Understanding ADHD: Information for Parents

Understanding ADHD

Almost all children have times when their behavior veers out of control. They may speed about in constant motion, make noise nonstop, refuse to wait their turn, and crash into everything around them. At other times they may drift as if in a daydream, unable to pay attention or finish what they start. 

 However, for some children, these kinds of behaviors are more than an occasional problem. Children with attention deficit hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.  

According to national data, ADHD affects about 9.4% of U.S. children ages 2-17―including 2.4% of children ages 2-5 and 4%-12% of school-aged children. Boys are more than twice as likely as girls to be diagnosed with ADHD. Both boys and girls with the disorder typically show symptoms of an additional mental disorder and may also have learning and language problems.

ADHD is a chronic condition of the brain that makes it difficult for children to control their behavior.

The condition affects behavior in specific ways. For example, children with ADHD often have trouble getting along with siblings and other children at school, at home, and in other settings. Those who have trouble paying attention usually have trouble learning. An impulsive nature may put them in actual physical danger. Because children with ADHD have difficulty controlling this behavior, they may be labeled “bad kids” or “space cadets.” 

Effective treatment is available. If your child has ADHD, your pedia­trician can offer a long-term treatment plan to help your child lead a happy and healthy life. As a parent, you have a very important role in this treatment.  

Left untreated, ADHD in some children will continue to cause ­serious, lifelong ­problems, such as poor grades in school, run-ins with the law, failed relationships, and the inability to keep a job. 

ADHD includes 3 groups of behavior symptoms: inattention, hyperactivity, and impulsivity.

Symptoms of ADHD
Behavior symptom:How a child with this symptom may behave:
InattentionOften has a hard time paying attention, daydreamsOften does not seem to listenIs easily distracted from work or playOften does not seem to care about details, makes careless mistakesFrequently does not follow through on instructions or finish tasksIs disorganizedFrequently loses a lot of important thingsOften forgets thingsFrequently avoids doing things that require ongoing mental effort
HyperactivityIs in constant motion, as if “driven by a motor”Cannot stay seatedFrequently squirms and fidgetsTalks too muchOften runs, jumps, and climbs when this is not permittedCannot play quietly
ImpulsivityFrequently acts and speaks without thinkingMay run into the street without looking for traffic firstFrequently has trouble taking turnsCannot wait for thingsOften calls out answers before the question is completeFrequently interrupts others

Not all children with ADHD have all the symptoms.

Children with ADHD may have one or more of the symptom groups listed in the table above. The symptoms are usually classified by the following types of ADHD: 

  • Inattentive only (formerly known as attention-deficit disorder [ADD])—Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is more common.
  • Hyperactive/impulsive—Children with this type of ADHD show both hyperactive and impulsive behavior, but they can pay attention. They are the least common group and are frequently younger.
  • Combined inattentive/hyperactive/impulsive—Children with this type of ADHD show a number of symptoms in all 3 dimensions. It is the type that most people think of when they think of ADHD.

If your child has shown symptoms of ADHD on a regular basis for more than 6 months, discuss this with your pediatrician.

Realize, it is normal for all children to show some ADHD symptoms from time to time. Your child may be reacting to stress at school or home, bored, or just going through a difficult stage of life. It does not mean he or she has ADHD. 

Sometimes a teacher is the first to notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to a parent’s attention.  

Other times, questions from the pediatrician raised the issue. At routine visits, pediatricians often ask questions such as: 

  • “How is your child doing in school?”
  • “Are there any problems with learning that you or your child’s ­teachers have seen?”
  • “Is your child happy in school?”
  • “Is your child having problems completing class work or homework?”
  • “Are you concerned with any behavior problems in school, at home, or when your child is playing with friends?”

Simplifying, Organizing, and Structuring the Home Environment: For Parents of Children with ADHD

You will find that your child’s ability to progress in nearly all areas of self-management and social interaction increases when his environment is organized and structured to meet his unique needs. If your child is physically impulsive or accident-prone, take the time to unclutter and safety-proof your home. Some children with ADHD may benefit from an orderly physical environment with a place for each object, while keeping the environment (eg, your child’s room) organized may be a hopeless task for others. Try helping your child organize his room at a level he can manage.

Daily routines are an absolute necessity for many children with ADHD. Consistent limitsetting with predictable consequences, along with limited choices (not “What do you want to eat?” but “Do you want an apple or a boiled egg?”), also make your child’s world more manageable and help him meet his goals. Written lists of chores or other daily tasks are especially useful in helping your child keep track of what he needs to do, and is an excellent habit for him to carry into adolescence and adulthood.

