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Attention-deficit/hyperactivity disorder (ADHD) in children - Symptoms and causes

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This condition affects children, and may continue into adulthood. It can include difficulty sustaining attention, hyperactivity and impulsive behavior.

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Obsessive-compulsive disorder (OCD) is a common disorder that often begins in childhood and is frequently unrecognized, underdiagnosed, and undertreated.

OCD is characterized by recurrent obsessions (unwanted ideas, thoughts, images, or urges) and compulsions (repetitive behaviors or mental acts) designed to ward off risk and/or to ease distress.

Pediatric OCD is distinct from developmentally typical rituals of childhood such as rule-bound bedtime routines and superstitious behaviors. OCD is distinct from occasional uncomfortable thoughts and common childhood worries. It is more intense and persistent and the experience of OCD is more disturbing and senseless than everyday worries.

Pediatric OCD has many different manifestations - concerns about germs, worrying about being responsible for harm, seeing disturbing violent images, preoccupation with luck rules, and having to have things be "just right."

What is consistent across the many faces of OCD is the persistent effort made to reduce uncertainty and distress. Unfortunately, these efforts actually maintain and strengthen OCD symptoms. When left untreated, pediatric OCD has the potential to become a chronic and debilitating condition that interferes with development and persists into adulthood.

At any point in time, about 1 in every 100 adults (or between 2 to 3 million adults in the United States) has OCD. It is estimated that at least 1 in 200 children and adolescents in the United States has pediatric OCD. This is about the same number of kids who have diabetes.

Both boys and girls are affected by pediatric OCD. Boys are more likely to have prepubescent onset (and a family history of OCD or Tourette syndrome). Girls are more likely to develop OCD in adolescence or in their twenties.

Causes and Risk Factors

As with many behavioral or mental health conditions, the causes of OCD are not fully understood. Most experts agree that OCD is a neurobehavioral disorder, involving both brain and behavior. The brain areas most frequently implicated are the front part of the brain and deeper brain structures (called the cortical-striatal brain circuits). Serotonin is the neurotransmitter (chemical messenger) involved in these circuits. Some evidence exists that a small subset of prepubescent children with OCD have onsets and symptom exacerbations that are associated with their immune response to certain infections (such as strep throat).

Additionally, evidence suggests that OCD runs in families, and genes likely play a role in the biologic vulnerability for this disorder for many individuals. Interestingly, some experts view the type of OCD that emerges in childhood as having a stronger genetic component relative to OCD that emerges in adulthood.

While differences in the brain and genes of those affected likely play a role in OCD's development, OCD is also a learned disorder. OCD typically begins with seemingly harmless and well-intentioned behaviors designed to make uncomfortable feelings go away. However, these ways of thinking and behavioral patterns become overlearned and strengthen over time the more they are practiced. Developing new learning about feared outcomes and one's own abilities is a key component of effective treatment.

Symptoms and Types

Obsessions are intrusive thoughts, images, or urges that occur over and over again. These thoughts get stuck in the affected child's mind, like industrial strength velcro. Children and adolescents experience these thoughts as highly disturbing and unwanted. Understandably so, because obsessions come with uncomfortable feelings including fear, anxiety, disgust, doubt, and/or "not right" sensations.

The following are examples of common obsessions experienced by those with OCD:

Preoccupation with body fluids or waste, dirt, germs/disease, chemicals, or sticky substances. Fear of becoming contaminated by and/or spreading perceived contaminants.

Preoccupation with getting sick or having an illness (e.g., vomiting, developing a disease, having cancer).

Fear about being responsible for terrible harm if not sufficiently cautious (e.g., burning down a house, running over someone, irreparably hurting someone's feelings).

Unwanted thoughts (e.g., violent images, forbidden thoughts or images about sex or taboo behaviors, worries about being gay).

Fear of losing control and doing something that is horrible or inconsistent with one's sense of self (e.g., stealing, harming others, harming self).

Over concern about right and wrong, having pure intentions, fear of offending God, or concerns about blasphemy.

Superstitious ideas about luck (lucky/unlucky numbers, colors, etc.).

Concerns about evenness, symmetry, completeness, or doing something "just right" (e.g., reading or writing, arranging).

Need to know, remember, understand, or say, or do something perfectly.

Compulsions (also called rituals) are repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. While children might not always be able to explain their purpose, compulsions are aimed at preventing or reducing distress, and/or preventing a dreaded outcome. These compulsive behaviors are clearly excessive, however, and are not connected in a realistic way to the outcomes they intended to neutralize or prevent.

The following are examples of common compulsions experienced by those with OCD:

Excessive hand washing, showering, grooming, cleaning or other efforts to decontaminate.

Following rigid rules or ritualized behaviors to ensure safety.

Checking to be sure that harm was not caused or no mistakes were made.

