ADHD in children: signs, getting assessed and how support and medicines are used

The NHS describes three areas: paying attention, energy levels and controlling impulses. Inattentive signs include being easily distracted, finding it hard to listen or follow instructions and forgetting everyday tasks like brushing teeth or putting on socks. Hyperactive and impulsive signs include high energy, fidgeting or tapping hands and feet, talking noisily, restlessness, getting up when meant to sit, finding it hard to wait a turn and interrupting.

Most children with ADHD have both types; some show only one. The NHS says ADHD is thought to be recognised less often in girls than boys, perhaps because girls more commonly have inattentive symptoms, which can be harder to spot.

Distractibility and impulsiveness are normal in young children. The NHS stresses this is particularly true under 5, and may be a sign of something else such as being tired, anxious or stressed. At a GP appointment, the NHS says the doctor will ask about symptoms and how they affect life and may consider other conditions that could cause similar symptoms, such as autism, Tourette's or anxiety. It also notes people with ADHD often have other conditions, including depression, anxiety, addictions or a learning difficulty such as dyslexia.

NICE adds that some groups have increased prevalence, including people born preterm, looked-after children, children with oppositional defiant or conduct disorder, children with mood disorders and people with a close family member with ADHD.

The NHS suggests talking first to one of the child's teachers, who will usually involve the school's special educational needs co-ordinator (SENCO). The SENCO can discuss classroom and homework support, or help with confidence and friendships. If the child still needs more, a GP appointment is the next step. If support at home and school is not helping, the NHS says to ask a GP or SENCO to request a referral for an ADHD assessment, and that support should continue while waiting. A local council family hub may also help for ages 0 to 19 (and up to 25 with special educational needs or disability).

The NHS says the assessment is with one or more ADHD specialists such as a paediatrician or a child and adolescent psychiatrist, who talk with the child and parents about symptoms, family life and development, may ask for forms, usually contact the school and may use a computer-based test. NICE says a diagnosis should not be made solely on rating scales or observation data, though scales and school observations are helpful added tools.

The NHS says waiting times vary and a child may wait several months or years. In England, you may be able to find a clinic with a shorter waiting list through your GP using the Right to Choose scheme, and can ask for an NHS appointment at any clinic, including a private clinic, if it provides ADHD services for the NHS. Before using this, check the provider is commissioned by the NHS for that service, and note that medicines still need to be started and monitored by an ADHD specialist.

The NHS lists lifestyle and practical measures, which do not depend on diagnosis and not every child needs health professional input.

• Make time for physical activities the child enjoys, as exercise is a good focus for energy.

• Encourage regular sleep, and a healthy balanced diet with regular mealtimes.

• If some foods or drinks seem to affect symptoms, keep a food and drink diary and share it with the school.

• Split tasks such as homework or sitting down to eat into 15 to 20 minute slots with a break between.

• Give clear, simple instructions one at a time in a calm voice, write a to-do list and use praise or a reward chart.

The NHS says ADHD medicines, such as methylphenidate, must be started and monitored by an ADHD specialist, and melatonin may be used for sleep problems when other methods have not worked. Children may need to try more than one medicine, a GP may take over prescribing only with a shared care agreement, and not everyone with ADHD needs or wants medicine. NICE says all ADHD medication should be initiated by a healthcare professional with training in ADHD and tailored to the child.

For children under 5, NICE says an ADHD-focused group parent-training programme is first-line treatment, and that medication should not be offered under 5 without a second specialist opinion from a service with expertise in young children. For children 5 and over with ADHD and oppositional or conduct symptoms, NICE recommends parent-training programmes. The NHS says talking therapies such as CBT might help with problem solving and expressing feelings.

The NHS says the cause is not always known, that genetic differences are involved and ADHD often runs in families, and that being born before 37 weeks, having epilepsy, a brain injury or being autistic are linked. People with ADHD may be more likely to have anxiety or depression and are at higher risk of suicide, and the NHS says help for a concerned young person is available immediately through children and young people's mental health support. Some people with ADHD describe themselves as neurodivergent.