When considering how to structure your child’s day-to-day experiences, it may help to picture your growing child as a construction project in progress. The limits, lists, routines, and other measures you are putting in place today are like scaffolding that will provide the necessary support as he develops fully. As he turns these routines into daily habits and becomes more self-directed, some of these supports can be gradually removed while his underlying functioning remains well in place. (You may no longer have to create homework checklists with him, for example, because he has learned to make them himself.) Far from “babying” your child, helping to structure and organize his world allows him to add to his competencies and experience many more small triumphs, increasing his self-esteem.

Just as you have observed that your child may feel less overwhelmed when his home life is well organized, so you may find that organizing your own family life as thoroughly as possible will help you feel calmer and more in control. (This is even more likely to be the case, of course, if you have ADHD.) With the number of medical visits, teachers’ conferences, and treatment reviews necessary to maintain your child’s well-being and continued progress, a family calendar including all scheduled activities can be an essential for many families. Daily lists of tasks to perform and errands to run will help you stay organized just as they help your child. Many parents find it worthwhile to devote a private 10 minutes to half an hour before the kids get up in the morning to “regroup”—thinking about everything that must be accomplished that day and arranging tasks in order of priority. Make sure that any plan is realistic and not overwhelming.


Parenting Teenagers with ADHD

​Achieving independence is a primary developmental goal of adolescence.

Your teenager will experience this urge as strongly as his peers without ADHD, but his or her impulsivity, inattention, and aspects of delayed maturity may mean moving slower toward this goal.  Specifically, you may need to:

  • Remove loss of privileges in response to a broken rule. Know that long-standing loss of privileges, however, harbors resentment and has little teaching value.
  • Work at consciously modeling responsible behavior. Watch the video Offering Boundaries & Being Role Models for more information and tips.
  • Break down tasks and responsibilities into smaller steps. Reward your teen for accomplishing them.
  • Develop a plan for transferring responsibilities over to your teenager as he or she works toward independence.

Addressing Your Concerns Directly

It’s easy to imagine that a teenager would resent a 10:00 pm curfew, if his or her friends are, for example, were allowed to stay out until midnight. Talk with your teen about the reasons if you worry about his staying out later.

You may be concerned that parties tend to get wilder after about 10:00 pm, a time where you have observed that his or her impulsivity usually increases, or that driving is potentially riskier late at night because his medication will have worn off by then. If your teen feels he or she is ready to take responsibility for staying out later, and you have made the necessary adjustments to ensure success (such as possibly changing his or her medication routine to enhance attention while driving), then extend the curfew for 1 hour. If he or she arrives home on time with no evidence of high-risk activity, give praise. Reward your teen with a continued 11:00 pm curfew. Moving in these small steps allows you to continue to build a mutual trust and respect—vital for your teen’s self- esteem.

Providing Structure & Support

During your child’s earlier years, you were encouraged to actively monitor his or her behavior in the classroom and at home. Now that your teenager is growing more independent, you may feel it is time to stop this type of monitoring. However, many teens with ADHD continue to need more parental monitoring and structure.

While it is best for parents of many other 15-year-olds to back off and let their child manage his or her own homework, for example, a teen with ADHD may need continued monitoring to see that he or she is completing work and turning it in on time.

While other parents may grow laxer about knowing where their older teenagers are every minute, you may have reason to continue monitoring where your teenager is, with whom, what he or she is doing, and when he or she will be home, particularly when you sense that he or she might be in a high-risk situation that may be difficult to manage. While monitoring is necessary, it must be done in a way that is also respectful of your teenager and his or her developmental needs.

Establishing & Enforcing Rules

Any teen might have an argumentative style, and your teen’s resistance to your continued monitoring may lead to a great deal of boundary testing, negotiating, and possibly outright rebellion. When warranted, you may feel better— and will be able to save some energy—if you identify 4 or 5 nonnegotiable rules based on the issues you consider essential for your family.

You may decide, for example, that use of illegal drugs of any kind—including marijuana, alcohol, and cigarettes—will not be tolerated in your house, or that driving can only be done at times when stimulant medication still has an active effect. These strict, nonnegotiable rules should be reserved for critical issues of safety or family functioning.

When you have arrived at the 4 or 5 basic rules, write them down and discuss them with your teenager. Explain that the trust built through compliance with these rules can open the door to negotiating the other freedoms he or she craves. Discuss the rewards for compliance (i.e. extended privileges in other areas) and the consequences (i.e. increased restrictions) for breaking these rules. Enforce these consequences consistently. Catch your teen doing something good. Remember, rewards are much more powerful than negative consequences.