Reassurance seeking, confessing, repeatedly asking questions.

Information seeking, body checking/inspecting.

Mental rituals such as special sayings, prayers, mentally reviewing situations.

Doing certain tasks perfectly and/or making things "just right."

Repeating, counting, touching, ordering/arranging, do-overs, or undoing.

Avoidance of situations that trigger obsessions and compulsions is a very frequent response (e.g., avoid touching items, going places, thinking things). Indeed, avoidance is often the go-to response because it frequently circumvents anxiety and the perceived need to engage in time-consuming compulsive rituals.

OCD compulsions and avoidance are sometimes called " safety behaviors " because they are used to avoid risk and discomfort. OCD does not follow the rules of common sense, however, and over time these safety behaviors actually strengthen the severity of and interference from OCD.

Diagnosis and Tests

Child psychologists, child psychiatrists and other qualified behavioral health professionals usually diagnose pediatric OCD following a comprehensive diagnostic evaluation based on observation and an assessment of symptoms. A comprehensive evaluation differentiates OCD symptoms from other conditions that also involve recurrent thoughts or repetitive behaviors (e.g., other anxiety disorders, tic disorders, habits, hair pulling, skin picking, preoccupation with body or weight, autism spectrum disorder or psychosis). Additionally, a comprehensive evaluation includes assessment of frequently co-occurring conditions as well as the family's understanding of, and participation in, the management of the child's OCD.

OCD is diagnosed when a child or adolescent has obsessions or compulsions that are time consuming, distressing, and/or are interfering with important areas of functioning (such as at school, with friends, or at home). If the child has a tic disorder (or a history of a tic disorder), a "tic-related" specifier is applied to the OCD diagnosis.

Treatment and Care

Pediatric OCD is very treatable. The first level treatment for mild to moderate pediatric OCD is a type of cognitive behavior therapy (CBT) that emphasizes an approach called exposure and response prevention or E/RP. When OCD symptoms are moderate to severe, or in circumstances that might impede successful CBT, a combined treatment approach (CBT plus medication management via serotonin reuptake inhibitors [SSRIs]) should be considered.

In CBT, children and parents are educated about the cycle of OCD and strategies to break free of OCD's dead-end traps. Early CBT involves building the child and family's readiness for engagement in the treatment. E/RP uses well-planned exposures to OCD situations combined with the child refraining from unproductive safety behaviors. Using E/RP, children and teens learn to demote the power of their OCD thoughts, learn to increase their tolerance for discomfort, and learn to develop the "mental muscles" needed to stop engaging in all the safety behaviors that keep OCD in charge.

Parents play a very important role in supporting successful CBT. They serve as cheerleaders who support and reinforce bravery, tolerance, and learning to live with doubt. Parents are taught how to change their engagement with their child's OCD, including how to fade family accommodation behaviors that enable OCD symptoms.

Since OCD often co-occurs with other disorders (e.g., Tourette syndrome, AD/HD, other anxiety disorders, eating disorders), the overall treatment plan frequently needs to take these into account. Such co-occurrences might shift treatment priorities and/or result in a refinement of the recommended treatment approach. In the small subset of children whose OCD is linked to infection, the treatment for OCD is the same (CBT and/or SSRI). Antibiotics are recommended only when a child has a current active infection.

More Information and related links

International OCD Foundation - www.ocfoundation.org Anxiety and Depression Association of America - www.adaa.org

References and Sources

American Academy of Child and Adolescent Psychiatry (2012) Practice parameters for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 98-113.

National Institute of Mental Health, Pediatrics and Developmental Neurosciences Branch - Information about PANDAS - www.nimh.nih.gov

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Obsessive-compulsive disorder (OCD) is a common disorder that often begins in childhood and is frequently unrecognized, underdiagnosed, and undertreated. OCD is characterized by recurrent obsessions (unwanted ideas, thoughts, images, or urges) and compulsions (repetitive behaviors or mental acts) designed to ward off risk and/or to ease distress.

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Bipolar & Depressive Disorders, Services, and Referral

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Bipolar & Depressive Disorders, Services, and Referral

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Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes extreme shifts in a person's mood, energy and ability to function. With this serious, chronic mental illness, common emotions become intensely and often unpredictably amplified.

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Name: Ashlynn Burdett
Email: ashlynnburdett@hebisd.edu
Phone: 817-237-1972
Office location: 325 Carolyn Dr, Bedford, TX 76021

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Crisis Intervention & Prevention Team / Crisis Intervention & Prevention Team

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Heather Andrews, LCSW Crisis Intervention and Prevention Team 817-399-2570 - heatherandrews@hebisd.edu Primarily works with: L.D. Bell High School, Bedford Jr. High, Hurst Jr. High, Arbor Creek, Bedford Heights, Hurst Hills, Meadow Creek, River Trails, Shady Brook, Trinity Lakes

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Eating & Eating Disorders - Child Mind Institute

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Resources on eating disorders and other eating challenges, including anorexia, bulimia, binge eating and picky eating.

