have difficulties with behavior, handling emotions, or relationships. These children might have learning or attention disorders:

• Learning disorders. There are a number of learning disorders, and they can look different for different children. Learning disorders are caused by brain differences that do not affect overall intelligence but make learning certain tasks harder. Some children might have dyslexia, which makes learning to read more difficult. An early sign of dyslexia is trouble learning the letters in the alphabet.

• Some children might have dyscalculia, which means problems doing math. Some might have dysgraphia, which means serious trouble with writing. Children can also have a combination or all of these learning problems at once. Learn more about learning disorders.

• Attention-deficit/hyperactivity disorder (ADHD). There are three types of ADHD: inattentive, impulsive/hyperactive, and combined type. All three types affect a person’s ability to pay attention. Children with inattentive ADHD might daydream a lot or often forget or lose things. Children with impulsive/hyperactive ADHD can be overly active and impulsive and might often squirm or fidget, make careless mistakes, or take unnecessary risks. Some children have both types of ADHD. Learn more about ADHD

Sometimes these children also have speech or language disorders, other developmental disabilities, or mental health conditions, such as anxiety or depression.

Because difficulties with learning and attention can get in the way of doing well at school, home, and with friends and can cause long-term problems, getting help and support early is important. Talking to your health care provider is always a good first step if you notice that your child is having problems with learning or attention, whether or not there is family history.

Why is it important to know if your child has a family health history of ADHD or learning disorders?

Difficulties with learning and attention can run in families. Knowing about this family health history can help your child’s health care provider make a diagnosis if your child is having difficulty with learning or attention. Having a family member, especially another child, with a learning or attention problem can help you identify concerns early in your child. Finding learning and attention disorders early can help your child get services sooner, which can help your child succeed.

Finding out more about family health history can help some parents discover for the first time that they also have a learning disorder or ADHD that has not been diagnosed or treated. However, having family members with learning or attention disorders does not automatically mean that your child will have a problem with learning or attention.

How do you collect a family health history of learning and attention problems?

Collect your child’s family health history information before seeing your child’s health care provider:

• Include your and your partner’s children, parents, sisters, brothers, grandparents, aunts, uncles, nieces, and nephews
• Include information on diagnoses of ADHD or a learning disorder, such as dyslexia, and any difficulties with learning or attention, even if they were never diagnosed. Older family members with ADHD or learning disorders might not have been diagnosed, as these diagnoses were less common in the past and might have been missed
• Include any other types of disorders that have to do with learning, development, the brain, or nervous system, such as Tourette syndrome, anxiety, depression, bipolar disorder, oppositional defiant disorder, personality disorders, schizophrenia, autism spectrum disorder, speech or language disorder, intellectual disability, epilepsy/seizures, fragile X syndrome, or Rett syndrome

When you talk with your provider, also include information on sleep, hearing, or vision issues, which can cause learning or attention difficulties that look like learning disorders or ADHD.

Sharing your child’s diagnosis of learning disorders or ADHD with your other family members might help their children get diagnosed if they have similar problems.

What might the doctor recommend for your child?

The health care provider may check your child more closely for early signs of ADHD or a learning disorder. The earlier these conditions are diagnosed, the better the outcome in the long term. In some cases, the health care provider might refer your child to a child development specialist for further evaluation. There are currently no genetic or blood tests available for learning disorders or ADHD. However, the health care provider might suggest genetic counseling and testing if your child has a family history of certain conditions that can cause learning and attention problems, including autism spectrum disorder or fragile X syndrome.

Obtaining a diagnosis of an attention or learning disorder allows you and your child to better understand your child’s difficulties and find ways for your child to succeed. A diagnosis of ADHD or a learning disorder is also important for tailoring children’s education to best accommodate their needs. While ADHD and learning disorders can cause challenges for children, children with these conditions have many strengths and, with the right support, can thrive both at school and at home.

