Diagnosing Attention Deficit Hyperactivity Disorder in Children

Attention deficit hyperactivity disorder (ADHD) is a behavioral condition that affects millions of children and adolescents in the United States, causing inattention, impulsivity, and hyperactivity. Most children can act impulsively or become distracted at times. In children with ADHD, however, these tendencies are frequent and severe enough to interfere with daily activities at home, in school, and during social situations.

Clinicians at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, conduct a thorough diagnostic evaluation to determine if your child has the signs and symptoms of ADHD or other conditions that might be impairing everyday functioning or hindering academic progress.

ADHD is more prevalent in boys than in girls. Its exact cause is unknown, although research has found a strong genetic component. Signs of ADHD may be apparent during the preschool years, but many families first seek help when the child is in elementary school and begins to display behaviors that interfere with learning. Symptoms may worsen over time as educational and behavioral expectations grow, especially during the early and middle adolescent years (from about 12 to 17 years old). In some children, the symptoms diminish or disappear during late adolescence (from about age 17 to 20) as the brain grows and develops.

Children with ADHD may also have anxiety, depression, and learning disorders, particularly in regard to reading and language processing. Some children with ADHD have difficulty regulating their behavior, making it challenging for them to follow rules and comply with limits and authority.

ADHD is diagnosed after a child has shown several or all of the commonly recognized signs of this condition for more than six months. These signs and symptoms must occur frequently, be severe, interfere with functioning, and be evident in multiple settings, such as at home, in school, and during social situations.

Types of Attention Deficit Hyperactivity Disorder

Depending on the number and type of symptoms, a child may be diagnosed with one of three types, or presentations, of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, or combined inattentive and hyperactive-impulsive.

Children with the predominantly inattentive presentation of ADHD may be distracted and forgetful, and they may have difficulty sustaining attention, listening, and attending to details. These children may have poor organizational and study skills, easily lose things, and have difficulty managing their time.

Children with the predominantly hyperactive-impulsive presentation of ADHD may seem to be restless or in constant motion. They may fidget or squirm when asked to sit still, and they may often have the urge to run or climb. These children may often interrupt, intrude, or blurt out answers and have difficulty waiting their turn in school or social situations. This is the least common presentation of ADHD, and occurs primarily in preschool-aged children. Children with the predominantly hyperactive-impulsive presentation of ADHD may have few or no problems with attention or concentration. For example, they may be able to follow directions while playing a game but have difficulty waiting for a turn.

The most common presentation of ADHD is combined type, in which children have inattentive, hyperactive, and impulsive signs and symptoms.

Psychological Evaluation

To diagnose ADHD, clinicians at the Child Study Center meet with you and your child to perform a thorough evaluation. They conduct a structured interview during which they ask about your child’s symptoms and may also observe his or her behavior in different situations. They may ask about your child’s medical history to help make a diagnosis and rule out other conditions that may be causing the symptoms, such as mood disorders, obsessive-compulsive and other anxiety disorders, or learning disorders. They may also recommend that specialists at the Child Study Center’s Institute for Learning and Academic Achievement evaluate your child if a learning disorder is suspected.

In addition to this in-office evaluation, which takes several hours, our doctors may ask that you permit your child’s caregivers, teachers, or others to fill out a questionnaire or to speak with the doctor by phone or in person. This helps our specialists to obtain a more complete understanding of your child’s behavior. Sometimes, our doctors also recommend in-school observation of your child, which allows them to talk to the child’s teachers to gauge how problematic his or her symptoms are in class.

After our specialists have obtained a complete picture of your child’s behavior, a diagnosis is made. If ADHD is confirmed, the clinicians at the Child Study Center work with you to develop a care plan that is designed to best meet your child’s needs.