Signs of ADHD in Children

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is characterised by differences in the brain development and brain activity of some children compared to their peers. Symptoms often begin in childhood and continue into adulthood and for many people, ADHD is life-long. It is estimated that more than 700,000 children and 1.9 million adults in the UK have ADHD, although these figures could be significantly higher as many people with ADHD are undiagnosed.

ADHD is characterised by symptoms of inattention, hyperactivity and impulsivity. These symptoms can significantly affect how a child functions in their everyday life and can affect how they learn, their relationships and interactions with others and how they function in their everyday lives. There are three main subtypes of ADHD:

Inattentive

Children with the predominantly inattentive subtype typically find it difficult to pay attention, concentrate and follow instructions. They find it difficult to listen to others, remember things and finish things they start. They may also have organisational difficulties and be more easily distracted. The inattentive subtype is more difficult for other people to recognise and is more commonly diagnosed in girls and those assigned female at birth (AFAB).

Hyperactive-Impulsive

This is the most commonly diagnosed type of ADHD. Children with the predominantly hyperactive/impulsive subtype often have issues with excessive movement, controlling their behaviour and lack of impulse control. They may be impulsive and do things without thinking. They may also interrupt others, find it difficult to wait their turn, find it difficult to stay still and act in ways that may seem disobedient.

Combined

Children with the combined subtype of ADHD usually experience both inattention and hyperactivity/impulsivity equally.

The symptoms of ADHD can impact many areas of a child’s life, including at school, at home and in their friendships.

The diagnosis rates for ADHD differ significantly for boys and girls, with boys four times more likely to receive an ADHD diagnosis compared to girls. This is thought to be because girls are more likely to have the Inattentive subtype of ADHD. When people think of ADHD, they generally think of the symptoms of hyperactivity-impulsivity and the inattentive subtype is much less well-known. Many people, including parents, teachers and doctors, have much less knowledge of the signs and symptoms of inattention and this can make it more difficult for them to recognise or make it more likely that they mislabel the symptoms as something else, such as anxiety, shyness or laziness.

Symptoms of ADHD in Children

The symptoms of ADHD differ from child to child. Some children experience mild symptoms that don’t have a significant impact on their everyday lives, whereas others experience more severe symptoms. The symptoms of ADHD can affect a child’s development, everyday functioning, relationships, communication and learning. For some people, symptoms peak in childhood, whereas for others, symptoms continue into adulthood.

The symptoms of ADHD are the subjective experiences or internal difficulties that a person with ADHD might experience and describe to others and are typically separated into two categories: symptoms of inattention and symptoms of hyperactivity-impulsivity.

Inattention

• Finding it difficult to follow instructions.
• Feeling restless and easily bored.
• Finding it difficult to concentrate or listen when someone is talking to you.
• Finding it hard to stay focused even on things you enjoy.
• Losing interest in games or activities if playing for an extended period of time.
• Daydreaming frequently.
• Finding it difficult to stay tidy and organised, for example, always having a messy bedroom.
• Often losing track of what you are doing or thinking.
• Feeling overwhelmed by multi-step instructions.
• Finding it difficult to organise your own thoughts.
• Frequently forgetting what you were supposed to be doing.

Hyperactivity

• Finding it difficult to wait your turn.
• Interrupting others or blurting out answers without meaning to.
• Finding it difficult to engage in quiet or relaxing activities.
• Feeling restless or unable to sit still.
• Finding it difficult to cope with frustrations or manage your own emotions.
• Finding it difficult to go to sleep or stay asleep.
• Finding it difficult to wait your turn or be patient.
• Acting on impulse without thinking things through.

Some symptoms of ADHD can be experienced by children with the inattentive subtype AND children with the hyperactive-impulsive subtype. For example, many children with ADHD find it difficult to make or keep friends, struggle to follow social cues or understand social rules and find it difficult to work in a group.

Friendship and relationship issues are also common in ADHD and some children may find it difficult to make or keep friends, particularly as they get older and their peers begin to develop stronger social skills. Friendships may be particularly difficult for children with ADHD who have difficulties managing their behaviour or regulating their emotions as their peers may become less tolerant and understanding of these difficulties as they enter middle childhood.

What are the Signs of ADHD in Children?

Many people use the terms ‘symptoms’ and ‘signs’ interchangeably, however, they actually mean two different things. The symptom is something the child themselves experiences and identifies. Symptoms are usually subjective, meaning other people only know about them because the individual tells them. For example, only the child knows what emotions they are feeling and how ADHD makes them think and feel.