Negotiating with Your Teen

Once your teenager has shown he or she is able to follow these few essential rules, you are likely to feel more at ease when negotiating other issues. Negotiation is based on the assumption that, as a teen matures, he or she will take a more active role in creating the rules by which he or she lives. It is important to establish the fact that as the parent, right now you assume the final responsibility for rules and consequences.

A good way to negotiate rules or solutions to family conflicts is to use a technique called problem-solving training. This technique consists of the following steps:

  • Define the problem and its effect.
  • Come up with a variety of possible solutions.
  • Choose the best solution.
  • Plan how to implement the solution.
  • Renegotiate a new solution if necessary.

When first attempting to solve problems in this way, it is best to start with issues that are important but not emotionally intense for your teenager or for you. Eventually you may become so adept at this rational form of problem solving that you and your teenager will be able to resolve arguments on the spot, in most cases, using informal versions of this technique.

Providing Appropriate Consequences

You will need to “stick to your guns” in enforcing the rules and procedures on which you have all already agreed. Provide rewards and consequences consistently, and as soon as possible after the behavior has occurred. 

Pre–agreed-on losses of privileges, for example, may be temporarily losing car key rights for coming home late. The tighter the link between the behavior and the consequences the better. Try to let these negotiated consequences take the place of argument, recrimination, yelling, or nitpicking. Keep the conflicts and emotions out of it. Simply provide the appropriate response to keep family life relatively pleasant and upbeat.

Fostering a Positive Attitude & Giving Each Other Breaks

Research suggests that the presence of one fully supportive adult in the life of a child with ADHD is one of the key factors in determining that child’s future success. Be sure to invest plenty of quality time in your teenager—and make it fun and rewarding for both of you.

Sometimes, when things get too tough at home, it is a good idea to take a break from one another. A weekend that you spend away can restore your awareness that your problems at home can be solved, and can give all of you the space you need to maintain a healthy relationship. Parents need support too!

As any teenager explores newly accessible choices, he or she will inevitably make some good and bad decisions. This is a normal and an important part of becoming a responsible adult.


Non-Stimulant Medications Available for ADHD Treatment

​​Some non-stimulant medicines may be appropriate for children who have been diagnosed with Attention Deficient Hyperactivity Disorder (ADHD) and certain coexisting conditions. These include ADHD with accompanying tic disorders (such as Tourette Syndrome), for example.. In some cases, these medicines can treat both conditions at the same time. Proven alternate choices of stimulant medications for children include AtomoxetineGuanfacine XR, and Clonidine XR.

Non-Stimulant Medications for ADHD
Generic Class
(Brand Name)
DosagePrescribing Schedule

Atomoxetine (Strattera)

Once a day to twice a day
0.5 mg/kg per day increasing to 1.4 mg/kg per day
Long acting (Intuniv)
1-4 mg daily

Start at lower doses
Short-acting (Tenex)
1-2 mg 2 to 3 times daily

Start at lower doses

Long-acting (Kapvay)
0.1 – 0.3 mg 2 to 3 times daily

Start at lower doses
Oral tablets
0.1 – 0.2 mg twice daily

Start at lower doses
Film patches
0.1 – 0.3 mg patch daily

Start at lower doses

 These are newer FDA approved medications that have not been used as long as stimulants. Atomoxetine, guanfacine XR and clonidine XR are considered second-line (second-choice) treatments. Products are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics. Your doctor or pharmacist can provide you with important safety information for the products listed.


Atomoxetine (Strattera) is a non-stimulant approved by the FDA for the treatment of ADHD. It is in the class of medications known as selective norepinephrine reuptake inhibitors. Because atomoxetine does not have a potential for abuse, it is not classified as a controlled substance.

Atomoxetine is a newer medication and the evidence supporting its use is more limited than for stimulants. Atomoxetine, unlike stimulants, is active around the clock. However, atomoxetine has been found to be only about two-thirds as likely to be effective as stimulant medications. After starting atomoxetine, it may take up to 6 weeks before it reaches its maximum effectiveness.

Possible side effects

Atomoxetine has a warning on it that it may, in a very small number of cases, have some potential for causing suicidal thoughts in the first few weeks of treatment. Atomoxetine may be helpful in the treatment of children who have both ADHD and anxiety, since stimulants may worsen anxiety symptoms. Side effects are generally mild but can include decreased appetite, upset stomach, nausea or vomiting, tiredness, problems sleeping, and dizziness. Jaundice (turning yellow) is mentioned in a warning on the medication, but is extremely rare. Taking atomoxetine with food can help avoid nausea and stomachaches. Atomoxetine should be used in lower doses in children also taking certain antidepressants like fluoxetine (Prozac) or paroxetine (Paxil), because they can raise the atomoxetine levels in the bloodstream.