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Anxiety is a very general term used to describe a feeling of extreme worry or unease. Feeling anxious is natural after something upsetting happens. But when a child feels anxiety that lasts a long time and prevents them from doing things like going to school or seeing friends, then it becomes an anxiety disorder. Children can be diagnosed with several different anxiety disorders. The specific disorder depends on what the child is struggling with most, but many of the symptoms overlap.

What are the symptoms of anxiety in children?

Anxiety has many symptoms and can look very different from child to child. Here are some common signs that a child might have an anxiety disorder:

Trouble sleeping

Complaining about stomachaches or other physical problems

Avoiding certain situations

Being clingy around parents or caregivers

Trouble concentrating in class or being very fidgety

Tantrums

Being very self-conscious

Children can be diagnosed with different kinds of anxiety depending on what they are most worried about.

What kinds of anxiety disorders can children experience?

Separation anxiety disorder: Children feel extremely upset when they have to be away from parents or caregivers. This anxiety goes beyond what other kids their age normally feel.

Symptoms of separation anxiety include:

Children with separation anxiety disorder show symptoms for at least four weeks.

Social anxiety disorder: Children with social anxiety disorder feel extremely self-conscious around other people. They are so afraid of being embarrassed that they avoid social situations and even speaking in class.

Symptoms of social anxiety disorder in children include:

Avoiding most social situations or feeling terrible when they have to participate in them

Physical symptoms like shaking, sweating or trouble breathing in social situations

In young children, tantrums and crying in social situations

Fear of others seeing their anxiety and judging them for it

For a child to be diagnosed with social anxiety disorder, their worry must be so extreme that it interferes with daily life.

Selective mutism: Children with selective mutism have a hard time speaking in some situations, like at school. These kids aren't just shy. Their anxiety is so bad that they feel frozen and are not able to speak.

To get a diagnosis of selective mutism, the child must:

Be able to speak in some situations but not others

Have had the problem for at least a month

Have problems with school and social activities as a result

Children are not diagnosed with selective mutism if their trouble speaking is caused by a communication disorder or language barrier.

Generalized anxiety disorder: Children with generalized anxiety disorder worry about a lot of everyday things. Their worry is not caused by anything specific and it is bad enough to get in the way of daily life.

Symptoms of generalized anxiety disorder in children include:

Restlessness

Feeling on edge

Feeling tired much of the time

Problems concentrating

Feeling angry

Trouble sleeping

To be diagnosed with generalized anxiety disorder, children must experience symptoms most days for at least six months.

Panic disorder: Children with panic disorder have frequent, unexpected panic attacks. Panic attacks cause physical feelings that can make kids think they are dying or having a heart attack.Children are diagnosed with panic disorder when they experience at least one panic attack and show other signs including:

Constant fear of more panic attacks

A big change from normal behavior after the panic attacks, like avoiding places that remind them of an attack

When diagnosing a child with panic disorder, a professional also rules out medical causes and other disorders like PTSD.

Obsessive-compulsive disorder (OCD): Children with OCD have thoughts and worries that make them very anxious. They develop rules for themselves that they feel they must follow to control the anxiety.

Obsessions are the unwanted thoughts that make kids feel upset and anxious.

Compulsions are the rules kids feel they have to follow to get rid of their anxiety.

Children can be diagnosed with OCD when they have obsessions, compulsions or both.

Specific phobia: Kids with specific phobias are very afraid of one or more specific things. This fear is of something that isn't normally considered dangerous. Phobias disrupt kids' lives when they go out of their way to avoid the things they're afraid of.

Common phobias in children include:

Anxiety is a very general term used to describe a feeling of extreme worry or unease. Feeling anxious is natural after something upsetting happens. But when a child feels anxiety that lasts a long time and prevents them from doing things like going to school or seeing friends, then it becomes an anxiety disorder. Children can be diagnosed with several different anxiety disorders. The specific disorder depends on what the child is struggling with most, but many of the symptoms overlap.

What are the symptoms of anxiety in children?

Anxiety has many symptoms and can look very different from child to child. Here are some common signs that a child might have an anxiety disorder:

Trouble sleeping

Complaining about stomachaches or other physical problems

Avoiding certain situations

Being clingy around parents or caregivers

Trouble concentrating in class or being very fidgety

Tantrums

Being very self-conscious

Children can be diagnosed with different kinds of anxiety depending on what they are most worried about.

What kinds of anxiety disorders can children experience?

Separation anxiety disorder: Children feel extremely upset when they have to be away from parents or caregivers. This anxiety goes beyond what other kids their age normally feel.

