ADHD in Children & Adolescents

ADHD affects up to 10% of school-aged children. About 70% of these children will continue to have ADHD as teenagers, and about half will still have it as adults. While hyperactivity and impulsivity often decrease with age, attention problems can last longer and may even get worse as school becomes more challenging.

Children with ADHD often have one or more of the following symptoms:

• Increased activity (hyperactivity): A child might have trouble sitting still or playing quietly.
• Acting impulsively: A child might interrupt others or do things without thinking first.
• Trouble paying attention: A child might be forgetful, lose things, or have trouble finishing a project.

These symptoms can make it hard for children to succeed in school, at home, and with friends.

Attention, impulsivity, and energy levels are normal traits in all children and change as they grow. Younger kids usually have shorter attention spans and more energy than older kids. However, ADHD is considered when a child's attention span is very low and their impulsivity and hyperactivity are very high compared to their peers of the same age and gender. These symptoms must also directly affect their learning, academic performance, behavior at school and home, friendships, and family life. When a child's attention is very low and their impulsivity and hyperactivity are very high, and these traits cause significant problems, we consider a diagnosis of ADHD.

Research has found that ADHD is related to how certain chemical messengers, called neurotransmitters, work in the brain. In people with ADHD, neurotransmitters like dopamine and norepinephrine are less available in specific parts of the brain. This affects how the brain controls attention, impulses, and activity levels.

Diagnosing ADHD involves two main steps. First, we look for signs like a very low attention span, poor organization, and high impulsivity and hyperactivity compared to what is typical for their age and gender. Next, we check if these behaviors are causing problems in schoolwork, relationships with family and friends, and emotions. These two steps are accomplished by a clinical assessment of your child and gathering information from family and teachers about their emotions, school performance, and behavior.

Diagnosing ADHD can sometimes be more challenging because symptoms can overlap with other conditions like anxiety and oppositional behavior. Different caregivers might give contradictory histories. Traits like inattention, impulsivity, and hyperactivity are normal to some extent in everyone, and at times it is difficult to determine just based on clinical assessment if they are significant enough to suggest ADHD. In these cases, neuropsychological testing is used. This testing helps by objectively measuring these traits and comparing them to other children of the same age and gender. [Click here to learn more about Neuropsychological testing for ADHD at MindWeal.]

This thorough process ensures an accurate diagnosis and helps us provide the best support for your child.

If your child’s ADHD symptoms, such as inattention, impulsivity, and hyperactivity, are affecting their learning, behavior, and emotions, it will not get better on its own. Active interventions are necessary to improve their current functioning and to prevent future problems. Even if your child’s ADHD doesn’t seem severe now, leaving it untreated can lead to later issues, such as:

• Academic underachievement: Struggling in school can affect their future opportunities and achievements.
• Emotional struggles: Constant academic challenges can lead to low self-esteem, depression, and anxiety.
• Behavioral issues: Untreated ADHD can result in oppositional behavior, trouble with relationships, motor vehicle accidents, and not following rules.
• Substance use problems: There is a higher risk of cigarette and substance use issues.

Many research studies in the United States and other countries show that early and continuous treatment of ADHD can reduce these negative outcomes. Treating ADHD helps children succeed and improves their quality of life.

For preschoolers (ages 3 to 5) with ADHD symptoms, parent training and behavior modification techniques are recommended first. These methods help change behavior patterns at home and school. Medication is considered only if significant behavior problems continue after trying these techniques.

For school-aged children, research shows that medication is usually the most effective treatment. Combining medication with parent training and behavior modification techniques often leads to better outcomes. Studies show that some children do well with just medication, while others benefit from adding parent training and behavioral therapies.

Using the right combination of treatments can help your child succeed at home, in school, and in their relationships.

For all ages, medication is often used along with other treatments, such as:

• Counseling: Structured talk therapies that help children and families understand and cope with ADHD. It helps children and their parents identify and unlearn problem behaviors (for example, getting mad and yelling at others) while learning new healthier behaviors and ways to cope with stress.
• Parent-Child Interaction Therapy (PCIT): It focuses on enhancing the parent-child relationship by encouraging positive interactions and teaching parents effective discipline techniques and ways to manage your child's challenging behaviors.
• Behavior modification: Uses rewards and consequences to encourage good behavior.
• Family therapy: Improves communication and problem-solving within the family.

Using a combination of treatments can provide the best results for children with ADHD.

ADHD medications are the most successful intervention for ADHD and are the most studied medication treatments in all of pediatrics. About three-quarters of children and adolescents respond well to one or more of these medications. While not every symptom may go away completely, you should see noticeable improvement.

