ADHD in children: symptoms, diagnosis and treatment

Key points

• ADHD affects attention, activity levels and impulse control. Symptoms start in childhood, appear in more than one setting, and cause at least moderate difficulty [1][2].
• Only a specialist can diagnose ADHD, usually a paediatrician or child psychiatrist. A GP or school cannot, and refers instead [1][2].
• ADHD is under-recognised in girls, who are less likely to be referred and may be given an incorrect diagnosis [1].
• NICE puts parent training and changes to the child’s environment before medication, and bars medication under age 5 without a second specialist opinion [1].
• A diagnosis does not automatically produce an education, health and care plan [5].

What ADHD in children is

ADHD, attention deficit hyperactivity disorder, is a neurodevelopmental condition in which a child’s brain manages attention, activity and impulses differently [2]. A child may struggle to concentrate, sit still, wait or think before acting, to a degree unusual for their age, in more than one setting [1].

NICE reports childhood prevalence of 1 to 2% under ICD-10 criteria for hyperkinetic disorder, and 3 to 9% under the wider DSM-IV criteria [1].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.

Symptoms

Symptoms fall into two groups. Most children show signs from both, some only one [2].

Inattention:

• being easily distracted
• finding it hard to listen or follow instructions
• forgetting everyday tasks, or starting things and not finishing them

Hyperactivity and impulsivity:

• high energy, fidgeting, tapping hands and feet
• getting up when meant to sit still
• talking noisily, interrupting, or finding it hard to wait

How this looks changes with age, and NICE says ADHD should be considered at all ages [1]. Pre-school children move constantly and struggle with routines. School exposes it further, because sitting still and following instructions are demanded all day. In teenagers, overactivity often turns into inner restlessness, and disorganisation stands out.

Girls are often missed. They more often have the inattentive presentation, which is quiet and easy to overlook in class, so difficulties are read as daydreaming or low ability [2]. NICE states that girls and women are less likely to be referred and may be more likely to receive an incorrect diagnosis [1].

ADHD is commonly confused with anxiety, autism and Tourette’s syndrome [2].

Types

ADHD has recognised presentations rather than separate conditions [1][2].

• Predominantly inattentive. Attention, memory and organisation problems dominate, with little visible overactivity.
• Predominantly hyperactive-impulsive. Restlessness and acting without thinking dominate.
• Combined. Features of both groups, the most common pattern in children [2].

Causes and risk factors

There is no single cause. ADHD often runs in families and is thought to involve genetic differences, though no one gene causes it [2]. NICE lists groups with higher rates than the general population [1]:

• children born preterm
• looked-after children, and those with oppositional defiant disorder or conduct disorder, or a mood disorder
• people with epilepsy, an acquired brain injury, or a neurodevelopmental condition such as autism, a tic disorder or a learning disability

These are associations, not proven causes. Parenting style, sugar and screen time are widely blamed and the evidence does not support them. NICE advises against removing artificial colouring and additives from the diet as a treatment [1].

How it is diagnosed

A diagnosis should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified professional trained in diagnosing ADHD [1]. A GP cannot diagnose it, and neither can a school, a SENCO or an online questionnaire.

The route starts with the GP or the school’s special educational needs co-ordinator, the SENCO, and leads to a paediatrician or a specialist ADHD service in CAMHS [1][2]. NICE says watchful waiting of up to 10 weeks can come first, that persisting problems with at least moderate difficulty should be referred to secondary care, and that severe difficulty warrants direct referral [1].

Assessment involves a full clinical and psychosocial assessment, a developmental and psychiatric history, observer reports and assessment of the child’s mental state, and should not rest on rating scales alone [1]. Information is gathered from more than one setting, because symptoms must be present in two or more important settings, including home and school [1]. That is why school staff complete forms and why school reports matter.

Waits are long and no national waiting time standard is published. NHS England Digital counted up to 803,658 referrals open in England in March 2026 that may be for an ADHD assessment [3].

Right to Choose is a legal right in England to pick any clinically appropriate provider for a first outpatient appointment after a GP referral, and it covers mental health referrals [6]. The guidance does not set out age-specific provisions. It excludes urgent care, and anyone already receiving care for the same condition, among other exclusions [6].

Treatment

NICE sets out different approaches by age. In both, medication is not the starting point [1].

