Step One: Identifying the Signs
Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that impacts one’s ability to direct and sustain their attention. There are three different presentations of ADHD: predominantly inattentive, predominantly hyperactive, and combined type. Symptoms onset must occur before the age of 12. While the symptoms may present themselves differently in different environments, a diagnosis of ADHD requires that impairment be present in at least two settings.
For a child with ADHD that has an inattentive presentation, this may mean that at school they can often be found looking out the window, daydreaming, or “in their own world.” They may make careless mistakes on their homework because they didn’t read the directions thoroughly, or forget to turn their homework in even though they completed it. They may often fly under the radar because their behavior isn’t disruptive, but by the end of the quarter the effects are apparent on their report card. At home, their parents may describe them as having “selective hearing.” They have no problem getting sucked into a video game, but it takes 10 commands to get them to complete a chore. When told to brush their teeth, comb their hair, and put their shoes on, parents may find themselves trailing behind them to make sure each step is completed in a timely manner.
A child with hyperactive presentation is more likely to have notes sent home from school about their tendencies to blurt out answers before the question is completed, impulsively jumping off the monkey bars at recess, getting up out of their seat, or being caught up in side conversations during instructional time. At home, their parents may be amazed by their child’s seemingly endless amount of energy. The family might be taking a break from going out to restaurants because their child struggles to sit still for a full meal, and it may feel that there is rarely a moment of quiet in the house. Even when they’re playing independently, you can hear exactly what room the child is in and what activity they’re doing. Importantly, gender norms tend to come into play in our perception of symptoms between boys and girls, often leading to girls getting diagnosed later than boys.
Step Two: Getting Diagnosed
Typically the first place where these concerns are raised is at the pediatrician’s office. In the most straightforward scenario, the provider would need to have at least two informants from two different settings (usually a caregiver and a teacher for home and school) complete the Vanderbilt ADHD Rating Scale. If both those responses reach the threshold for ADHD, we have an ADHD diagnosis.
However, pediatricians vary widely in their practices and areas of expertise. Some offices may not be equipped with the diagnostic tools needed and would feel more comfortable providing a referral to see a child psychologist. The psychologist can diagnose by using the Vanderbilt and conducting a clinical interview, or they may feel it’s necessary to do more comprehensive psychoeducational testing. This may be more likely to occur if learning disabilities, cognitive delays, memory impairment, or other diagnoses need to be ruled out before diagnosing ADHD.
Step Three: School Accommodations
Once you’re in the process of getting a diagnosis, it’s a great idea to get in touch with your child’s school to ensure that reasonable accommodations are made to best support your child’s learning. This can take the form of a 504 plan or an Individualized Education Plan (IEP). A 504 plan is a set of supports that can be implemented in the regular classroom for any medical condition or disability. An IEP similarly has structured guidelines for educational supports, plus there are personalized learning and behavioral goals that are monitored throughout the school year in order to determine the effectiveness of the plan. IEP plans are only valid for the 13 disabilities classified by the Individuals with Disabilities Education Act (IDEA; USDE, 2026).
For elementary age children with ADHD, accommodations may look like a daily report card that monitors and reinforces target behaviors, such as staying on task during assignments or staying seated (Fabiano et al., 2025). Other accommodations may include extended time on tests, preferred seating, movement breaks, modifications to the presentation of testing materials, and additional small group work. Families often state that their child’s current teacher already does a wonderful job voluntarily making the adjustments to their classroom without a formal plan. The benefit of a formal education plan is that it sets these accommodations as a standard across every classroom that the child participates in without depending on the flexibility of the individual teacher.
Step Four: Therapy Options for ADHD
ADHD is a condition that is managed, not cured. Approximately 60% of children with ADHD will continue to experience their symptoms in adulthood (Sibley et al., 2017). To support your family with managing ADHD symptoms, the gold standard therapeutic treatment is behavioral parenting therapy (Ogundele, 2023). In this therapy, parents learn evidence-based strategies to structure routines, discipline, and reinforce child behaviors. For children ages 12 and under, this therapy is almost exclusively done with the parents on a weekly basis for 8-12 sessions.
For children over the age of 12, they may benefit from engaging in Cognitive Behavioral Therapy (CBT) with a focus on organization and time management skills. CBT can include aspects of behavioral parenting therapy with a more developmentally appropriate approach so that teens can learn to increase their independence by fostering responsibility with parent support. Standalone play therapy, sand tray therapy, and general talk therapy are not evidence-based treatments for ADHD (Ogundele, 2023).
Step Five: When to Seek Medication
ADHD has a heritability rate of between 77% to 88% (Faraone & Larsson, 2018), meaning it’s likely that a child with ADHD has at least one parent with ADHD. For parents who grew up in the 90s, they often relate their own personal struggles with medication as a child. They talk about meeting with a pediatrician one time about having a hard time focusing and leaving with a prescription for Ritalin. Or, they talk about being dismissed as “lazy” or “disruptive” throughout school until they finally tried medication in college. When parents see their own children going through the same symptoms that they did as a child, they want to do whatever they can to give their child a better, more validating experience.
Thankfully, the standards of care for ADHD have become a bit more balanced in the past decade. Generally speaking, greater symptom reduction is seen when parents implement behavioral strategies to manage ADHD and then incorporate medication later (Ramos et al., 2024). The behavior strategies teach long-term lifestyle adjustments for managing ADHD, while medication supplies short-term relief of symptoms. I like to say that our attention span, motivation, and impulsivity are controlled by a dial; people with ADHD have a harder time turning the dial up and down depending on what the situation calls for. Medication helps people be better in control of the dial. If you’re finding that no matter what you’ve tried behaviorally your child is still struggling to manage their symptoms, it’s likely time to try medication.
There are hundreds of combinations of both stimulants (e.g., Concerta, Focalin) and non-stimulant medication (e.g., Strattera, Guanfacine) options available for ADHD. The right dosage and type will strike the balance of improving attention and/or reducing hyperactivity without turning them into a “zombie” – your child’s beautiful personality should still shine through. Stimulant medications don’t need time to build up in the child’s system to know if they’re working. This allows parents to understand if any unwanted side effects (loss of appetite, sleep difficulties) are apparent quickly so that they can try something else.
Keep In Mind
ADHD is likely to co-occur with other disorders or emotional distress, particularly anxiety. Sometimes we hear from parents that while their child is impulsive and hyperactive at home, at school they always receive good feedback. While this usually tells us that there’s something about the school environment that is supportive of the child’s behavior (i.e., visual schedules, structure, behavior charts, breaks), it can also mean that the social pressure present at school prevents the child from talking over their peers or leaving their seat.
This inconsistency is where a lot of parents struggle to make a decision about treatment. When difficulties are interfering with a child’s academics, it tends to be an easier decision to try medication. Whether your child is experiencing impairment with their academics, extracurriculars, social interaction, or their functioning at home, your concerns are valid and warrant intervention.
Self-Reflection:
- How does your child’s level of inattention and hyperactivity compare to other children their age?
- Which supports could your child benefit from? Which aren’t needed right now?
- If you have also been managing a neurodevelopmental disorder, what strategies would have been beneficial for you as a child?