Symptoms of separation anxiety include:

Children with separation anxiety disorder show symptoms for at least four weeks.

Social anxiety disorder: Children with social anxiety disorder feel extremely self-conscious around other people. They are so afraid of being embarrassed that they avoid social situations and even speaking in class.

Symptoms of social anxiety disorder in children include:

Avoiding most social situations or feeling terrible when they have to participate in them

Physical symptoms like shaking, sweating or trouble breathing in social situations

In young children, tantrums and crying in social situations

Fear of others seeing their anxiety and judging them for it

For a child to be diagnosed with social anxiety disorder, their worry must be so extreme that it interferes with daily life.

Selective mutism: Children with selective mutism have a hard time speaking in some situations, like at school. These kids aren't just shy. Their anxiety is so bad that they feel frozen and are not able to speak.

To get a diagnosis of selective mutism, the child must:

Be able to speak in some situations but not others

Have had the problem for at least a month

Have problems with school and social activities as a result

Children are not diagnosed with selective mutism if their trouble speaking is caused by a communication disorder or language barrier.

Generalized anxiety disorder: Children with generalized anxiety disorder worry about a lot of everyday things. Their worry is not caused by anything specific and it is bad enough to get in the way of daily life.

Symptoms of generalized anxiety disorder in children include:

Restlessness

Feeling on edge

Feeling tired much of the time

Problems concentrating

Feeling angry

Trouble sleeping

To be diagnosed with generalized anxiety disorder, children must experience symptoms most days for at least six months.

Panic disorder: Children with panic disorder have frequent, unexpected panic attacks. Panic attacks cause physical feelings that can make kids think they are dying or having a heart attack.Children are diagnosed with panic disorder when they experience at least one panic attack and show other signs including:

Constant fear of more panic attacks

A big change from normal behavior after the panic attacks, like avoiding places that remind them of an attack

When diagnosing a child with panic disorder, a professional also rules out medical causes and other disorders like PTSD.

Obsessive-compulsive disorder (OCD): Children with OCD have thoughts and worries that make them very anxious. They develop rules for themselves that they feel they must follow to control the anxiety.

Obsessions are the unwanted thoughts that make kids feel upset and anxious.

Compulsions are the rules kids feel they have to follow to get rid of their anxiety.

Children can be diagnosed with OCD when they have obsessions, compulsions or both.

Specific phobia: Kids with specific phobias are very afraid of one or more specific things. This fear is of something that isn't normally considered dangerous. Phobias disrupt kids' lives when they go out of their way to avoid the things they're afraid of.

Common phobias in children include:

Almost all types of anxiety are best treated with cognitive behavioral therapy (CBT). CBT is based on the idea that how we think and act both affect how we feel. By learning to change negative thoughts and unhealthy actions, kids can change their bad feelings.

An important part of CBT in treatment for anxiety is called exposure and response prevention. In exposure and response prevention, the therapist helps the child face the thing they're afraid of a little at a time. By dealing with their fear in small amounts in a safe space, kids learn to deal with the big feelings that come up.

For some children, taking medication for anxiety in addition to going through therapy makes treatment more effective.

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Quick Guide to Anxiety in Children - Child Mind Institute

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Download our free guide to different kinds of anxiety in children. Anxiety causes an extreme feeling of unease in kids. While some anxiety in stressful situations is normal, it becomes a disorder if it lasts a long time or gets in the way of daily life.

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Schizophrenia is a mental health condition that can cause teenagers and young adults to lose touch with reality. They see, hear or believe things that aren't real or true. This is called psychosis. People with schizophrenia think and act in ways that don't make sense to other people. Many people with schizophrenia think that someone or something is reading their mind or trying to hurt them. These false beliefs are called paranoid delusions. Some also see things that aren't there, which are called hallucinations.

Schizophrenia is very rare in young children, but they can show some early signs. It is more often diagnosed in teenagers and young adults.

What are the symptoms of schizophrenia?

Kids with schizophrenia have strange thoughts and behaviors. Some signs include:

Ideas that don't make sense

Believing things that aren't true

Seeing, hearing or feeling things that aren't there

Seeming distracted

Speaking in ways that other people can't understand

Thinking that others want to hurt them

Hearing voices that tell them what to do

Thinking strangers know them or are talking about them

Believing that TV shows are sending them special messages

Trouble with regular tasks, such as eating, bathing and going to school

Withdrawing from friends and family

Not showing a lot of feelings

Moving around way too much or way too little

How is schizophrenia diagnosed?

Before diagnosing schizophrenia, a mental health professional will rule out other possible causes of the strange thoughts and behavior. This includes drug or alcohol abuse, medical issues and other mental health problems. Kids are only diagnosed with schizophrenia if they have had symptoms for at least six months. The symptoms also have to interfere with their regular lives.

