ADHD in children and teenagers: signs, assessment and support

The NHS describes ADHD as a condition where the brain works differently, affecting attention, energy levels and impulse control. Children can show mainly inattentive signs, mainly hyperactive-impulsive signs, or both, and most show both types.

• Inattentive: easily distracted, difficulty listening or following instructions, forgetting everyday tasks such as brushing teeth or putting on socks.

• Hyperactive and impulsive: high energy, fidgeting or tapping hands and feet, noisy talking, restlessness, leaving a seat when expected to sit still, struggling to wait a turn, interrupting.

• Girls: ADHD is thought to be recognised less often in girls, who more often show inattentive symptoms that are harder to notice.

Plenty of children are fidgety or impulsive, particularly under 5. The NHS says this does not mean ADHD and may be a sign of tiredness, anxiety or stress. Clinicians consider other explanations, such as autism, Tourette's or anxiety, and know that ADHD often occurs alongside depression, anxiety, learning difficulties such as dyslexia, and later in life addictions.

NICE says universal screening for ADHD should not be undertaken in nursery, primary or secondary schools, and that ADHD is thought to be under-recognised in girls, who are less likely to be referred for assessment.

The NHS advises speaking to a teacher first. They can refer to the school's special educational needs co-ordinator (SENCO), who can discuss classroom support, homework strategies, confidence and friendships. If this is not enough, a GP appointment is the next step. Local authority family hubs also offer support for children and young people aged 0 to 19, and up to 25 for those with special educational needs or a disability.

If support is not helping, ask the GP or SENCO to request an ADHD assessment. The child should keep receiving support at home and school while waiting.

An ADHD specialist, such as a paediatrician or child and adolescent psychiatrist, talks with the parents and child about symptoms and family life, asks about development milestones such as when they walked or read, and usually contacts the school. Forms may need completing, and a computer-based test is sometimes used. The NHS says waits can be months or years, and that Right to Choose in England may allow an NHS-funded appointment at any suitable clinic, including a private one providing ADHD services for the NHS.

NHS suggestions include splitting homework or mealtimes into slots of 15 to 20 minutes with breaks, giving clear and simple instructions one at a time in a calm voice, writing a to-do list somewhere easy to see, and praising good effort or using a reward chart.

Lifestyle matters too: time for physical activity the child enjoys, regular sleep (the Royal College of Psychiatrists website has sleep advice), a balanced diet and regular mealtimes. If certain foods seem to make symptoms worse, a food and drink diary can be shared with school.

NICE says medication should be offered to children aged 5 and over only when symptoms still cause persistent significant impairment after environmental changes have been tried and reviewed, and after a baseline health assessment. Methylphenidate is the example the NHS gives, and children may need to try more than one medicine. NICE describes switching to lisdexamfetamine after a 6-week trial of methylphenidate if there has not been enough benefit, with other options if neither works.

The NHS adds that melatonin may be prescribed for sleep problems when other methods have not helped. Talking therapies such as CBT may help older children with problem solving and expressing feelings. NICE recommends measuring height every 6 months in children and young people, monitoring weight, and checking heart rate and blood pressure after dose changes and every 6 months. It also says young people should be reassessed at school-leaving age to decide whether treatment should continue into adulthood.

People with ADHD may be more likely to have anxiety or depression and are at higher risk of suicide, according to the NHS. If a child or teenager is struggling, speak to the GP, NHS 111 or the school; in an emergency call 999.

Private child ADHD assessments exist, but not every GP will agree to shared care for a privately made diagnosis, so check how medicines would be started, monitored and prescribed afterwards. Contact with school is a normal part of a good assessment, whichever route is chosen.