All About Recognising Signs of ADHD in Children

According to government statistics, it is estimated that between 1% and 2% of children in the UK have Attention Deficit Hyperactivity Disorder (ADHD). This figure is rising and ADHD is now considered to be the most common behavioural disorder in the country. In this article, we’ll cover how to recognise the signs of ADHD in children. 

What is ADHD in children?

Attention Deficit Hyperactivity Disorder is a neurological disorder that is characterised by a persistent pattern of hyperactivity, impulsivity or inattention. This is such to the extent that it interferes with development and functioning. 

Hyperactivity means excessive motor activity like running around a room when it isn’t appropriate to do so or excessive tapping, talkativeness or fidgeting. It can also manifest as extreme restlessness. 

Impulsivity refers to making hasty decisions and decisions in the moment with no forethought about their consequences. This might mean a child runs into the road without looking. Impulsiveness can also appear as interrupting conversations and social intrusiveness. A person might also agree to something without thinking of its long-term impacts. 

Inattention means wandering off task or being unable to focus. A child with ADHD can come across as being disorganised and lacking in persistence. 

What are the signs and symptoms of ADHD in children?

There are several signs and symptoms of ADHD in children. Generally speaking, a child will possess at least six of them if they have ADHD. 

Here are some examples:

Symptoms of inattention:

• Making careless mistakes in schoolwork or hobbies and not paying close attention to detail.
• Finding it hard to concentrate when playing or performing tasks at school.
• Looking like they’re not listening to what is being said, as if they’re daydreaming but there is no obvious distraction.
• Avoiding tasks and disliking tasks that require mental effort over a sustained period of time.
• Losing items frequently like pencils, coats, gloves, etc.
• Being easily distracted by stimuli outside of the immediate environment.
• Forgetfulness, even with daily activities.
• Being late.
• Leaving homework until the last minute.

Symptoms of hyperactivity and impulsivity:

• Squirming, fidgeting and tapping when seated.
• Getting out of their chair when they’re supposed to remain seated.
• Running around and climbing on things inappropriately.
• Being unable to engage in quiet leisure activities.
• Appearing always ‘on the go’.
• Excessive talking.
• Blurting out answers in class.
• Difficulty waiting their turn.
• Intruding on others.
• Interrupting others.

How to recognise signs of ADHD in children in school

Identifying signs of ADHD in a school setting requires observation and an understanding of the disorder. Many teachers aren’t given enough training on ADHD and may be unable to spot the more subtle signs as the focus tends to be on hyperactivity. 

Here are some key indicators that ADHD might exist:

• The child struggles to focus on their schoolwork.
• The child appears to be lost in their thoughts or daydreaming.
• Older children will often forget to bring the right equipment or their homework.
• The child may be excessively restless or find it hard to remain seated.
• They may talk excessively or struggle to remain quiet.
• They will appear impulsive and blurt out answers.
• Their schoolwork will often be disorganised. Instructions and deadlines are likely to be missed.
• They may struggle with social cues, which leads to difficulties in making and maintaining friendships.
• Their impulsiveness might lead to conflicts in social situations and they might not participate well in group activities.
• There might be inconsistency in their academic performance.

How to recognise signs of ADHD in children at home

The home environment will present different challenges for a child with ADHD. Here are some behaviours that might suggest a child has the condition:

• There will likely be a difficulty in maintaining a tidy bedroom and personal items might frequently go missing.
• They will be forgetful with household routines and responsibilities.
• There might be impulsive behaviours and risk-taking during activities at home.
• They may struggle with completing homework on time.
• They will need frequent reminders.
• They might experience emotional dysregulation and have mood swings and outbursts that are disproportionate.
• They will struggle to cope with frustration, which can lead to meltdowns or tantrums.
• They might find sleep difficult and suffer from insomnia.
• There will often be a resistance to following bedtime or morning routines.
• There will often be communication challenges like interrupting or difficulties expressing themselves.

How common is ADHD in children?

