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ADHD: Age-by-Age Guide

There is no legitimate way to diagnose an infant with ADHD, but the American Academy of Child and Adolescent Psychiatry says that all of the following can be signs of a tendency to develop ADHD later.

  • Colic
  • Poor sucking/frequent feedings
  • Irritability
  • Thumb sucking
  • Difficult to comfort/dislikes being held
  • Poor sleeper

Of course many babies exhibit these behaviors and do not go on to develop ADHD. They’re of more concern if the baby has other risk factors, such as a family history of ADHD or prenatal exposure to drugs, alcohol or cigarettes.

Diagnosing toddlers with ADHD is extremely controversial since developmentally, most lack impulse control and have short attention spans. However, children that will later be diagnosed with ADHD can exhibit these traits to the point where they are actually dangerous – hitting, taking toys, even dashing into the street – on an ongoing basis. Children with ADHD may have frequent and violent temper tantrums, and be poor sleepers and picky eaters as toddlers. (But please remember, none of these signs guarantees your child will have ADHD!)

Some parents do seek diagnosis and treatment for very young children with severe behavioral issues. But because the brain is still rapidly developing at this point and few psychiatric medications are approved for very young children since side effects can be severe and troubling, doctors are most likely to recommend only parental training and behavior modification.

In 2011, the AAP expanded its guidelines to diagnose children as young as age 4 in an attempt to provide evidence-based, specific recommendations for what some pediatricians were already doing unofficially: using Ritalin and other stimulants off-label to treat small kids with problems severe enough to get them expelled from preschool and wreak havoc on their families. Behavior modification therapy should be the first line of defense for preschoolers diagnosed with ADHD, with prescription medications like Ritalin to be tried at a low dose only if therapy is not effective on its own.

Grade-school Children
The vast majority of children are diagnosed with ADHD during the first few years of school when their inability to focus and lack of control make learning and social functioning difficult.

Children with ADHD may be rude, aggressive or inattentive in class. They are likely to forget assignments and lose materials. Many will fall behind because of ADHD behaviors or learning disabilities, which are common in children with ADHD. However, ADHD children can be extremely bright and may compensate, working feverishly to get good grades. Children with ADHD may have difficulty behaving appropriately on sports teams, at parties and on family outings. ADHD behaviors can cause family stress and strain parental relationships and marriages.

Once diagnosed with ADHD, children are most often treated with a combination of medication and therapy, however, some will only need one or the other. These therapies are effective in most children, but they’re not magic – many ADHD children will struggle more than their peers to succeed in school and social environments.

Early diagnosis and intervention is key to later success for ADHD children. Thanks to federal civil rights laws, public schools are required to provide accommodations or strategies and aids to enable children with ADHD to learn and compete with their non-ADHD classmates.

The Middle School Years
Many kids who have the inattentive type may be diagnosed for the first time around this age. Whether your middle schooler’s been recently diagnosed or not, an increasingly difficult curriculum and adolescent hormones can wreak havoc in the lives of ADHD kids (not to mention their parents!) Parents, teachers and doctors need to be ready to readjust treatment strategies, including changing medications and doses, and developing new methods for organizing more complex schedules.

Middle schoolers should also begin to take more responsibility for their decisions and therapy. Some experts recommend that kids take a “holiday” from medication if they want and see how it affects their lives and their school performance. Otherwise it can become an area of conflict with parents.

Behavioral therapy should also focus on strategies that kids, rather than parents, can employ to remember homework and materials. Color coded charts will give way to notebook or computer organizers.

Beyond Middle School
All teens are impulsive, but since ADHD kids can be even more so, the dangers that lurk for all teens -- car accidents, drinking, drug abuse and irresponsible sex -- are magnified for them. Experts used to think children outgrew ADHD in their teen years, but now research indicates that about 60% of children with ADHD will have the condition as adults, although symptoms become less severe over time. That’s why it is important for children to continue treatment and for parents to continue to advocate for their education. ADHD students may qualify for accommodations like extra time on standardized tests in high school and college.

Experts say teens who have learned how to schedule themselves and how to make appropriate decisions through therapy earlier in life will be less likely to struggle in school and with social relationships during the critical teen years. This will boost their self-esteem and lead to happier, healthier kids.