People with ADHD experience an ongoing pattern of the following types of symptoms:

• Inattention—having difficulty paying attention
• Hyperactivity—having too much energy or moving and talking too much
• Impulsivity—acting without thinking or having difficulty with self-control

Some people with ADHD mainly have symptoms of inattention. Others mostly have symptoms of hyperactivity-impulsivity. Some people have both types of symptoms.

Signs of inattention may include:

• Not paying close attention to details or making seemingly careless mistakes in schoolwork or during other activities
• Difficulty sustaining attention in play and tasks, including conversations, tests, or lengthy assignments
• Trouble listening closely when spoken to directly
• Finding it hard to follow through on instructions or to finish schoolwork or chores, or starting tasks but losing focus and getting easily sidetracked
• Difficulty organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, managing time, and meeting deadlines
• Avoiding tasks that require sustained mental effort, such as homework
• Losing things necessary for tasks or activities, such as school supplies, books, eyeglasses, and cell phones
• Being easily distracted by unrelated thoughts or stimuli
• Being forgetful during daily activities, such as chores, errands, and keeping appointments

Signs of hyperactivity and impulsivity may include:

• Fidgeting and squirming while seated
• Getting up and moving around when expected to stay seated, such as in a classroom
• Running, dashing around, or climbing at inappropriate times or, in teens, often feeling restless
• Being unable to play or engage in hobbies quietly
• Being constantly in motion or on the go and/or acting as if driven by a motor
• Talking excessively
• Answering questions before they are fully asked or finishing other people’s sentences
• Having difficulty waiting one’s turn, such as when standing in line
• Interrupting or intruding on others, for example, in conversations, games, or activities

ADHD symptoms can change over time as a child grows and moves into the preteen and teenage years. In young children with ADHD, hyperactivity and impulsivity are the most common symptoms. As academic and social demands increase, symptoms of inattention become more prominent and begin to interfere with academic performance and peer relationships. In adolescence, hyperactivity often becomes less severe and may appear as restlessness or fidgeting. Symptoms of inattention and impulsivity typically continue and may cause worsening academic, organizational, and relationship challenges. Teens with ADHD also are more likely to engage in impulsive, risky behaviors, including substance use and unsafe sexual activity.

Inattention, restlessness, and impulsivity continue into adulthood for many individuals with ADHD, but in some cases, they may become less severe and less impairing over time.

To be diagnosed with ADHD, symptoms must have been present before the age of 12. Children up to age 16 are diagnosed with ADHD if they have had at least six persistent symptoms of inattention and/or six persistent symptoms of hyperactivity-impulsivity present for at least 6 months. Symptoms must be present in two or more settings (for example, at home or school or with friends or relatives) and interfere with the quality of social or school functioning.

Parents who think their child may have ADHD should talk to their health care provider. Primary care providers sometimes diagnose and treat ADHD. They may also refer individuals to a mental health professional, such as a psychiatrist or clinical psychologist, who can do a thorough evaluation and make an ADHD diagnosis. Stress, sleep disorders, anxiety, depression, and other physical conditions or illnesses can cause similar symptoms to those of ADHD. Therefore, a thorough evaluation is necessary to determine the cause of the symptoms.

During an evaluation, the health care provider or mental health professional may:

• Examine the child’s mental health and medical history.
• Ask permission to talk with family members, teachers, and other adults who know the child well and see them in different settings to learn about the child’s behavior and experiences at home and school.
• Use standardized behavior rating scales or ADHD symptom checklists to determine whether a child or teen meets the criteria for a diagnosis of ADHD.
• Administer psychological tests that look at working memory, executive functioning (abilities such as planning and decision-making), visual and spatial skills, or reasoning skills. Such tests can help detect psychological or cognitive strengths and challenges as well as identify or rule out possible learning disabilities.

Although there is no cure for ADHD, currently available treatments may help reduce symptoms and improve functioning. ADHD is commonly treated with medication, education or training, therapy, or a combination of treatments.