It can be hard to tell schizophrenia apart from other mental health disorders. Sometimes, kids with schizophrenia are incorrectly diagnosed with conduct disorder because their delusions make them behave aggressively. It's important to get a thorough assessment that looks closely at the child's physical and mental health, as well as their family history.

What are the risk factors for schizophrenia?

Children are more likely to have schizophrenia if someone in their family has it or if there were problems during pregnancy or at birth. However, most children with these risk factors don't have schizophrenia.

How is schizophrenia treated?

Schizophrenia is usually treated with therapy and medication.

The recommended treatment is a special program called Coordinated Specialty Care. This should be done in the first two or three years after the child shows signs of schizophrenia. It can decrease symptoms in the future by a lot and help with many of the problems linked to this illness.

Coordinated Specialty Care teaches kids how to deal with their symptoms. It also helps them build a group of people who can help them. The treatment includes:

Low doses of antipsychotic medication

Cognitive behavioral therapy for psychosis (CBTp)

Family education and support

Learning skills for school and work

Children with schizophrenia are at risk of developing other disorders, including:

Obsessive-compulsive disorder (OCD)

Depression

Panic disorder

Post-traumatic stress disorder (PTSD)

Problems with drugs or alcohol, which can make symptoms of schizophrenia worse

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Quick Guide to Schizophrenia - Child Mind Institute

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Schizophrenia is a mental health condition that can cause teenagers and young adults to lose touch with reality. They see, hear or believe things that aren't real or true.

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1-HEB ISD Community Resource Quick Links3 E-S-A-F (002)

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Children with OCD have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay. This guide explains the often confusing behaviors that can be associated with OCD, and the treatments most effective for helping kids who develop it.

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Guide

Children with attention-deficit hyperactivity disorder (ADHD) find it unusually difficult to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. This ADHD guide offers parents the information you need to understand the behaviors associated with the attention disorder to help you make effective decisions for your child about symptoms, diagnosis and treatment.

Children with attention-deficit hyperactivity disorder (ADHD) find it unusually difficult to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. This guide offers parents the information you need to understand the behaviors associated with the disorder and make effective decisions for your child about symptoms, diagnosis, and treatment.

Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for children to concentrate, to pay attention, to sit still, to follow directions, and to control impulsive behavior. While all young children are at times distractible, restless, and oblivious to parents' and teachers' instructions, kids with ADHD behave this way much more often than other children their age. And their inability to settle down, focus, and follow through on tasks in age-appropriate ways makes it very hard for them to do what's expected of them at school. It can also lead to conflict at home and difficulty getting along with peers.

Symptoms of ADHD are divided into two groups: inattentive behaviors and hyperactive and impulsive behaviors.

Inattentive symptoms of ADHD:

Makes careless mistakes

Is easily distracted

Doesn't seem to be listening when spoken to directly

Has difficulty following instructions

Has trouble organizing

Avoids or dislikes sustained effort

Is forgetful, always losing things

Hyperactive or impulsive symptoms of ADHD:

Fidgeting or squirming, trouble staying in one place or waiting his turn

Excessive running and climbing

Trouble playing quietly

Extreme impatience

Always seems to be "on the go" or "driven by a motor"

Excessive talking or interrupting, blurting out answers

Some children exhibit only the first group ADHD of symptoms, and some exhibit only the latter. But the majority of those with an ADHD diagnosis have a combination of both, which can make it very difficult for them to function in school, and in other activities, and can create a lot of conflict at home.

How Are ADD and ADHD Different?

ADD, or attention-deficit disorder, is an older term for the disorder we now call ADHD, or attention-deficit hyperactivity disorder. It was called ADD up until 1987, when the word "hyperactivity" was added. Some people still use the old term, ADD, out of habit, or because it's a more familiar term than ADHD. Some use it to refer to kids with ADHD who aren't hyperactive.

Can a Child Who's Not Hyperactive Have ADHD?

Yes. Kids who have trouble focusing but are not unusually restless or impulsive have a more inattentive type ADHD. They tend to be diagnosed later because they are less prone to disruptive or problematic behavior that comes to the attention of teachers and parents. But kids who have inattentive symptoms may start to struggle in the middle of elementary school, when it becomes increasingly difficult for them to keep up.

Why Can Kids With ADHD Concentrate on Some Things? What Is ADHD Hyperfocus?

While ADHD is called an attention deficit disorder, experts say what's really disordered is the child's ability to control and direct what he's paying attention to. So many kids with ADHD are perfectly capable of intense focus on things that are very exciting to them, like video games, but they can't maintain that kind of focus on things that aren't immediately rewarding, like schoolwork or putting on their shoes or going to bed.

That intense concentration, sometimes called hyperfocus, is also the reason kids with ADHD often get upset when asked to stop doing something they are engaged in, like a favorite activity at school or playing a video game. They have what experts call an inability to "attention switch," which can cause a lot of conflicts with adults.