Atomoxetine is now considered an option for first-line therapy for ADHD, and is the first non-stimulant to fall into the first-line category. Parents concerned about the possibility that stimulants may be used for substance abuse may choose atomoxetine as the first-line agent for their child. It is often used for children who have had unsuccessful trials of stimulants.

Long-acting guanfacine

Long-acting guanfacine (Intuniv) is in the group of medications known as alpha agonists. These medications were developed for the treatment of high blood pressure but have also been used to treat children with ADHD who have tics, sleep problems, and/or aggression. It has recently been approved by the FDA for the treatment of children with ADHD.

Long-acting guanfacine is a pill, but it cannot be crushed, chewed, or broken and must be swallowed whole. Like atomoxetine, it is not a controlled substance.

Possible side effects

It does not suppress appetite much, so may be a good choice for children who lost a significant amount of weight when taking a stimulant. Side effects can include sleepiness, headaches, fatigue, stomachaches, nausea, lethargy, dizziness, irritability, decreased blood pressure, and decreased appetite. Although sleepiness occurs in a large number of children when children start taking long-acting guanfacine, it seems to get better as they continue to take it. It may take 3 to 4 weeks to see medication benefit.

Long-acting clonidine

Long-acting clonidine (Kapvay) is also FDA approved for the treatment of ADHD. It is taken twice a day while long acting guanfacine is once a day. Both long-acting alpha agonists have been studied for use alone or as an add-on to stimulants when the stimulant alone does not stop all the symptoms of ADHD.

Two other shorter-acting alpha agonists are available for use, but not approved by the FDA for ADHD. These are clonidine (Catapres) and short-acting guanfacine (Tenex). These can be used as adjunctive medications, or if FDA-approved medications are not helpful.

If no FDA-approved medication has been found helpful for your child, you should also consider whether ADHD is the correct diagnosis, and whether additional coexisting conditions might be present.


Neurofeedback, Hypnotherapy, and Guided Imagery

A number of proposed treatments for ADHD—including hypnotherapy, self-hypnosis, guided imagery, neurofeedback, and relaxation training—are aimed at helping a child begin to regulate his own behavior and psychological state. The fact that these techniques can be used quite successfully for children in other areas of self-regulation (headache management, teaching bowel control, etc) increases their appeal as a form of treatment.

Hypnotherapy has not been shown to significantly improve the core symptoms of ADHD, though it may improve such accompanying problems as sleep problems and tics when used as part of an integrated treatment approach. One difference between the use of hypnotherapy for headaches versus ADHD is that children learn to institute the self-hypnosis at the early signs of a headache. There is no comparable “trigger” with ADHD, and children cannot do self-hypnosis all day long.

Neurofeedback treatment involves placing electrodes on a child’s head to monitor brain activity. Children are asked, for example, to change the aspects of a video game (for example “making the sun set with your mind”), which happens when their brainwaves are of a desired frequency. The theory is that learning to do this increases their arousal levels, improves their attention, and results in reductions in hyperactive-impulsive behaviors. This is based on findings that many children with ADHD show low levels of arousal in frontal brain areas, with excess of theta (daydreamy) waves and deficit of beta waves (indicators of a highly focused mind), thereby reducing ADHD. The studies on the use of neurofeedback to date have been criticized for lacking the appropriate controls or the random assignment of test subjects to the treatment or sham treatment groups. It should also be pointed out that neurofeedback treatment is an expensive approach to treating ADHD.


Mood Disorders & ADHD

The mood disorders most likely to be experienced by children with ADHD include dysthymic disorder, major depressive disorder (MDD), and bipolar disorder. Dysthymic disorder can be characterized as a chronic low-grade depression, persistent irritability, and a state of demoralization, often with low self-esteem. Major depressive disorder is a more extreme form of depression that can occur in children with ADHD and even more frequently among adults with ADHD. Dysthymic disorder and MDD typically develop several years after a child is diagnosed with ADHD and, if left untreated, may worsen over time. Bipolar disorder is a severe mood disorder that has only recently been recognized as occurring in children. Unlike adults who experience distinct periods of elation and significant depression, children with bipolar disorder present a more complex disturbance of extreme emotional instability, behavioral difficulties, and social problems. There is significant overlap with symptoms of ADHD, and many children with bipolar disorder also qualify for a diagnosis of ADHD.