The signs of ADHD are more objective. The signs of ADHD are the characteristics that are identified by other people, such as a parent, teacher, doctor or friend. They are the outward signs of ADHD that other people can recognise, for example, how the person behaves or communicates.  

The important difference between a symptom and a sign is who observes it. If the individual with ADHD is the one who observes it, it is a symptom. If another person observes it, it is a sign. Sometimes, the person with ADHD doesn’t notice the signs, but other people around them do. It is also possible for something to be both a symptom and a sign.

The signs of ADHD can vary depending on the individual child, the subtype of ADHD and their experience. Some of the most common signs of ADHD include:

• Difficulties concentrating on what other people are saying or on their work (e.g., they may seem like they are constantly daydreaming).
• Being easily distracted (e.g., by noises, other people or displays on the wall).
• Forgetting everyday tasks that other people can remember, such as brushing their teeth, eating breakfast or turning off lights.
• Making careless mistakes in their schoolwork or homework.
• Their writing or work may be messy or disorganised
• They find it difficult to organise tasks and activities.
• Frequently losing items, such as their homework, pencils or a favourite toy.
• Avoiding tasks that require more mental effort or focus.
• Forgetting to bring what they need to school, e.g., their P.E kit, homework or pencil case.
• Interrupting conversations and struggling with turn-taking in conversation.
• Strong emotional reactions that are typically too intense for the situation.
• Difficulties sitting still (e.g., fidgeting, fiddling or tapping their hands and feet).
• Constantly on the go or constantly in motion.
• Shouting out in class or interrupting other people’s activities or games.
• Excessive talking.
• More likely to engage in risky or dangerous activities.
• A lack of fear compared to their peers.
• Resistance to bedtime routines and difficulties sleeping.
• Running or climbing excessively in inappropriate situations.

Although all children can struggle with these things at times, for children with ADHD, these struggles are much more pronounced and much more frequent. Additionally, as children get older, typically developing children begin to improve and learn these skills from adults and their peers. However, many children with ADHD continue to have difficulties.

It is also important to be aware that the hyperactive-impulsive subtype of ADHD is only one type. The signs of this subtype are much easier to recognise, for example, if a child regularly climbs on tables in the classroom, has emotional meltdowns and is constantly moving around and fiddling, this can be much easier for the teacher and other school staff to recognise.

However, if a child has the inattentive subtype of ADHD, signs such as daydreaming in class and constantly losing and forgetting things may be much harder to recognise or the teacher may attribute these signs of ADHD to something else.

Additionally, the signs of the hyperactive-inattentive subtype are typically much more difficult to manage at home and at school and so are much more likely to be flagged by parents or teachers. However, just because a child with the inattentive subtype is less disruptive and may be showing less obvious signs, this doesn’t mean they are not also struggling and do not also need support.

Being aware of other symptoms of ADHD, particularly those relating to inattention, can help more children with ADHD to get diagnosed earlier and receive the support they need.

When Do Symptoms of ADHD Start to Show?

It is generally agreed upon that ADHD is often present from birth or very young childhood. However, the signs and symptoms are not usually recognised until the child is older. The symptoms of ADHD usually become apparent before the age of 12, although they can begin as early as three years old.

Even though symptoms of ADHD can be obvious at a younger age (before the age of 5), children are not usually diagnosed before the age of 7. This is because many of the signs of ADHD are very common in childhood, even for typically developing children. For example, many young children are impulsive, find it difficult to sit still, may be easily distracted and find it difficult to follow social rules, such as not interrupting in a conversation.

By the age of 7, typically developing children usually begin to grow out of these behaviours, whereas children with ADHD do not. Additionally, while a typically developing child can still usually function well when they are experiencing difficulties, such as having many distractions around them, for a child with ADHD, these difficulties can significantly interfere with how well they function daily. As children get older, these differences become more apparent.

It is often when a child starts school and is in Reception or Year 1 that symptoms begin to become more obvious. While their symptoms may be less obvious in the playground, in less strict settings (such as in nursery or at sports clubs) or even at home, the classroom setting has significantly more rules and puts more demands on the child, including self-control, attention, focus, listening and following the rules.

By the time the child reaches the age of 7 and is beginning to prepare for Key Stage 2, parents and teachers are more likely to be aware that their difficulties with inattention and/or hyperactivity-impulsivity are more significant than their peers.

However, some children learn how to mask their difficulties, making it more difficult for their parents and teachers to recognise the signs of ADHD. This is particularly common in the predominantly inattentive subtype of ADHD and in girls with ADHD. This is how some children with ADHD make it to adulthood without receiving a diagnosis.

How is ADHD Diagnosed?

