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Does your child have ADHD?

Here are the symptoms to watch for.

Published: July 2010

It's not unusual for parents to have conflicts with their children about finishing homework, following instructions, or not listening. High levels of physical activity, the inability to sit still, and a lack of focus are also common parental complaints. If you're worried about your child, perhaps the first thing to think about is how often and for how long these behaviors occur.

Attention deficit hyperactivity disorder is a persistent pattern of behavior that lasts at least six months. Children with ADHD may show abnormally high levels of physical activity (hyperactivity) and an inability to control their impulses, pay attention, focus, or complete tasks. A pattern usually begins before age 7, although the disorder may be diagnosed at a much later date.

ADHD is one of the most common problems involving behavior and brain function. The Centers for Disease Control and Prevention estimates that about 7 percent of children ages 3 to 17 are affected (about 4.5 million in 2006). But less than half of them actually receive a diagnosis of ADHD. When not properly diagnosed and managed, ADHD can have damaging effects on children and their families.

Some children and teenagers have only mild ADHD symptoms while others are severely affected. In general, boys are more likely to be diagnosed with ADHD than girls, perhaps because they are prone to act out and exhibit hyperactivity, while girls with ADHD are more likely to be perceived as simply inattentive (daydreaming, forgetful, easily distracted). Boys and girls with ADHD are more likely than other children to underachieve at school, have low self-esteem, and develop emotional and social problems.

In our survey, personal concerns about their child's behavior and/or academic performance were the major reasons that 65 percent of the parents sought professional help. A recommendation from someone at school, such as a teacher or school nurse, was a starting point for 39 percent of the parents, and a doctor's recommendation motivated 17 percent.

What led you to seek help from a medical or mental health professional for your child's ADHD?*
I felt my child needed help because of his/her behavior and/or academic performance 65%
Someone at school recommended getting help (e.g., teacher, school nurse) 39
Doctor's recommendation 17
My child is gifted and was not performing as expected academically 17
I felt my child could benefit from extra time or accommodations during standardized testing 8
Friend's recommendation 4
Other 11
* Editor's Note: Multiple responses allowed
Source: Consumer Reports National Research Center

A brief history of ADHD

ADHD might appear to be a relatively new condition, but the first mention of it is credited to physician George Still, in a 1902 edition of the British medical journal The Lancet. And the amphetamine Benzadrine was used as early as 1937 to treat hyperactive children, according to a review of the book "Medicating Children: ADHD and Pediatric Mental Health" in the New England Journal of Medicine. It was found to be helpful, but was allowed to be given only to children who were hospitalized or in severe distress.

In 1955, a new stimulant called methylphenidate (Ritalin, generic), which was similar to Benzedrine, was developed and marketed as having fewer side effects and less potential for abuse than other stimulants, according to the review. The Food and Drug Administration approved the use of stimulants for children in 1961—24 years after they were first reported to be effective

Until the late 1980s, ADHD was thought to affect only children. It wasn't until the publication of the 1987 edition of the Diagnostic and Statistical Manual of Mental Disorders that adult ADHD was formally recognized in the U.S. There is controversy to this day as to whether ADHD is a valid, diagnosable, and treatable condition.

In 1998 the American Medical Association reported that the criteria developed to identify ADHD were the result of extensive research and, if applied appropriately, led to a reliable diagnosis. That same year the National Institutes of Health released a statement on the diagnosis and treatment of ADHD. It said that although the use of psychostimulants remained controversial, short-term studies had established their efficacy. But it also said that conclusive recommendations for long-term treatment couldn't be made.

Why does it seem as though ADHD is something new? It might be because the condition and treatment have been more accepted and discussed since the late 1980s and early '90s, when the diagnosis was extended to adults as well as children, and short- and long-acting medications became available.

3 subtypes of ADHD

There are three subtypes of ADHD recognized by the American Psychiatric Association: predominantly inattentive; predominantly hyperactive and impulsive; and a combined type. Although many children have inattentive and hyperactive/impulsive symptoms, one or the other pattern is more prevalent in some of them.