In general, medications can reduce ADHD symptoms by 40–50%. This often leads to better performance at school, improved homework completion, and better interactions with peers and family. However, medication alone does not teach organizational skills or help with learning disabilities. These need to be addressed with counseling and extra support from parents and teachers.

Several different categories of medication have proven to be effective for treatment of ADHD: 

Stimulants: Stimulants are the most effective and most commonly prescribed medications for ADHD. They include both methylphenidate (Ritalin, Concerta, Focalin, and others) amphetamine (Adderall, Vyvanse, and others)

Nonstimulants: If your child does not respond to and/or cannot tolerate stimulants because of side effects,  there are a variety of nonstimulant medications that may be considered. In general, the non-stimulants are somewhat less effective than the stimulants; however, they tend to treat ADHD throughout the day with minimal effects on appetite or sleep. Sometimes a non stimulant may be used together with a stimulant medication to improve effects and reduce side effects. Non stimulant medications include Guanfacine, Clonidine, Atomoxetine (Strattera) & Viloxazine (Qelbree) 

Second-line nonstimulants: These medications are not FDA approved for the treatment of ADHD but have been shown in research studies and in clinical practice to be useful options if the stimulants or approved nonstimulant medications do not work well for your child or have too many side effects. Second-line non stimulants include Bupropion (Wellbutrin) & Modafinil (Provigil) 

Choosing the right medication for your child's ADHD is a careful process. We recommend medications that have been proven to work in research studies and follow guidelines from national organizations like the American Academy of Child & Adolescent Psychiatrists and the American Academy of Pediatrics.

Our providers consider your child's age, past medications and their effects, family history of medication responses, and the preferred form of medication (capsule, tablet, or liquid). They also look at your child’s unique circumstances, such as which symptoms of ADHD are more prominent and where (school or home) they are most affecting them.

For school-aged children, stimulants are usually the first choice. If one stimulant doesn’t work or causes side effects, we try another type. Research shows that methylphenidate and amphetamine can work differently in the brain, so one might be more effective or have fewer side effects for your child.

If stimulants don’t work or cause too many side effects, we consider nonstimulant medications. Although non stimulants are generally less effective than stimulants, they can treat ADHD throughout the day with minimal effects on appetite or sleep. Sometimes, a non stimulant is used with a stimulant to improve results and reduce side effects.

For preschool children (ages 3 to 5), guanfacine and clonidine might be considered first because younger kids are more likely to have side effects from stimulants. These medications are very effective for impulsivity and hyperactivity, which are often major concerns in this age group.

To find the right dose for your child’s medication, we start with a low dose and gradually increase it. We do this until you and your child's teachers notice a significant improvement in ADHD symptoms or until side effects prevent further increases. During treatment, you and your child will have regular check-ins with the clinician. These meetings help us see how well the medication is working and if there are any side effects.

It depends on the type of medication chosen.

Stimulants: You will likely see effects on your child’s attention and behavior within 30–60 minutes of taking the medication. For short-acting (immediate-release) stimulants, these effects usually last about 4 hours, often requiring 2 or 3 doses per day. Many parents prefer long-acting (extended-release) stimulants so their child doesn’t need a dose during the school day. Extended-release stimulants start working within an hour and last 10–12 hours, depending on the form. Often, a single morning dose lasts through the school day and into the evening. Sometimes, a combination of short- and long-acting stimulants is prescribed to cover the entire day.

Guanfacine and Clonidine: You will likely see effects on your child’s attention and behavior within 30–60 minutes of taking the medication. For short-acting (immediate-release) formulations, these effects usually last about 4 hours, often requiring 2 or 3 doses per day. Many parents prefer long-acting (extended-release) formulations so their child doesn’t need a dose during the school day. Guanfacine extended-release starts working within an hour and lasts up to 24 hours, though the majority of benefit is noted within the first 12 hours. Clonidine extended-release starts working within an hour and lasts up to 12 hours, though the majority of benefit is noted within the first 8 hours.

Atomoxetine, Qelbree, Bupropion: With these medications, you might see some improvement in 2 to 4 weeks, with more progress over 8 to 12 weeks. Some children feel better quickly with a low dose, while others might need a higher dose. We start with the lowest dose to help children get used to the medication and reduce side effects. If it doesn’t help, we increase the dose. Finding the best dose can take 8 to 12 weeks.

You will know that the medication is working if you notice these improvements in your child:

• They can pay more attention and stay focused on tasks.
• They are more organized with their daily activities and responsibilities.
• They make more thoughtful and mindful decisions.
• Their energy levels are balanced and not causing disruptions.
• Their behavior has improved both at school and at home.
• Their academic performance and grades are improving.
• They have better relationships with friends and family members.
• They show increased confidence and a better sense of well-being.