And speaking of video games: Because they are constantly stimulating and rewarding, experts say they can induce a kind of trance state in a child who has trouble regulating her attention. In that case, it's less a matter of hyperfocus than what one calls "screen suck."

What Is Executive Functioning?

Executive functions are the self-regulating skills that we all use to accomplish tasks, from getting dressed to doing homework. They include:

Planning

Organizing time and materials

Making decisions

Shifting from one situation to another

Controlling emotions

Learning from past mistakes

Most kids with ADHD have deficits in some executive functions, though not all children with executive function issues have ADHD.

Does ADHD Affect Kids Outside of School?

Yes. Their inattention and impulsivity also affects their friendships, extra-curricular activities, and family life. They may have trouble making and keeping friends because they interrupt constantly, and are prone to blowing up when they don't get their way. It's not uncommon for children with severe ADHD to be blackballed from playdates because they can't be counted on to behave. Kids with ADHD may have trouble playing on teams because they find it hard to focus and follow the rules.

At home, they may find themselves on a collision course with parents and siblings because they don't follow instruction, are impulsive, and melt down when they are asked to transition from some activity they enjoy to mealtime, homework time, or bedtime.

By the time kids with ADHD reach adolescence, their impulsivity can be dangerous, making them prone to car accidents, unsafe sex, and other risky behaviors.

Why Are Kids With ADHD Often Defiant or Demonstrate Disruptive Behavior?

Defiance and emotional outbursts are very common in kids with ADHD, though they are not, themselves, symptoms of ADHD.

Kids who have ADHD tend to become defiant when they are expected to do things that are hard for them, especially when it means stopping something that's pleasurable-like playing a video game. So things like homework, going to bed, getting dressed, and coming to dinner can become battlegrounds. These situations are difficult for them to tolerate because of inherit deficits in paying attention, tolerating a boring situation, reining in impulses, transitioning from a fun activity, and controlling their activity level. Since these situations are really challenging for them, they may try to avoid them. Unfortunately when it comes to ADHD parenting, the avoidance strategies that these kids typically use are disruptive behavior, tantrums, arguing, defiance, and power struggles.

ADHD symptoms change as children get older, and it's estimated that about a third of children who are diagnosed with the attention-deficit hyperactivity disorder will no longer meet the criteria by the time they reach young adulthood.

In general, hyperactivity declines as kids move through elementary school, and inattention becomes the primary problem for them as the schoolwork they are expected to do becomes more demanding and their parents and teachers are not so closely supervising their activities. In adolescence, impulsivity also becomes a big concern, as it leads to car accidents, unsafe sex, and other risky behavior.

Children who are most likely to have ADHD that continues into adulthood are those whose symptoms are very severe in childhood, and those who also have another psychiatric disorder, like depression or anxiety.

When is ADHD diagnosed?
Because the symptoms of ADHD can also be the result of other issues, such as anxiety, depression, or trauma, a professional diagnosing your child should carefully rule out other possible reasons for his behavior.

A child should receive an ADHD diagnosis only if he exhibits a variety of inattentive or impulsive behaviors

At a level that is abnormal for children his age

Over an extended period

In more than one setting-both at home and at school, for instance.

These behaviors must also be interfering significantly with schoolwork or social interaction.

How is an ADHD diagnosis done?
To make an accurate diagnosis, a clinician should collect information from several people who have observed your child, including you, other caregivers, and teachers.

Parents and teachers should be asked to fill out a rating scale, such as the SNAP, the Child Behavior Checklist, or Connor's Checklist, to capture an accurate assessment of the frequency of symptoms over a period of time. A child may be given a test called a Continuous Performance Test, which rates her ability to complete a repetitive task over a period of time and can give a more complex picture of her ADHD symptoms.

A child should not be diagnosed with ADHD just based on a parent's or teacher's report that she is overly active or distracted.

Who can diagnose ADHD?
ADHD can be diagnosed by any doctor or mental health professional, including:

Pediatricians

Psychiatrists

Clinical psychologists

Social workers

Many school psychologists are also qualified to diagnose ADHD, but in most cases they're not authorized by their school districts to do so. Instead, school psychologists will often help identify that a child is showing symptoms of ADHD, determine if their symptoms hinder their school functioning, and make recommendations for needed academic supports. They can also often refer families to an outside mental health professional for the diagnosis.

In the majority of cases, only medical doctors like psychiatrists can prescribe medication to treat ADHD. (Some states allow psychologists to prescribe, and nurse practitioners and physician's assistants often can, as well.)