What to Look For

Every child feels discouraged or acts irritable once in a while. Children with ADHD, who so often must deal with extra challenges at school and with peers, may exhibit these behaviors more than most. If your child claims to be depressed, however, or seems irritable or sad a large portion of each day, more days than not, she may have a coexisting dysthymic disorder. To be diagnosed with dysthymic disorder, a child must also have at least 2 of the following symptoms:

  • Poor appetite or overeating 
  • Insomnia or excessive sleeping 
  • Low energy or fatigue 
  • Low self-esteem 
  • Poor concentration or difficulty making decisions 
  • Feelings of hopelessness

Before dysthymic disorder can be diagnosed, children must have had these symptoms for a year or longer, although symptoms may have subsided for up to 2 months at a time within that year. The symptoms also must not be caused by another mood disorder, such as MDD or bipolar disorder, a medical condition, substance abuse, or just related to ADHD itself (low self-esteem stemming from poor functioning in school, for example). Finally, the symptoms must be shown to significantly impair your child’s social, academic, or other areas of functioning in daily life.

Major depressive disorder is marked by a nearly constant depressed or irritable mood or a marked loss of interest or pleasure in all or nearly all daily activities. In addition to the symptoms listed previously for dysthymic disorder, a child with MDD may cry daily; withdraw from others; become extremely self-critical; talk about dying; or even think about, plan, or carry out a suicide attempt. Unlike the brief outbursts of temper exhibited by a child with ODD who does not get her way, a depressed child’s irritability may be nearly constant and not linked to any clear cause. Her inability to concentrate differs from ADHD-type inattention in that it is accompanied by other symptoms of depression, such as loss of appetite or loss of interest in favorite activities. Finally, the depression itself stems from no apparent cause—as opposed to being demoralized as a result of specific obstacles posed by ADHD or becoming depressed in response to parental divorce or any other stressful situation. (In fact, research has shown that the intactness of a child’s family and its socioeconomic status have little or no effect on whether a child develops MDD.) While children with ADHD/CD alone are not at higher than normal risk for attempting suicide, children with ADHD/CD who also have an MDD and are involved in substance abuse are more likely to make such an attempt and should be carefully watched.

Talk of suicide (even if you are not sure whether it is serious), a suicide attempt, self-injury, any violent behavior, or severe withdrawal should be considered an emergency that requires the immediate attention of your child’s pediatrician, psychologist, or local hospital.

A depressed child may admit to feeling guilty or sad, or she may deny having any problems. It is important to keep in mind the fact that many depressed children refuse to admit to their feelings, and parents often overlook the subtle behaviors that signal a mood disorder. By keeping in close contact with her teacher, bringing your child to each of her treatment reviews with her pediatrician, and including her in all discussions of her treatment as appropriate to her age, you can improve the chances that her pediatrician or mental health professional will detect any signs of developing depression, and that she will have someone to talk to about her feelings.

A child with bipolar disorder and ADHD is prone to explosive outbursts, extreme mood swings (high, low, or mixed mood), and severe behavioral problems. Such a child is often highly impulsive and aggressive, with prolonged outbursts typically “coming out of nowhere” or in response to trivial frustrations. She may have a history of anxiety. She may also have an extremely high energy level and may experience racing thoughts and inflated self-esteem or grandiosity, extreme talkativeness, physical and emotional agitation, overly sexual behavior, and/or a reduced need for sleep. These symptoms can alternate with periods of depression or irritability, during which her behavior resembles that of a child with MDD. A child with ADHD/ bipolar disorder typically has poor social skills. Family relationships are often strained because of the child’s extremely unpredictable, aggressive, or defiant behavior. Early on the symptoms may only occur at home, but often begin to occur in other settings as the child gets older. Bipolar disorder is a serious psychiatric disorder that can sometimes include psychotic symptoms (delusions/hallucinations) or self-injurious behavior such as cutting, suicidal thoughts/impulses, and substance abuse. Many children with bipolar disorder have a family history of bipolar disorder, mood disorder, ADHD, and/or substance abuse. Children with ADHD and bipolar disorder are at higher risk than those with ADHD alone for substance abuse and other serious problems during adolescence.

If your child has ADHD with coexisting bipolar disorder, her pediatrician will generally refer her to a child psychiatrist for further assessment, diagnosis, and recommendations for treatment.


As with ADHD with anxiety disorders, treatment of ADHD with depression usually involves a broad approach. Treatment approaches may include a combination of cognitive-behavioral therapy, interpersonal therapy (focusing on areas of grief, interpersonal relationships, disputes, life transitions, and personal difficulties), traditional psychotherapy (to help with self-understanding, identification of feelings, improving self-esteem, changing patterns of behavior, interpersonal interactions, and coping with conflicts), as well as family therapy when needed.