There are between 1% and 2% of children with ADHD and there are three subtypes. Between 20% and 30% of children with ADHD will have the inattentive subtype, 15% will have the hyperactive-impulsive subtype, while between 50% and 75% will have the combined subtype. 

ADHD is diagnosed more often in boys than girls. This is largely put down to the fact that boys’ behaviour tends to be of the disruptive type, which prompts referrals quicker. Girls also tend to have the inattentive subtype and don’t often have comorbidity with conduct disorder and oppositional defiance disorder (ODD) like boys.

Risk factors for developing ADHD

There is no known cause of ADHD. It is believed to be influenced by genetic and environmental factors that alter the structure and neurochemistry of the brain. 

The mean hereditability of the condition is around 76%, which means that it’s common for parents to also have the condition. There are suggestions that a few genes interact to cause ADHD. 

Other risk factors are environmental. These include:

• Low birth weight
• Maternal smoking during pregnancy
• Preterm delivery
• Epilepsy
• Acquired brain injury
• Exposure to lead or environmental toxins like pesticides during early childhood
• Iron deficiency
• Alcohol exposure during pregnancy
• Adverse maternal mental health or maternal stress or trauma during pregnancy
• Psychosocial adversity
• Complications during birth (trauma during delivery, oxygen deprivation)

How is ADHD in children diagnosed?

A diagnosis of ADHD is not a quick process in the United Kingdom and waiting times are long. If the condition is suspected, the diagnostic process usually begins with a referral from the family GP or school to a neurodevelopmental specialist. 

Consultants will assess the child and their symptoms. They usually send questionnaires to parents and school staff and might even observe the child while at school or home to spot signs. 

For ADHD to be diagnosed, any symptoms must have been present before the age of 12. They also need to occur in at least two settings like school and home. They will also need to interfere with education or social functioning. 

Several strands will be looked at for school-aged children. This will explore the extent of their impairment in:

• Self-care (hygiene, eating, toileting)
• Their ability to travel independently
• Their ability to make and keep friends
• Their school achievement
• Their ability to form positive relationships with family
• Their ability to maintain a positive self-image
• Their involvement in criminal activity or substance misuse
• Their level of unhappiness and anxiety
• Their understanding and avoidance of common hazards

The QbTest

Many NHS trusts now use the QbTest as part of their diagnosis for ADHD. This is a computerised test that aids in the assessment of a child. It measures their attention, impulsivity and activity level by analysing their response on a computer-based task and by observing their movements. 

The child is required to wear a headband containing a sensor. They sit in front of a receiver and play a simple game on a laptop. The camera captures how much the marker moves in the test. During the test, the child is required to click the responder whenever they see a particular shape. However, there are similar shapes that they must avoid clicking when they see them. For example, they might be required to click whenever they see a circle but abstain from clicking when there is a cross through the circle. 

The Conners’ Rating Scale

Another diagnostic tool used by specialists is the Conners’ Questionnaire. This is a norm-referenced assessment that uses observations from parents and teachers to see whether or not a child meets the criteria for an ADHD diagnosis. The questionnaire covers different aspects of life including behaviour, schoolwork and social life. 

The test uses scale questions with options: 

• Very often/very much true
• Often/pretty much true
• Occasionally/just a little
• Never/not at all true

Other conditions commonly associated or confused with ADHD

There is often confusion over the symptoms of ADHD and whether or not they are for a different condition. This is why the QbTest can be helpful in determining whether or not the symptoms relate to ADHD or something else. Here are some commonly associated conditions:

• Anxiety: Inattention can be present in ADHD but it is also a symptom of anxiety disorders like generalised anxiety disorder.
• Depression: Poor concentration is also a symptom of depressive disorders.
• Autism Spectrum Disorder: There are many overlaps with ADHD and ASD. These include social disengagement, meltdowns, and inability to cope with changes to routines. A child can also have both conditions.
• Personality disorders: It might be difficult to determine whether symptoms of ADHD are a personality disorder. However, those with a personality disorder usually have a fear of abandonment or are extremely ambivalent. They might also self-harm.
• Oppositional defiant disorder (ODD): Children who have ADHD might refuse school or refuse to carry out tasks they find demanding. In ODD, this aversion is hostile and defiant and is specifically targeted towards people seen as authority figures.
• Foetal Alcohol Syndrome: There are many overlapping symptoms of ADHD and Foetal Alcohol Syndrome. However, those with FASD tend to have distinct facial features like an upturned nose, thin upper lip, smooth philtrum and epicanthal folds.
• Visual impairments or hearing loss: In younger children, inattention could be down to problems with hearing and vision.
• Seizure disorders: Absence seizures in epilepsy can present as inattention.

How is ADHD in children treated?

Treating ADHD in children typically involves a multimodal approach. There will likely be support with behaviour and performance in school, and often medication. 

School interventions for ADHD

School teachers and parents will need to collaborate to ensure the child is fully supported. With a diagnosis of ADHD, the child will be placed on the school SEND register, which means parents will have frequent meetings and updates on their child and the support put into place to help them. 

Examples of school interventions for ADHD include:

• Modified tasks
• Modified seating plans to ensure the child is sitting close to the teacher or teaching assistant for prompting
• Help with time management and frequent reminders
• Taking sensory breaks
• Using fiddle toys
• Allowing movement breaks
• Using timers
• Using diaries or planners to aid organisation
• Using visual reminders

Medications for ADHD

Around 50,000 school pupils take ADHD medication. This equates to around 62% of children who have the condition. 

There are five medicines that are licensed for ADHD treatment in the UK. These are:

• Methylphenidate
• Lisdexamfetamine
• Dexamfetamine
• Atomoxetine
• Guanfacine

Medicines will not cure the condition but they can help the child to concentrate, feel calmer and be less impulsive. This means they’re more likely to learn and be able to practise new skills. 

Some ADHD medications will need to be taken daily while others can be taken as and when needed. 

Methylphenidate

This is the most common ADHD medication. It is a stimulant that works by increasing activity in the brain. This is in areas that control attention and behaviour. This is either prescribed as an immediate-release tablet or a modified-release dose. 

There are side effects, which include:

• Increase in heart rate and blood pressure
• Poor appetite
• Difficulty sleeping
• Stomach aches and headaches
• Feelings of aggression, irritability, depression and anxiety

Lisdexamfetamine

This is a stimulant that improves concentration. It reduces impulsiveness and helps to focus the attention. It comes in a capsule form and is taken once per day. 

Possible side effects include:

• Poor appetite
• Drowsiness
• Dizziness
• Aggression
• Nausea
• Vomiting
• Diarrhoea
• Headaches

Dexamfetamine

This is similar to lisdexamfetamine but it comes in a tablet that is taken between two and four times per day. There is also an oral solution. 

The side effects are similar to those of lisdexamfetamine. 

Atomoxetine

This is different to other ADHD medicines as it is not a stimulant. Instead, this is a selective noradrenaline reuptake inhibitor (SNRI). This means that it increases the amount of noradrenaline, a chemical in the brain. This helps to control impulses and improves concentration.

It comes in a capsule that is taken once or twice per day. Side effects might include:

• Stomach aches
• Problems sleeping
• Irritability
• Nausea and vomiting
• Rises in heart rate and blood pressure

Guanfacine

This helps to improve attention but it also reduces blood pressure. This isn’t given to adults with ADHD. It can be taken once a day. Side effects could include:

• Abdominal pain
• Headache
• Fatigue
• Dry mouth

Final thoughts on recognising the signs of ADHD in children

When signs of ADHD are present, it’s important to seek advice from professionals to get a confirmed diagnosis. A diagnosis of ADHD means that children can get appropriate support in their education, which may or may not be helped by a prescription of medication. The waiting times for assessment are long so it is important to seek early intervention.