Medication

Stimulants are the most common type of medication used to treat ADHD. Research shows these medications can be highly effective. Like all medications, they can have side effects and require an individual’s health care provider to monitor how they may be reacting to the medication. Nonstimulant medications are also available. Health care providers may sometimes prescribe antidepressants to treat children with ADHD, although the Food and Drug Administration (FDA) has not approved these medications specifically for treating ADHD. Sometimes an individual must try several different medications or dosages before finding what works for them.

For general information about stimulants and other medications used to treat mental disorders, see NIMH's Mental Health Medications webpage. The FDA website has the latest medication approvals, warnings, and patient information guides.

Psychotherapy and Psychosocial Interventions

Several psychosocial interventions have been shown to help children and their families manage symptoms and improve everyday functioning.

• Behavioral therapy aims to help a person change their behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, learning social skills, or monitoring one’s own behavior and receiving praise or rewards for acting in a desired way.
• Cognitive behavioral therapy helps a person to become more aware of attention and concentration challenges and to work on skills to improve focus.
• Family and marital therapy can help family members learn how to handle disruptive behaviors, encourage behavior changes, and improve interactions with children.

All types of therapy for children and teens with ADHD require parents to play an active role. Psychotherapy that includes only individual treatment sessions with the child (without parent involvement) is not effective for managing ADHD symptoms and behavior. This type of treatment is more likely to be effective for treating symptoms of anxiety or depression that may occur along with ADHD.

Parent Education and Support

Mental health professionals can educate the parents of a child with ADHD about the disorder and how it affects a family. They also can help parents and children develop new skills, attitudes, and ways of relating to each other. Examples include parenting skills training, stress management techniques for parents, and support groups that help parents and families connect with others who have similar concerns.

School-Based Programs

Children and adolescents with ADHD typically benefit from classroom-based behavioral interventions and/or academic accommodations. Interventions may include behavior management plans or teaching organizational or study skills. Accommodations may include preferential seating in the classroom, reduced classwork load, or extended time on tests and exams. The school may provide accommodations through what is called a 504 Plan or, for children who qualify for special education services, an Individualized Education Plan (IEP).

Complementary Health Approaches

Unlike specific psychotherapy and medication treatments that are scientifically proven to improve ADHD symptoms, complementary health approaches for ADHD, such as natural products, do not qualify as evidence-supported interventions.

The American Academy of Pediatrics (AAP) published a clinical practice guideline that provides recommendations for the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD). This guideline is based on the best available evidence, and is intended for use by primary care providers, such as pediatricians, family physicians, and other healthcare providers.

Diagnosis and Evaluation of ADHD

The AAP guidelines for diagnosis and evaluation of ADHD recommend that primary care providers complete these steps:

• Evaluate children and adolescents ages 4 to 18 years for ADHD if they are having academic or behavioral problems and show inattention, hyperactivity, or impulsivity.
• Get reports on the child’s symptoms from parents or guardians, school staff, and mental health workers involved with their care, and get information from the child or adolescent as well.
• Use rating scales and other sources to document the symptoms and ensure that DSM-5 criteria have been met.
• 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 (such as anxiety, depression, and behavior problems), developmental disorders (such as learning and language disorders or autism spectrum disorder), and physical conditions (such as tics, sleep disorders, or apnea).
• Refer children to a specialist if they detect co-occurring conditions that they are not experienced in treating or diagnosing.

Treatment

The AAP guidelines for treatment of ADHD recommend:

Children and adolescents with ADHD should be treated the same as would any other child or adolescent with special healthcare needs, following the principles of the chronic care model and the medical home.

Children ages 4-6 years

• The first line of treatment should include
  • Parent training in behavior management; and/or
  • Behavioral classroom interventions (if available).
• Methylphenidate may be used if behavioral interventions do not provide significant improvement and the child continues to have serious problems.

Children and adolescents 6-18 years

Recommended treatment for children and adolescents includes

• FDA-approved medications along with
• Parent training in behavior management and/or
• Behavioral classroom interventions.

Treatments often work best when used together.

For all children attending school, the school is a necessary part of any treatment plan. These plans can include

• Educational interventions; and
• Individual school supports, such as school environment and behavioral supports.