The most common route for ADHD diagnosis in the UK is through a referral from the child’s school or other educational establishment. The teacher or other school staff may recognise the signs of ADHD and speak to the parents and the school’s special educational needs and disabilities coordinator (SENDCO). The SENDCO can then ensure the child has support in place in the school and can make a referral to an educational psychologist for an ADHD assessment.

Alternatively, the child’s parents or guardians can make an appointment with the child’s GP. The GP may ask about any signs and symptoms of ADHD they have noticed and how it affecting the life of the child, their day-to-day functioning and their learning. The GP will rule out anything else that could be causing the child’s symptoms. If they are satisfied, they can then make the referral for an ADHD assessment.

The assessment is conducted by at least one ADHD specialist, such as an educational psychologist, child and adolescent psychiatrist or a specialised paediatrician. Assessments differ depending on the child’s age and stage of development, but it could involve a combination of the following:

• A discussion with the child about their symptoms and their experiences (depending on their age).
• An observation of the child (e.g., in conversation, playing or interacting with others and their general behaviour).
• A discussion with parents/guardians about any signs they have recognised, any concerns they have and any difficulties the child has at home.
• A detailed history from parents/guardians, including questions about the child’s development, such as when they started to walk, talk, read or successfully potty train, their health, and any relevant family health or history.
• A report from the child’s school (most likely from the SENDCO and the child’ teacher) about how they are doing in school, any areas of difficulty, any concerns the school has and any difficulties with learning the school has identified.
• A computer-based test to help assess their symptoms.
• An observation at school (e.g., in the classroom or at playtime). This may focus on their activity and energy levels, their concentration, their impulsivity and their relationships with adults and peers.
• A report from any other relevant professionals who have had contact with the child, such as social workers, clinicians or doctors.

To be diagnosed with ADHD, there needs to be evidence across more than one setting. For example, at home, at school and/or during the ADHD assessment.

ADHD is typically diagnosed in childhood. However, more and more people are receiving a diagnosis in adulthood because the signs and symptoms were missed during childhood or were attributed to something else.

Getting Help for ADHD

In the UK, the waiting list for an ADHD assessment can be lengthy due to extremely high demand, particularly since the COVID-19 pandemic. Statistics from ADHD UK from October 2023 showed that the waitlist can range from 5 weeks to 5 years, depending on where in the UK you live and the wait time of your local trust. This means that some children in the UK will wait up to 50 times as long as others for an ADHD assessment.

The NHS runs the Right to Choose scheme, which allows parents to look for a clinic with a shorter waiting list and ask for an NHS appointment (as long as it offers NHS services for NHS England). However, this service may not always be available. While a child is waiting for an assessment, it is important that they get access to support at both school and at home. The school’s SENDCO should be able to put support in place in school, focused on the child’s specific areas of difficulty. The school or the GP may also be able to recommend resources that can help the child in other areas of their life.

With the right support, individuals with ADHD can learn effective coping strategies, flourish and succeed and reach their full potential. There are many different ways to support a child with ADHD, depending on the ADHD subtype, the child’s symptoms and their specific areas of difficulty, and what works for one child might not work for another. It is, therefore, important that support plans are individualised and child-centric. 

Support could include:

Support at school

The school environment can be extremely difficult for some children with ADHD, as behavioural expectations are so high. A child may be highly intelligent and extremely capable, but the rigidity of the classroom can make it difficult for them to concentrate, follow behavioural rules and expectations and fulfil their potential. The type of support a child needs at school can vary depending on their specific difficulties but could include:

• 1:1 support
• A behaviour plan or an education, health and care (EHC) plan.
• Use of fidget tools, such as stress balls, wobble cushions and standing desks.
• Breaking down instructions and giving them one at a time.
• Breaking up tasks into smaller, more manageable pieces. For example, if the child has a 60-minute maths test, offering them a 15-minute break in the middle.
• Extra time to complete tasks or for transitions.
• Instructions given one step at a time, ideally with visual aids.
• Use of timers, visual schedules and checklists to help with independence.
• Use of positive behaviour reinforcement rather than punitive systems.
• Friendship or emotional literacy groups.
• Small-group social skills training.