Yes, your child may experience some side effects from ADHD medications, but most can be managed and may improve over time. Here’s a breakdown of common medications and their side effects:

Stimulants: Common side effects include loss of appetite leading to weight loss, difficulty falling asleep, bellyaches, nausea, and irritability. Less frequent side effects include becoming very quiet and over-focused (sometimes called the “zombie” effect), tics, anxiety, and skin picking. We start medications at a low dose to help minimize these side effects, which often improve as your child gets used to the medication. One rare risk is heart rhythm disturbances, which is more likely in children with a genetic predisposition. We carefully review your child’s medical and family history and monitor for heart issues. If heart rhythm problems are present, we avoid stimulants and consider non-stimulants. 

Guanfacine & Clonidine: The most common side effect is drowsiness, which usually improves with time. Starting these medications at low doses helps minimize this effect. Higher doses can cause dizziness and a slow heart rate, so we increase the dose gradually. If stopped abruptly, these medications can cause a temporary increase in blood pressure, so they should be tapered off slowly.

Atomoxetine (Strattera): Common side effects include nausea, bellyaches, and excessive tiredness. Most side effects are mild and improve over time. We start with a low dose to help minimize these side effects.

Viloxazine (Qelbree): Common side effects include excessive tiredness and nausea. Most side effects are mild and improve over time. We start with a low dose to help minimize these side effects.

Bupropion (Wellbutrin): Common side effects include nausea, dry mouth, constipation, headache, and stomach upset. Most side effects are mild and improve over time. We start with a low dose to help minimize these side effects.

To reduce the odds of these side effects and to effectively manage them, it's crucial to follow the prescribed dosage and schedule and to have regular check-ins with your child’s provider.

No, ADHD medications do not increase the risk of substance abuse. In fact, research shows that treating ADHD with medication can actually reduce the risk of future substance abuse. When ADHD symptoms are well-managed, children and adolescents are less likely to turn to drugs or alcohol to cope with their challenges. They are also more likely to make thoughtful and less impulsive decisions, further reducing the risk of substance use. By effectively managing ADHD symptoms, medications help children succeed in school, build better relationships, and develop healthy habits, all of which decrease the likelihood of substance abuse later in life. Stimulant medications are carefully prescribed and monitored by doctors to ensure they are used safely.

When used properly under a doctor’s supervision, ADHD medications do not lead to dependency. It’s important to follow the prescribed dosage and schedule, and to have regular check-ins with your child’s doctor to monitor progress and watch for any potential misuse or diversion.

Stimulant medications are classified as Schedule II-controlled substances and have the potential to be misused or diverted, particularly among high school and college students, especially those who are also using other substances. Misuse includes taking medication in larger amounts, more often, or in a different way than prescribed. Diversion involves giving, trading, or selling prescribed medication to others.

To prevent misuse and diversion, MindWeal follows strict guidelines, including an initial negative urine drug screen (UDS) for children ages 14 and older before starting stimulant medication, and annual negative UDS for patients ages 14 and older on stimulant medications. To further reduce the risk of misuse and diversion, parents should stay actively involved in their child's treatment, carefully monitor the medication and store it securely, attend all visits with the child's provider, and report any suspicious changes in behavior.

Children with ADHD may have trouble sleeping. They might be too energetic to fall asleep and may move a lot during sleep, waking up frequently through the night. Good sleep habits, known as sleep hygiene, can help all children with sleep issues. If these habits don't work, your provider may prescribe medications to help your child fall asleep and stay asleep.

Here are some commonly used medications:

• Melatonin: Often the first treatment used to help regulate sleep.
• Clonidine: Can be very effective as it also helps reduce hyperactivity at night.
• Antidepressants: Medications like Trazodone and Mirtazapine can also be helpful for sleep.

These medications should only be taken as prescribed by your provider to ensure they are safe and effective for your child. By improving sleep, your child can feel more rested and better able to manage their ADHD symptoms during the day.

Approach conversations with empathy and patience. Ask open-ended questions to encourage sharing. Listen actively, showing that you understand and care. Avoid being critical or dismissive. Let your child know it’s okay to feel the way they do and that you are there to support them.

Discuss their concerns openly and involve them in treatment decisions, understanding their fears to help address them. Emphasize the benefits of medication in managing anxiety and improving quality of life. Use the DESC technique to communicate effectively and foster cooperation—click here for a guide on implementing this method. If necessary, consult their healthcare provider to explore alternative treatment options. 

Maintain regular communication with your child, their teachers, and school counselors to understand how ADHD symptoms affect their school functioning. If ADHD is impacting your child, discuss with their provider and counselor whether school accommodations would be helpful. If recommended, work closely with school staff to develop an individualized education plan (IEP) or 504 plan. Ensure the school provides the necessary accommodations. Being proactive helps create a supportive school environment.