Medication management approaches, as with ADHD and other coexisting conditions, include treating the most disabling condition first. If your child’s ADHD-related symptoms are causing most of her functioning problems, or the signs of depression are not completely clear, your child’s pediatrician is likely to start with stimulant medication to treat the ADHD. In cases when the depressive symptoms turn out to stem from poor functioning due to ADHD and not to a depressive disorder, they may diminish as the ADHD symptoms improve. If the ADHD and depressive symptoms improve, your child’s pediatrician will probably maintain stimulant treatment alone. If her ADHD symptoms improve but her depression remains the same, even after a reasonable trial of the type of broad psychotherapeutic approach described previously, her pediatrician may add another medication, most commonly an SSRI—a class of medications including Prozac, Zoloft, Paxil, Luvox, and Celexa. Selective serotonin reuptake inhibitors can make the symptoms of bipolar disorder worse, so a careful evaluation must be completed before starting medication. If this approach is unsuccessful, you may be referred to a developmental/behavioral pediatrician or a psychiatrist, who may try other classes of medications.


Learning, Motor Skills, and Communication Disorders

Learning Disorders

Reading Disorders

Reading disorders, the most common and best studied of the learning disabilities, account for 80% of all children diagnosed as learning disabled. Children with reading disorders are able to visualize letters and words but have difficulty recognizing that letters and combinations of letters represent different sounds. Most reading disorders involve difficulties with recognizing single words rather than with reading comprehension. The cause often lies in the area of the child’s “phonologic awareness”—difficulty perceiving how sounds make up words. Reading disorders—even including letter reversals—have little to do with vision. These problems make it quite difficult for children to add new words to their reading repertoire and become good readers. While their listening and speaking skills may be adequate, they may have trouble naming objects (such as quickly coming up with the word for “computer” or “backpack”) and/or remembering verbal sequences (such as “The boy saw the man who was driving the red car.”). A smaller group of children also have reading disabilities that involve comprehension, and these children tend to have poor receptive language skills—that is, difficulty understanding language even when it is spoken to them. A reading disorder, depending on how it is defined, is not necessarily a lifelong condition, but these problems do persist into adulthood in at least 40% of children.

Like all other learning disabilities, reading disorders cannot be detected through neurologic tests, such as special examinations, electroencephalograms (EEGs: brain wave tests), or brain scans like computed tomography and magnetic resonance imaging. They are identified when a child’s reading level or language achievement scores are significantly lower than those of his classmates. In assessing reading disabilities, it is important to identify each component of your child’s problem so that specific treatment measures can be applied. It is also important to address the attentional and behavioral aspects of the ADHD so that your child can make optimal progress at school.

Mathematics Disorder

Mathematics disorder can be thought of as a type of learning disability in which spoken language is not affected, but computational math is. Children with mathematics disorder also may have difficulties with motor and spatial, organizational, and social skills.

Children with coexisting ADHD, or even ADHD alone, can have additional problems in math—such as delays in committing math facts to memory, the making of careless math errors, rushing through problems and impulsively putting down the wrong answers or not showing their work, and making errors because they misaligned columns during addition or long division. Although math disabilities are about as common as reading disabilities, they are not well studied. It is not known whether math skills stem from the innate abilities of children to understand the concepts of magnitude or quantities and compare numbers, or whether they arise in brain areas that are responsible for language, visual-spatial, or attention and memory systems.

It is generally agreed that children with mathematics disability have a deficit in recalling math facts. Accurate and fluent recall of single digit math facts is felt to be important in freeing up higher brain areas for learning and applying more complex tasks. Children with both reading and math disabilities struggle particularly with word problem-solving.

Written Expression Disorder

Children with written expression disorder can have difficulty composing sentences and paragraphs; organizing paragraphs; using correct grammar, punctuation, and spelling in their written work; and writing legibly. Children with spoken-language problems can develop problems with written language as well as math. Children with ADHD can also have difficulty with taking the mental time to plan their writing, and their handwriting can be immature and sometimes unreadable without necessarily having a written expression disorder. When handwriting problems are more a function of ADHD than a written expression or motor skills disorder, they sometimes improve rapidly and dramatically with appropriate stimulant medication treatment.

Nonverbal Learning Disability

Nonverbal learning disability is a condition that is not yet formally categorized as a disorder but that has been the subject of increasing interest. It is particularly important to consider in children with ADHD because it relates to attentional functioning. It is often difficult to decide whether a child with ADHD has a coexisting NLD or whether he just has an NLD that mimics ADHD—especially the inattentive symptoms.