School treatment plans often include an Individualized Education Program (IEP) or a 504 plan that describes accommodations.

Any child or adolescent who is taking medication

The AAP guidelines for treatment of ADHD recommend that

• The primary care provider adjusts the patient’s medication dose as needed to achieve the most benefit with the least amount of tolerable side effects.
• For adolescents, medications should be used with patient approval.

Did you know that many children with severe symptoms of ADHD are diagnosed before 6 years of age? Young children with ADHD need the right treatment for ADHD. Learn about using behavior therapy first to help young children with ADHD.

ADHD is one of the most common enduring conditions of childhood and affects many children, including very young children. Those with more severe symptoms are often diagnosed earlier.

Being easily distracted, impulsive, and highly active is normal for young children, but when the symptoms are severe and persistent, it can cause problems. Young children with ADHD are more likely than those without ADHD to have difficulties in early education programs or school, including problems with peer relationships, learning, and a higher risk of injuries.

My Young Child has been Diagnosed with ADHD, Now What?

For older children, the best treatment is often a combination of behavior therapy and medication. But for children under 6 years of age, experts recommend that ADHD be treated with behavior therapy first, before trying medication. Behavior therapy is the recommended treatment for ADHD in children under 6 years of age. The type of behavior therapy that is most effective for this age is parent training in behavior management, meaning that therapists work with parents and teach them the skills needed to help their child better manage their ADHD.

How Can Parent Training in Behavior Management Help my Child?

Children who have ADHD act in ways that are often challenging for parents. Children may forget things they are told, be overly active, and act before thinking. They might not be able to get positive attention the way that other children can; they tend to misbehave and might be punished more frequently than other children. Even if children with ADHD really try to follow rules, they might not be able to. This can have a negative impact on their self-image, and cause them to give up trying or to act up more often.

A therapist skilled in behavior management can help parents understand how ADHD affects their child. Parent training in behavior management is used to help change problem behaviors by building parenting skills, improving the relationship between parents and their child with ADHD, and helping children manage their own behaviors.

Others (daycare providers, preschool teachers, and other caretakers) can also help to manage the behavior of preschoolers who have ADHD by becoming educated about the disorder and by being trained in behavioral techniques.

The Recommended First Choice

Behavior therapy is the recommended ADHD treatment for children under 6 and should be used first, before medications that treat ADHD.

• Children under 6 are more likely than older children to experience side effects from ADHD medications, such as increased heart rate and blood pressure, trouble sleeping, loss of appetite, and a loss of energy.
• The long-term effects of ADHD medications on children under 6 are not known since ADHD medications have not been well-studied in young children.
• Behavior therapy works as well as medication in young children with ADHD in helping to manage symptoms. Studies have shown that families who receive training in behavior therapy notice improvements for several years after treatment.

Parent training in behavior management has evidence as an effective treatment. There are several programs that meet the criteria of the Agency for Healthcare Research and Quality for effective treatments. Read more about these behavior therapy training programs for parents of young children.

What You Can Do:

• Talk to your doctor about behavioral therapy first.
• Share information about behavioral therapy for ADHD with other families.

Children with attention-deficit/hyperactivity disorder (ADHD) experience more obstacles in their path to success than the average student. The symptoms of ADHD, such as inability to pay attention, difficulty sitting still, and difficulty controlling impulses, can make it hard for children with this diagnosis to do well in school.

To meet the needs of children with ADHD, schools may offer

• ADHD treatments, such as behavioral classroom management or organizational training;
• Special education services; or
• Accommodations to lessen the effect of ADHD on their learning.

Classroom Treatment Strategies for ADHD Students

There are some school-based management strategies shown to be effective for ADHD students: behavioral classroom management and organizational training.

The behavioral classroom management approach encourages a student’s positive behaviors in the classroom, through a reward systems or a daily report card, and discourages their negative behaviors. This teacher-led approach has been shown to influence student behavior in a constructive manner, increasing academic engagement. Although tested mostly in elementary schools, behavioral classroom management has been shown to work students of all ages.