The overwhelming majority of ADHD diagnoses are made by pediatricians, though parents should be aware that many pediatricians don't have advanced training in psychiatric disorders, and an ADHD diagnosis should not be made in a quick office visit, based solely on a report that a child is having trouble concentrating in school. Inattention can be caused by other things, and giving a child ADHD medication won't address his problems if he doesn't have ADHD.

ADHD Medication Treatment

What is the most effective ADHD treatment?
Research shows that a combined approach of medication and behavioral therapy is the most effective treatment.

For moderate to severe cases of ADHD the first line of treatment is usually medication. ADHD medications called psychostimulants, which increase the amount of certain chemicals in the brain, help children focus and curb impulsivity and hyperactivity.

Behavioral therapies help kids rein in impulsive behavior and be better organized.

What are the kinds of stimulant medications for ADHD?
If a child has ADHD, studies show there's an over 80% chance that he will respond to stimulant medication with a significant reduction in symptoms.
There are two main classes of stimulant medications:

Methylphenidate-based medications
Ritalin, Methylin, Concerta, Metadate, Daytrana Patch

Dextroamphetamine-based medications
Adderall, Vyvanse, Dexedrine

Of the children who respond to stimulants, half will respond equally well to both groups of medications, and the other half will respond better to one or the other. There are many different release formulas for stimulant medications, which make them effective for different periods of time.

Immediate-release formulas
are effective for about 4 hours

Extended-release formulas
last as long as 14 hours.

Within the extended-release group, medications vary in the doses they deliver morning and afternoon. Some deliver 50 percent in the first half of the day and 50 percent in the second; others deliver just 30 percent in the first half and 70 percent in the second.

Finding the right dose
Since different children metabolize medication in different ways, the goal is to find the formula that delivers an effective dose over a desirable period of time for your child. Getting the right dosage for a particular child takes several weeks of trial. The clinician normally increases the dosage gradually until it becomes effective. If your child experiences undesirable side effects, it may mean that the dosage is too high, or the medication isn't right for her.

It's important to note that some children respond differently to the two different stimulants used in these medications-methylphenidate and dextroamphetamine. Changing from one to the other, or even to a different release formula of the same basic medicine, can help reduce or eliminate side effects.

Once an effective dosage is established, your child should be monitored periodically to make sure it's still meeting her needs as she grows.

Side effects of stimulant medications
Stimulant medications can be very effective in reducing symptoms of ADHD, but some kids do experience adverse side effects. They include:

Sleep issues
If medication is interfering with a child's sleep, it's because the medication is still active at bedtime.
If he's taking a short-acting formula, it may mean that he is taking a second or third dose too late in the day. If he's taking medication that lasts 12 or 14 hours, it may help to try one that's not quite as long-acting. Sleep issues caused by the medication tend to get better over time, so it's worth giving kids four to six weeks to see if they adjust. Trouble going to sleep may also be caused by kids being too stimulated at bedtime.

Are there non-stimulant medications for ADHD?
There are two types of medications that aren't stimulants that can help alleviate symptoms of ADHD. They are useful for kids who don't respond to stimulant medica-tions, or who experience adverse side effects from them.

Atomoxetine (sold as Strattera) is in a class of drugs called norepinephrine reuptake inhibitors.
Norepinephrine is a natural substance in the brain that is needed to control behavior.

Clonidine (Catapres, Nexicon) and guanfacine (Tenex) are called alpha-adrenergic agonists.
These medications were developed to lower high blood pressure, but at the doses given to kids for ADHD they rarely affect blood pressure.Both clonidine and guanfacine come in a 24-hour-release version (Kapvay and Intuniv), and they are sometimes used to treat tics.

Finally, omega fatty acids can also be helpful for ADHD, though not as helpful as stimulants or these other medications.

Should children stop taking ADHD medication during holidays and the summer?
Since children with ADHD don't need to perform academically during the summer or on extended holidays, parents sometimes seize the opportunity to take kids off their regular medication regimen, especially if they are experiencing side effects. Other parents avoid an interruption, fearing that their children's behavioral problems will rebound.

One reason to stay with treatment year-round is that ADHD doesn't only affect a child's performance in school. During the summer, children still have to get along with family and friends and function effectively in group activities like sports and camp.

However, if you are concerned that taking a stimulant medication may be slowing your child's growth, a summer break can allow him to catch up. And if you are concerned that he is underweight due to suppressed appetite, a summer without medication can help him put on some pounds.
For more on the pros and cons of a drug holiday, click here.

Behavioral Treatment for ADHD

What are the behavioral treatments for ADHD?
Behavior therapies do not eliminate the core symptoms of ADHD, but they can be very helpful in teaching children to manage them better. For example, children who have trouble finishing things and staying organized can learn techniques for completing tasks, keeping track of assignments, and getting their schoolwork done.