Nonverbal learning disability accounts for about 5% to 10% of children with learning disabilities. It consists of a cluster of deficits, including poor visuospatial skills, problems with social skills, and impaired math ability. Problems with disorganization, inconsistent school performance, and social problems may lead to an evaluation for ADHD. In some cases this makes children with NLD difficult to differentiate from children with Asperger disorder. General functioning in children with NLD younger than 4 years can be relatively typical or only involve mild deficits. Following this period, children can develop disruptive behavior and may develop hyperactivity and inattention. They are frequently thought of as acting out and hyperactive, and are commonly identified by their teachers as overtalkative, trouble makers, or behavior problems. As they grow older, their high activity level can disappear. By older childhood and early adolescence, problems can tend to be more internal, characterized by withdrawal, anxiety, depression, unusual behaviors, and social skills problems. Interactions with other children may become more difficult, and their faces can seem unexpressive. These behaviors can be accompanied by deficits in how they judge social situations, judgment, and interaction skills. Children with NLD are particularly prone to emotional problems over the course of their development, as opposed to children with other learning disabilities. Nonverbal learning disabilities are less prevalent than languagebased learning disorders. Where it is estimated that about 4% to 20% of the general population have identifiable learning disabilities, it is thought that only 1% to 10% of those individuals would be found to have NLD.

Children with NLD are often not identified until late elementary school or middle school, when the peer problems increase and academic tasks become more complicated. They frequently develop symptoms of depression and anxiety.

Academic Problems

As was pointed out earlier in this chapter, children with ADHD frequently experience significant challenges at school and elsewhere that cannot be formally categorized as disabilities or formal disorders. Forty percent of children with ADHD, for example, who do not qualify for a diagnosis of learning disability still experience learning problems that lead to underachievement at school. These learning problems may include

  • Inattention and distractibility
  • Lack of persistence and inconsistent performance
  • A tendency to become easily bored or to rush through or not complete work
  • Impulsive responses and careless errors
  • Difficulty self-correcting mistakes
  • A limited ability to sit still and listen
  • Difficulty with time-limited tasks and test taking
  • Problems with planning, homework flow, and work completion
  • Difficulty taking notes or performing other forms of multitasking
  • Difficulty memorizing facts
  • Difficulty organizing and producing written work
  • Immature and slow handwriting that can also create obstacles in expressive writing
  • Difficulty with reading comprehension

Stimulant medications that decrease your child’s ADHD symptoms are likely to help her address many of these problems. Behavior therapy techniques aimed at increasing or decreasing specific behaviors at home and in school can also prove beneficial. Specific behavioral goals, such as improving completion of assignments, can be addressed by understanding your child’s individual strengths and weaknesses and collaborating with school staff in using positive reinforcement, appropriate behavioral techniques, daily report cards, and ongoing monitoring.

Motor Skills Disorder

Motor skills disorder, also known as developmental coordination disorder, is diagnosed when motor skills problems significantly interfere with academic achievement or activities of daily living. It is frequently overlooked in children with ADHD due to its nonspecific cluster of symptoms—yet it can affect children’s lives by interfering with writing and other academic activities or preventing children from participating at their classmates’ level in sports and play. Children with ADHD and other learning disabilities frequently have motor skills disorder as well. Motor skills disorder involves a developmental delay of movement and posture that leaves children with coordination substantially below that of others of their age and intelligence level. These children seem so clumsy and awkward they are rarely picked for teams at school. As the years pass, they tend to fall further behind in terms of motor skills, and their confidence diminishes as a result. By adolescence, most children with motor skills disorder not only perform poorly in physical education classes, but may also have a poor physical self-image and perform below expectations academically.

Motor skills disorder may be first identified when a preschooler or kindergartner is unable to perform age-appropriate skills, such as buttoning buttons and catching a ball, or when an elementary school child struggles with writing or sports activities. A child with motor skills disorder may have difficulty with the mechanics of writing, with planning motor actions, or with memorizing motor patterns. While many young children with ADHD but no motor skills disorder may seem clumsy in their younger years, their awkwardness is related more to inattentiveness or impulsivity than to poor motor control and it is frequently outgrown. However, a child with ADHD and coexisting motor skills disorder may not outgrow his clumsiness.

If your child is diagnosed with developmental coordination disorder, he may be referred to a pediatric occupational therapist for individualized therapy and, particularly if his deficits negatively affect his academic performance or daily skills, be recommended for special gym activities at school to promote hand-eye coordination and motor development and improve specific skills.

Communication Disorders

Communication disorders—conditions that interfere with communications with others in everyday life—involve not only the ability to appreciate language sounds (phonologic awareness) but also to acquire, recall, and use vocabulary (semantics) and to deal with word order and appropriately form or comprehend sentences (syntax). Subcategories of these disorders have been identified, including expressive language disorder, mixed receptive-expressive disorder, phonologic disorder, articulation (word pronunciation) disorder, and stuttering.