Organizational training teaches children time management, planning skills, and ways to keep school materials organized in order to optimize student learning and reduce distractions. This management strategy has been tested with children and adolescents.

These two management strategies require trained staff—including teachers, counselors, or school psychologists—follow a specific plan to teach and support positive behavior.

The American Academy of Pediatrics (AAP) recommends that the school environment, program, or placement is a part of any ADHD treatment plan. AAP also recommends teacher-administered behavior therapy as a treatment for school-aged children with ADHD. You can talk to your child’s healthcare provider and teachers about working together to support your child.

Did you know?

Parents report that only about 1 in 3 children with ADHD receive behavioral classroom management.

Special Education Services and Accommodations

Most children with ADHD receive some school services, such as special education services and accommodations. There are two laws that govern special services and accommodations for children with disabilities:

• The Individuals with Disabilities Education Act (IDEA)
• Section 504 of the Rehabilitation Act of 1973

The support a child with ADHD receives at school will depend on if they meet the eligibility requirements for one of two federal plans funded by IDEA and Section 504: an individualized education program (IEP) or a 504 Plan.

What are the main differences between the two Plans?

IEPs provide individualized special education services to meet the unique needs of the child.

A 504 Plan provides services and changes to the learning environment to meet the needs of the child as adequately as other students.

Accommodations

IEP and 504 Plans can offer accommodations for students to help them manage their ADHD, including:

• Extra time on tests;
• Instruction and assignments tailored to the child;
• Positive reinforcement and feedback;
• Using technology to assist with tasks;
• Allowing breaks or time to move around;
• Changes to the environment to limit distraction; and
• Extra help with staying organized.

There is limited information about which types of accommodations are effective for children with ADHD. However, there is evidence that setting clear expectations, providing immediate positive feedback, and communicating daily with parents through a daily report card can help.

Did you know?

Parents of children with ADHD report receiving more services through an IEP than through a 504 plan.

What Teachers Can Do To Help

For teachers, helping children manage their ADHD symptoms can present a challenge. Most children with ADHD are not enrolled in special education classes, but do need extra assistance on a daily basis. The National Resource Center on ADHD provides information for teachers from experts on how to help students with ADHD.

Here are some tips for classroom success.

Communication

• Give frequent feedback and attention to positive behavior;
• Be sensitive to the influence of ADHD on emotions, such as self-esteem issues or difficulty regulating feelings;
• Provide extra warnings before transitions and changes in routines; and
• Understand that children with ADHD may become deeply absorbed in activities that interest them (hyper-focus) and may need extra assistance shifting their attention.

Assignments and Tasks

• Make assignments clear—check with the student to see if they understand what they need to do;
• Provide choices to show mastery (for example, let the student choose among written essay, oral report, online quiz, or hands-on project;
• Make sure assignments are not long and repetitive. Shorter assignments that provide a little challenge without being too hard may work well;
• Allow breaks—for children with ADHD, paying attention takes extra effort and can be very tiring;
• Allow time to move and exercise;
• Minimize distractions in the classroom; and
• Use organizational tools, such as a homework folder, to limit the number of things the child has to track.

Develop a Plan That Fits the Child

• Observe and talk with the student about what helps or distracts them (for example, fidget tools, limiting eye contact when listening, background music, or moving while learning can be beneficial or distracting depending on the child);
• Communicate with parents on a regular basis; and
• Involve the school counselor or psychologist.

Close collaboration between the school, parents, and healthcare providers will help ensure the child gets the right support.

Parent Education and Support

How to best advocate for your child

• Understand your child’s diagnosis, how it impacts their education, and what can be done at home to help.
• Understand your child’s IEP. If you have questions, don’t be afraid to ask.
• Speak with your child’s teacher.
• When possible, obtain written documentation from teachers, administrators, or other professionals working with your child.
• Know your rights.
• Play an active role in preparing your child’s IEP or 504 Plan.
• Keep careful records, including written documentation, communication between home and school, progress reports, and evaluations.
• Try to maintain a good working relationship with the school while being a strong advocate for your child.
• Communicate any concerns you may have about your child’s progress or IEP or 504 Plan.
• Encourage your child every day, and work with your child to create a system to help with homework and other school projects.