There's also a kind of behavior therapy for ADHD called parent training that can help reduce behavior problems that stem from ADHD in children. Parent-child interaction therapy and other forms of parent training teach parents how to work with their kids to cultivate good behaviors while minimizing impulsive or inattentive ones. Stimulated by more positive reinforcement, kids who have been out of control can learn to rein in their behavior and enjoy more rewarding relationships with parents and teachers.

As children get older, they often begin working more one-on-one with clinicians to strengthen their organizational skills and develop effective behavioral plans.

When a child is old enough, cognitive behavioral therapy can help teach her to control her behaviors by understanding how her thoughts and feelings influence them.
For more on behavioral therapy for kids with ADHD click here.
What can we do to help kids strengthen executive functions?
To bolster kids with weak skills in these areas, learning specialists teach a mix of specific strategies and alternative learning styles that complement or enhance a child's particular abilities.

With elementary school children, the educational specialist usually works with parents and kids together, to establish routines and tools to use to get work done successfully and with minimal conflict. For instance:

Checklists can be useful for anything from getting out of the house on time in the morning to doing homework after school to the bedtime routine. Since the steps necessary for completing a task often aren't obvious to kids with ADHD, defining them clearly ahead of time, and posting them prominently, makes a task less daunting and more achievable.

Assigning a time limit for each step, particularly if it is a bigger, longer-term project, helps kids manage their time and avoid underestimating how long it will take to do something.

Using a planner is essential for kids with ADHD who struggle to remember things like homework assignments.

A rewards chart at home, as well as at school, can help motivate kids who are easily distracted and struggle to acquire new skills.
For more information on adolescents with ADHD, click here.

This guide was last reviewed or updated on May 2, 2023.

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Children with attention-deficit hyperactivity disorder (ADHD) find it unusually difficult to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. This ADHD guide offers parents the information you need to understand the behaviors associated with the attention disorder to help you make effective decisions for your child about symptoms, diagnosis and treatment.

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Teen Depression Treatment Programs | Dallas-Fort Worth | Charis

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Our Partial Hospitalization Program (PHP) & Intensive Outpatient Program (IOP) is a great fit for DFW kids & teens struggling with depression

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Substance Abuse and Mental Health Services Administration

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Frequently Asked Questions - What is SAMHSA’s National Helpline?

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Local Psychiatric Services + Hospitalization

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Local Psychiatric Services + Hospitalization

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Our Mission

Changing People's Lives®.

Our Vision

Mesa Springs will transform the delivery of behavioral health services and solve the largest healthcare challenge of our generation, the lack of access to quality care for mental illness and addiction. We will:

Engage with patients, families, employees, communities, healthcare providers, and health insurers to increase access to behavioral healthcare

Provide a continuum of care that delivers the right care, in the right place, at the right time, at the right cost

Partner to integrate behavioral and medical healthcare to improve the health of populations and reduce the per capita cost of healthcare

Be nationally known for providing high quality, consistent, evidence-based, and innovative care

Decrease suicide rates, decrease addiction-related deaths, reverse the decline in life expectancy, and improve productivity in the communities we serve

Destigmatize mental illness and addiction, which are conditions that transcend race, gender, age, and socioeconomic class

Our Values

CompassionWe serve as compassionate healers for those suffering from mental illness and/or addiction

RespectWe respect patients, families, co-workers, and our communities

Safety
We provide a safe environment for our patients, employees, and visitors

Quality
We deliver quality services as defined by nationally recognized metrics and outcome measures

Innovation
We strive for continuous improvement in all that we do

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About Us | Mesa Springs - Mental Health & Addiction Treatment

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Changing People's Lives®. Mesa Springs will transform the delivery of behavioral health services and solve the largest healthcare challenge of our generation, the lack of access to quality care for mental illness and addiction.

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Children First provides HOPE and HEALING through counseling and education for all ages, emphasizing the prevention of and recovery from physical and emotional abuse.

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Local Psychiatric Services + Hospitalization 

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Local Psychiatric Services + Hospitalization 

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Growing up in today's world is hard and many children or teens may go through life experiences that cause them to feel anxious, depressed or even suicidal. As a parent or a caregiver, it can be hard to know when to ask for help. The Behavioral Health Center brings all services together in an expanded space that will provide a talented, dedicated team of caregivers, physicians and professionals with the facilities, resources, tools and programs they need to ensure that these most vulnerable children receive the high quality treatment they need and deserve.
Meet your care team
Specialty programs

Behavioral Health addresses the psychological and psychiatric needs for children, adolescents, and their families.

Resources

Cook Children's Behavioral Health offers a Links of Hope support group, and has identified educational articles for families and caregivers of children who have emotional and behavioral problems.

Support Group Educational Articles

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Growing up in today's world is hard and many children or teens may go through life experiences that cause them to feel anxious, depressed or even suicidal. As a parent or a caregiver, it can be hard to know when to ask for help.