What are the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in children?

Symptoms of ADHD in Children

The core symptoms of ADHD in children include a persistent pattern of inattention, hyperactivity, and impulsivity that interferes with functioning or development across multiple settings such as home, school, and social environments. 1

Inattentive Symptoms

• Poor attention to detail, making careless mistakes in schoolwork and other activities 1
• Difficulty concentrating or sustaining attention on tasks or play activities 1
• Appearing preoccupied or having difficulty shifting focus even when spoken to directly 1
• Difficulty completing tasks due to getting distracted or side-tracked 1
• Organizational challenges resulting in chronic lateness, messiness, and disorganized work 1
• Reluctance to engage in tasks requiring sustained mental effort (like homework or lengthy papers) 1
• Frequently losing or misplacing items necessary for tasks or activities 1
• Being easily distracted by external stimuli or unrelated thoughts 1
• Often forgetful in daily activities 1

Hyperactive-Impulsive Symptoms

• Frequent fidgeting, tapping, or squirming when seated 1
• Difficulty remaining seated in situations where staying seated is expected 1
• Feelings of inner restlessness or agitation, especially in older children 1
• Often being loud and disruptive in quiet settings 1
• Always "on the go" as if "driven by a motor" 1
• Excessive talking 1
• Blurting out answers before questions have been completed 1
• Difficulty waiting turn in conversations or activities 1
• Frequently interrupting or intruding on others' conversations or games 1

Diagnostic Requirements

For a diagnosis of ADHD according to DSM-5 criteria, children must have:

• At least 6 symptoms from either the inattentive or hyperactive-impulsive categories (5 symptoms for those 17 years or older) 1
• Symptoms present for at least 6 months 1
• Several symptoms present before age 12 1
• Symptoms present in two or more settings (e.g., home, school) 1
• Clear evidence that symptoms interfere with functioning 1
• Symptoms not better explained by another mental disorder 1

ADHD Subtypes

• Predominantly Inattentive Type: 5 or more symptoms of inattention but fewer than 5 symptoms of hyperactivity-impulsivity 1
• Predominantly Hyperactive-Impulsive Type: 5 or more symptoms of hyperactivity-impulsivity but fewer than 5 symptoms of inattention 1
• Combined Type: 5 or more symptoms of both inattention AND hyperactivity-impulsivity 1

Age-Specific Considerations

Preschool Children (4-5 years)

• Hyperactive symptoms are often more prominent than inattentive symptoms 1
• Excessive motor activity, difficulty sitting still during activities, and impulsive behaviors are common 1
• Symptoms must be distinguished from age-appropriate high activity levels 2

Elementary School Children (6-12 years)

• Both inattentive and hyperactive symptoms may be evident 1
• Academic difficulties often become apparent as school demands increase 2
• Disruptive behaviors in classroom settings are frequently reported 1

Adolescents (12-18 years)

• Hyperactive symptoms often decline while inattentive symptoms persist 1
• Symptoms may be less obvious as overt hyperactivity decreases 1
• Adolescents may minimize their problematic behaviors in self-reports 1
• Inner restlessness may replace visible hyperactivity 1

Common Comorbid Conditions

• Learning disabilities and language disorders 1
• Anxiety and depression 1
• Oppositional defiant disorder and conduct disorders 1
• Sleep disorders 1
• Tics and Tourette syndrome 1
• Autism spectrum disorders 1

Important Clinical Considerations

• Boys are more than twice as likely as girls to receive an ADHD diagnosis, possibly because hyperactive behaviors are more easily observable 1
• Girls with ADHD are more likely than boys to have comorbid anxiety or depression 1
• ADHD symptoms often vary between different settings and with different observers 1
• Symptoms that appear similar to ADHD may be caused by other conditions, including substance use, anxiety, depression, or trauma 1
• Untreated ADHD is associated with poorer long-term outcomes in academic achievement, occupational performance, substance use, and relationship difficulties 3

Diagnostic Pitfalls to Avoid

• Relying solely on parent or teacher reports without obtaining information from multiple sources 1
• Failing to screen for common comorbid conditions that may alter treatment approach 2
• Not establishing that symptoms were present before age 12, particularly when evaluating adolescents 1
• Overlooking that certain substances (e.g., marijuana) can produce effects that mimic ADHD symptoms 1
• Misinterpreting age-appropriate behaviors in very young children as pathological 1