For children under 5, an ADHD-focused group parent-training programme comes first. If symptoms still cause significant difficulty after the programme and environmental changes, the specialist should seek advice from an ADHD service with expertise in young children, ideally a tertiary service. No child under 5 should be offered medication without that second specialist opinion [1].

For children aged 5 and over and young people, NICE expects information about ADHD and ADHD-focused support for parents and carers, which can be group based and as few as one or two sessions [1]. Changes to the child’s environment come next: seating, shorter tasks, written instructions, less distraction. Medication should be offered only if symptoms still cause persistent significant difficulty after those changes have been made and reviewed [1]. The NHS also describes talking therapies such as CBT [2].

Where medication is used, NICE names methylphenidate first, then lisdexamfetamine if a six-week trial has not helped enough, and atomoxetine or guanfacine where stimulants are unsuitable [1]. A specialist starts and monitors it, after checks on physical and mental health [1]. Doses are for the prescriber.

Monitoring continues, with repeated checks on weight, height, heart rate and blood pressure, and a review at least yearly of whether medication should continue [1]. With consent, the service should tell the school the diagnosis and treatment plan [1].

Living with ADHD in children

Changes at school and at home are part of treatment. The NHS suggests splitting work into 15 to 20 minute slots, step-by-step instructions and visual lists [2]. YoungMinds adds consistent routines and separating the behaviour from the child [7].

Most school support is arranged through SEN support, which the school arranges itself. Talk to the class teacher or the SENCO. Examples include extra help from a teacher or assistant, a special learning programme, and reasonable adjustments for disabled children [4].

An education, health and care plan, an EHCP, is the higher tier, for children and young people up to 25 who need more support than SEN support provides [5]. You, the school or a doctor can ask the local authority for an EHC needs assessment, and it will say within 16 weeks whether a plan will be made [5]. A diagnosis alone does not produce a plan: the test is the level of need, not the label. If the authority refuses, you can appeal to the Special Educational Needs and Disability Tribunal [5].

ADHD often occurs alongside anxiety, depression, dyslexia, autism and Tourette’s syndrome [2].

When to speak to a professional

Speak to your GP, or the school SENCO, if your child’s attention, activity or impulsiveness shows up at home and at school and is holding back learning, friendships or family life [1][2]. Ask sooner if your child is being excluded, is falling behind despite effort, is becoming low or anxious, or if you are struggling to keep them safe from impulsive risks [2].

If your child takes ADHD medication, contact the prescribing service about side effects or changes in appetite, sleep or mood, rather than stopping it yourself [1].

If your child talks about ending their life, or you cannot keep them safe, call 999, call Samaritans free on 116 123 at any hour, or text SHOUT to 85258.

Common questions

Can a school diagnose ADHD?

No, and neither can a GP. Only a specialist psychiatrist, paediatrician or other qualified specialist trained in diagnosing ADHD can [1]. A SENCO or GP starts the referral [2].

Why is ADHD missed in girls?

Girls more often have the inattentive presentation, which does not disrupt a classroom and so does not prompt a referral [2]. NICE states that girls and women are less likely to be referred and may be given an incorrect diagnosis [1].

Does an ADHD diagnosis mean my child will get an EHCP?

No. Most children with ADHD are supported through SEN support arranged by the school [4]. An EHC plan is for children who need more, and the local authority decides after an EHC needs assessment [5].

Clinical review pending

References

1. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. NICE guideline NG87, 2018, last updated 2019. https://www.ncbi.nlm.nih.gov/books/NBK493361/
2. NHS. ADHD in children and young people. NHS website. https://www.nhs.uk/conditions/adhd-children-teenagers/
3. NHS England Digital. ADHD Management Information, May 2026. NHS England, 28 May 2026. https://digital.nhs.uk/data-and-information/publications/statistical/mi-adhd/may-2026
4. GOV.UK. Children with special educational needs and disabilities (SEND): special educational needs support. https://www.gov.uk/children-with-special-educational-needs/special-educational-needs-support
5. GOV.UK. Children with special educational needs and disabilities (SEND): extra help. https://www.gov.uk/children-with-special-educational-needs/extra-SEN-help
6. NHS England. Patient choice guidance. NHS England. https://www.england.nhs.uk/long-read/patient-choice-guidance/
7. YoungMinds. A guide for parents: supporting your child with ADHD. YoungMinds. https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/adhd/