Support at home

One of the most effective things family members can do is to learn all they can about ADHD, including the specific subtype the child has been diagnosed with and their difficulties. It is also essential that parents and guardians follow all recommendations and follow any support plan that is put into place. Some ways a child with ADHD can be supported at home include:

• Encouraging them to keep a diary or a to-do list so they don’t forget things.
• Setting alarms or visual reminders, for example, to pack their football kit on Thursday nights. 
• Using visual schedules or checklists for daily routines (e.g., morning, homework, bedtime).
• Keeping consistent mealtimes, sleep times and activities as predictability helps with regulation.
• Use positive reinforcement, such as reward systems (e.g., sticker charts) for effort, not just outcome.
• Give clear, concise instructions, one at a time if needed.
• Use natural consequences instead of punishment where possible.
• Have safe spaces for emotional regulation.
• Teach and model emotional regulation, such as naming emotions, using breathing techniques, etc.

It can be extremely unhelpful for children to be punished for something that is related to their ADHD, particularly if no support or helping strategies have been put into place. For example, punishing them for forgetting to pack their P.E kit if there are no strategies in place to help them remember can just cause future anxiety or cause the child to become frustrated.

Lifestyle changes

This could include lifestyle changes, such as helping the child to get regular sleep, having a structured schedule in place to make it easier for the child to stay organised and making time for exercise and physical activity. It is also important for children with ADHD to maintain a healthy, balanced diet. Some children with ADHD experience worse symptoms depending on what they eat and drink. Keeping a food diary and a symptom diary can help parents to recognise whether any particular foods, drinks or ingredients are impacting the child. For example, for some children, eating or drinking foods with high sugar can worsen their symptoms.

Medication

Some children with ADHD find medication to be beneficial. This could be medication such as methylphenidate (e.g., Ritalin, Concerta, Medikinet, Delmosart or Equasym), which is a stimulant that can help to treat the symptoms of ADHD, particularly attention difficulties. Methylphenidate helps to stimulate the area of the brain that controls attention and behaviour and can help improve attention and concentration and reduce the symptoms of hyperactivity and impulsivity. However, medication is not effective for everyone and methylphenidate is not recommended for all people with ADHD.

Children with ADHD who have significant sleeping issues may also be prescribed melatonin to help improve their sleep. However, this is generally only recommended for severe sleep issues and when other methods have failed.

Psychoeducation

Psychoeducation can be particularly helpful in helping children and young people to understand their ADHD, their difficulties and how it affects their lives. The child can discuss things they find difficult and how their ADHD makes them feel and can learn strategies to help them manage their difficulties.

Support groups

There are many support groups, operating both online and in the local community, that can help support individuals with ADHD and their families. These support groups can provide information, practical advice and suggestions, mental health support and access to a community of people who have experienced something similar. Some support groups in the UK include:

• ADHD UK
• The ADHD Foundation Neurodiversity Charity

Your GP can also recommend a local support group that operates in your community.

What Causes ADHD in Children?

There is not one known cause for ADHD. Instead, there are multiple factors that can increase a child’s likelihood of developing ADHD, such as:

• Having an immediate family member (a parent or sibling) with ADHD, as there is strong evidence that it is caused by genetic differences that typically run in families.
• Premature birth, usually before 37 weeks.
• Having epilepsy.
• Having a brain injury.
• Have autism.
• Being exposed to drugs or alcohol during pregnancy.
• Exposure to environmental toxins, such as lead found in the paint and pipes of old buildings.

Because ADHD often runs in families, it is thought the genetic component is particularly prominent. However, research into ADHD is ongoing and there is a lot we still do not know about the disorder. The lack of understanding can result in harmful beliefs and stereotypes about ADHD, such as it being a result of poor parenting, a poor diet or too much time spent playing video games or using screens. It is important to be aware that none of these myths are rooted in fact and they can be extremely harmful to people with ADHD and their families.

The Importance of Early Diagnosis

An earlier diagnosis, during childhood, ensures children and young people with ADHD have access to the support they need. Additionally, understanding ADHD and the ways it can affect different areas of their lives can help the individual and those around them, including their family members, friends and teachers, better understand their difficulties, be more patient and help the individual learn coping strategies and how to manage their ADHD. The earlier a child is diagnosed, the sooner they will have access to support.

With a diagnosis, the child can access help that might not otherwise be available, such as tailored support at school, psychological therapies or medication if needed. These interventions are often far more effective when introduced early, while the child is still developing core skills like emotional regulation, organisation and social interaction. It is much easier to build strong habits and coping strategies from the start than to try and undo harmful patterns of frustration, anxiety or low self-esteem later on.

Without early recognition, a child with ADHD might struggle silently and constantly feel like there is something wrong with them, which can lead to poor self-image, academic struggles and even mental health difficulties. Some people with ADHD who don’t receive a diagnosis and support either learn to mask their difficulties or learn unhealthy coping strategies, which can be more damaging long term. An earlier diagnosis can give a child access to the tools and support they need to thrive and succeed.