Because there is such a close association between communication and social relationships, these language deficits are often accompanied by social skills difficulties. Children with ADHD without a language disorder may also have difficulties in using language, particularly in social situations. You may notice that your child has problems with excessive talking, frequent interruption, not listening to what is said, blurting out answers before questions are finished, and having disorganized conversations.


How Schools Can Help Children with ADHD

​Your child’s school is a key partner in providing effective behavior ­therapy for your child. In fact, these principles work well in the classroom for most students. 

Classroom management techniques may include: 

  • Keeping a set routine and schedule for activities
  • Using a system of clear rewards and consequences, such as a point system or token economy
  • Sending daily or weekly report cards or behavior charts to parents to inform them about the child’s progress
  • Seating the child near the teacher
  • Using small groups for activities
  • Encouraging students to pause a moment before answering questions
  • Keeping assignments short or breaking them into sections
  • Close supervision with frequent, positive cues to stay on task
  • Changes to where and how tests are given so students can succeed (e.g., allowing students to take tests in a less distracting environment or allowing more time to complete tests)

Federal laws to help children with ADHD:

Your child’s school should work with you and your pediatrician to develop strategies to assist your child in the classroom. When a child has ADHD that is severe enough to interfere with her ability to learn, 2 federal laws offer help. These laws require public schools to cover costs of evaluating the ­educational needs of the affected child and providing the needed services.  

  • The Individuals with Disabilities Education Act, Part B (IDEA) requires public schools to cover costs of evaluating the educational needs of the affected child and providing the needed special education services if your child qualifies because her learning is impaired by her ADHD.
  • Section 504 of the Rehabilitation Act of 1973 does not have strict ­qualification criteria but is limited to changes in the classroom, modifi­cations in homework assignments, and taking tests in a less distracting environ­ment or allowing more time to complete tests.

If your child has ADHD and a coexisting condition, she may need additional special services such as a classroom aide, private tutoring, special classroom settings, or, in rare cases, a special school.  

It is important to remember that once ADHD is diagnosed and treated, children with it are more likely to achieve their goals in school.  


Homeopathic Treatments for ADHD

Homeopathy, a therapeutic approach developed in the 1800s that is especially popular in Europe, springs from the concept that illness results from a disorder of “vital energies,” and that these energies must be restored if a patient is to recover. Vital energies can be restored through the use of diluted animal, plant, or mineral extracts designed to treat specific symptoms. These treatments have been shown to be more effective than placebos in reliable scientific studies, though the reason for this is not yet known.

Homeopathic treatment for ADHD, increasingly widespread in the United States as individual accounts of success have spread, has been demonstrated effective in one initial study in improving ADHD-type behavior, although the study failed to use a fully double-blind design.

Though the mechanisms underlying this treatment are still not scientifically defined, the success of the study merits further investigation of homeopathy as a treatment for ADHD, but it cannot be recommended as a proven therapy at this time.

If you do become interested in using this approach, be sure to discuss your plans first with your child’s physician. Some extracts can interact negatively with medications your child may be taking.


Encouraging Independence in Teenagers with ADHD

​The teenage years can be a special challenge. Academic and social demands increase. In some cases, symptoms may be better controlled as the child grows older; however, frequently the demands for performance also increase so that in most cases, ADHD symptoms persist and continue to interfere with the child’s ability to function adequately.

According to the National Institute of Mental Health, about 80% of those who required medication for ADHD as children still need it as teenagers.

Parents play an important role in helping teenagers become independent.

Encourage your teenager to help herself with strategies:

  • Using a daily planner for assignments and appointments
  • Making lists
  • Keeping a routine
  • Setting aside a quiet time and place to do homework
  • Organizing storage for items such as school supplies, clothes, CDs, and sports equipment
  • Being safety conscious (e.g., always wearing seat belts, using protective gear for sports)
  • Talking about problems with someone she trusts
  • Getting enough sleep
  • Understanding her increased risk of abusing substances such as tobacco and alcohol

Activities such as sports, drama, and debate teams can be good places to channel excess energy and develop friendships. Find what your teenager does well and support her efforts to “go for it.”

Milestones such as learning to drive and dating offer new freedom and risks. Parents must stay involved and set limits for safety. Your child’s ADHD increases her risk of incurring traffic violations and accidents.

It remains important for parents of teenagers to keep in touch with teachers and make sure that their teenager’s schoolwork is going well.

Talk with your pediatrician if your teenager shows signs of severe problems such as depression, drug abuse, or gang-related activities.