What every parent should know

• School support and services are regulated by laws.
• Healthcare providers play an important part in collaborating with schools to help children get the special services they need. Read more about the role of healthcare providers in assisting children with special needs.

Prescription stimulants are effective at treating attention disorders in children and adolescents, but concerns have been raised that they could make a young person more vulnerable to developing later substance use disorders. On balance, the studies conducted so far have found no differences in later substance use for ADHD-affected children who received treatment versus those that did not. This suggests that treatment with ADHD medication does not affect (either negatively or positively) an individual’s risk for developing a substance use disorder.

Therapy and medication are the most effective treatments for ADHD. In addition to these treatments, other strategies may help manage symptoms. Encourage your child to:

• Get regular exercise, especially when they seem hyperactive or restless.
• Eat regular, healthy meals.
• Get plenty of sleep.
• Stick to a routine.
• Use homework and notebook organizers to write down assignments and reminders.
• Take medications as directed.

In addition, you can help your child or teen by being clear and consistent, providing rules they can understand and follow. Also, keep in mind that children with ADHD often receive and expect criticism. You can look for good behavior and praise it and provide rewards when rules are followed.

Behavior therapy is an effective treatment for attention-deficit/hyperactivity disorder (ADHD) that can improve a child’s behavior, self-control, and self-esteem. It is most effective in young children when it is delivered by parents. Experts recommend that healthcare providers refer parents of children younger than 12 years old for training in behavior therapy. For children younger than 6 years old, parent training in behavior management should be tried before prescribing ADHD medication.

When parents become trained in behavior therapy, they learn skills and strategies to help their child with ADHD succeed at school, at home, and in relationships. Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child and the family.

What should parents look for?

If possible, families should look for a therapist who focuses on training parents. Some therapists will have training or certification in a parent training program that has been proven to work in young children with ADHD.

Therapists may also use strategies like those in proven programs. The following list of questions can be used to find a therapist who uses a proven approach:

• Does this therapist
  • Teach parents skills and strategies that use positive reinforcement, structure, and consistent discipline to manage their child’s behavior?
  • Teach parents positive ways to interact and communicate with their child?
  • Assign activities for parents to practice with their child?
  • Meet regularly with the family to monitor progress and provide coaching and support?
  • Re-evaluate treatment plans and remain flexible enough to adjust strategies as needed?

What can parents expect?

Parents typically attend eight or more sessions with a therapist. Sessions may involve working with groups of parents or with one family alone. The therapist meets regularly with the parents to review their progress, provide support, and adjust strategies, as needed, to ensure improvement. Parents typically practice with their child between sessions.

Parents have the greatest influence on their young child’s behavior. Only therapy that focuses on training parents is recommended for young children with ADHD because young children are not mature enough to change their own behavior without their parents’ help. Some therapists may use play therapy or talk therapy to treat young children with ADHD. Play therapy provides a way for children to communicate their experiences and feelings through play. Talk therapy uses verbal communication between the child and a therapist to treat mental and emotional disorders. Neither of these has been proven to improve symptoms in young children with ADHD.

Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child. Ask your healthcare provider about the benefits of parent training in behavior therapy for young children with ADHD.

What can healthcare providers do?

Healthcare providers can:

• Follow the clinical practice guideline for diagnosis and treatment of ADHD in young children
• Discuss with parents the benefits of behavior therapy and why they should consider getting training.
• Identify parent training providers in their area and refer parents of young children with ADHD for training in behavior therapy before prescribing medicine.

Many children with attention-deficit/hyperactivity disorder (ADHD) struggle with school. Recently, children have faced a variety of changes in the way that they attend school. Some might be attending virtual classes; others might attend school in-person with many new rules. To help your child with ADHD adjust to these changes,learn about the resources available for parents.