In the Consumer Reports survey, we asked parents with children diagnosed with ADHD which symptoms they noticed. Interestingly, more than 60 percent of them checked six or more symptoms of inattention and hyperactivity/impulsivity associated with ADHD. When we compared parent reports of symptoms with the ADHD diagnosis (hyperactive/impulsive, inattentive, and combined type) their children received, we found that they did not always correspond, and 23 percent of the parents were unsure of the subtype.

For an official diagnosis, a child should have six or more symptoms of inattention with fewer than six symptoms of hyperactivity/impulsivity to fit the "inattentive" label (see chart below). For an official diagnosis of hyperactivity/impulsivity, a child should have six or more symptoms from that subtype (see chart below).

Additionally, 14 percent of the parents whose children had received a diagnosis of ADHD were not convinced their child really had it. Although this group of unsure parents tended to report fewer ADHD symptoms, a parent's report of his or her child's symptoms is only one source of information used by professionals. These results reinforce recommendations to get information from schools and other independent observers because children behave differently in different settings.

If this list of ADHD symptoms raises concerns about your own child or a child you know, we encourage you to identify specific examples of the behaviors so that an objective and trained professional with knowledge of what is appropriate for your child's stage of development can determine if further evaluation is needed.

Inattentive behavior

Experts have found that children with ADHD marked by inattention tend to have the most profound problems with academic performance and other school-related problems. Before receiving an ADHD diagnosis, 93 percent of the children asked about in the survey had six or more inattentive symptoms that occurred a lot or somewhat frequently. Among the most commonly reported were being easily distracted (93 percent), having difficulty focusing or maintaining attention during tasks (92 percent), and losing interest quickly (89 percent).

Inattentive Symptom Present (A lot or Somewhat)
Was easily distracted 93%
Had difficulty focusing or maintaining attention during tasks 92
Lost interest quickly 89
Didn't follow through with homework or chores 89
Had trouble organizing or planning activities 87
Missed details or made careless mistakes in schoolwork or other activities   
85
Avoided or disliked activities that involved long periods of attention (homework, puzzles) 84
Didn't seem to listen when spoken to 83
Was forgetful 78
Lost things often 73
Editor's Note: Source: Consumer Reports National Research Center

Hyperactive/impulsive behavior

Children with hyperactive/impulsive ADHD seem to experience more accidental injuries and peer rejection, the experts say. Of the 934 children asked about in this survey, 73 percent had six or more symptoms of hyperactive and impulsive behavior before receiving an ADHD diagnosis. Eighty percent had difficulty sitting still or they squirmed or fidgeted, the most common hyperactivity symptoms mentioned by parents. Interrupting others (70 percent) and having trouble taking turns (68 percent) were among the most commonly reported symptoms of impulsivity.

 

Hyperactivity Symptom Present (A lot or Somewhat)
Had difficulty sitting still; squirmed or fidgeted 80%
Always "on the go" 69
Talked too much 66
Left seat when they shouldn't (in class or at mealtime) 65
Had trouble playing quietly 59
Ran or climbed when they shouldn't 59
Editor's Note: Source: Consumer Reports National Research Center    
Impulsivity Symptom Present (A lot or Somewhat)
Interrupted others (e.g.,during games or conversations) 70%
Had trouble waiting their turn 68
Did things without thinking, placing themselves in danger 63
Blurted out answers before others finished talking 62
Editor's Note: Source: Consumer Reports National Research Center

Here are some signs that it may be time to consult a professional:

  • Your child has six or more symptoms from either subtype (inattention or hyperactive/impulsive) from the list above.
  • Some of those symptoms were present before age 7.
  • The problems are present in at least two settings, such as at home and in school.
  • Your child's ADHD symptoms have persisted for at least six months to a degree that interferes with his or her functioning.
  • Teachers or day-care workers say that the symptoms interfere with the social or academic functioning expected of your child.
   

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