ADHD and schools

Children with ADHD might experience more obstacles in their path to success than the average student.

Most children with ADHD receive some school services. This can mean special education services, such as individual or small group instruction with a special education teacher; or accommodations, such as changing how assignments, tasks, and tests are done, extra help with remembering and organizing work, and frequent communication. Together, teachers and parents can help children with ADHD succeed in school.

A changing school environment

In the recent past, many children experienced changes in their learning environment. Early in the COVID-19 pandemic, many schools switched from in-person schooling to distance schooling, including learning at home and online. Some schools continued with virtual-only schooling, others had a mix of in-person and virtual schooling, and some returned to in-person schooling, but with additional rules in place. Changes in COVID-19 Community Levels may mean more changes, and virtual schooling is an ongoing option in many areas.

School can present challenges for many children with ADHD. Because ADHD symptoms include difficulty with attention regulation, hyperactivity, and impulsivity, which can affect planning, organizing, and managing behavior, many children with ADHD struggle with change. Here are some of the challenges that children with ADHD can face in different learning environments:

• Physical activity and movement are important for all children, but especially so for children with ADHD. Rules about keeping distance and more time spent with virtual learning can mean sitting still without moving for longer periods of time. Changes in after-school activities may mean fewer opportunities for active group play. Finding time to move may be especially important for children who struggle with hyperactivity.

• Children with ADHD struggle more with boredom and putting mental effort into challenging tasks. Virtual learning or in-person school with more rules may lack the novelty and excitement. Teachers may need to find new ways to keep children with ADHD from being bored and keep them engaged in learning.
• Children with ADHD are more likely than their peers to have some difficulties with social relationships, so having fewer opportunities to interact freely during the day may mean they need other ways to practice social skills and build on relationships.
• Transitions can be challenging for children with ADHD, and having to spend time doing schoolwork, homework, and family activities in the same space where parents may also have to do their own work can create additional stress for students and parents.
• Children with ADHD are likely to have other disorders in addition to ADHD, which can make coping with stress, change, and social isolation associated with virtual learning even more difficult. They may need additional support.

With changes in how school is being conducted, there is also the possibility that children who have special needs are not getting the services they need. The U.S. Department of Education has issued information for implementing special education services for schools that use distance learning.

However, some children with ADHD may respond positively to some of the changes. For example, virtual learning may provide fewer distractions for children who find it more difficult to tune out other people around them. More structured classrooms with more distance between students might help some children focus. With fewer activities in their daily schedules, some children may have more time to get the sleep they need. Since each child may react differently to changes in their environment, parents, teachers, and students need support that works for each individual child.

Working to help parents, students, and teachers

Information and Resources

To help parents and students adapt to the changing environment, the National Resource Center on ADHD (NRC), a funded CDC partner, has worked to create resources and support for parents. These resources include advice for parents and teachers on

• creating enough structure so that the child can learn new routines,
• keeping the child engaged with learning,
• managing difficulty with attention while coping with changes,
• setting up the home learning environment,
• helping children stay connected with other children, and
• keeping children healthy and active.

Caring for a child with special needs can mean extra challenges. Parents of children with ADHD may experience extra stress from supporting their child while coping with changes and may need additional help. The NRC has created a parent toolkit, including information and resources to help parents understand more about ADHD and how to support their child, and tips and advice that help parents with their own stress during uncertain times.

Schools are a part of ADHD treatment

To meet the needs of children with ADHD, schools can

• Be part of effective treatment plans for children with ADHD; and
• Provide special education services or accommodations.

The American Academy of Pediatrics’ recommendations for ADHD treatment state that school is a necessary part of any treatment plan. Behavioral classroom management focusing on positive responses is an evidence-based treatment for ADHD and can complement parent training in behavior management. The NRC also provides some tips for receiving treatment via when in-person treatment is not possible. Parents, teachers, healthcare providers, and older children and teens can collaborate to develop an approach that works best for each student.

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.