Many children who have attention-deficit/hyperactivity disorder (ADHD) have other concerns or disorders. Recognizing symptoms of different disorders and finding ways to help children can be a challenge for families. 

Is it ADHD?

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

A child with ADHD might

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

Could it be something else?

Many other disorders or conditions can also have symptoms that look like those of ADHD. For example, a child with a sleep disorder might have trouble focusing or remembering. A child with a learning disorder might make seemingly careless mistakes. A child with a behavior disorder might have difficulty getting along with others or resisting temptation. A child with anxiety might squirm or fidget often. For some children, symptoms that look like ADHD can be better explained by another diagnosis, but many children with ADHD also have another condition.

Sometimes symptoms that might look like ADHD or other conditions can be temporary. Having difficulties with behavior or emotions might be a reaction to stress and change. For example, coping with stress from significant life changes, such as COVID-19, can be a challenge, particularly for children who are already struggling with managing their behavior and emotions. Changes in routines like switching between in-person and virtual learning, or returning to school after a longer break, can be stressful and can make children more easily distracted or fidgety. If children do not settle quickly into a new situation, it can be hard for parents to understand whether their child is reacting to temporary stress, or if there is a problem that needs treatment. A thorough evaluation may be needed to learn what causes the problems.

For some children, having ADHD without getting the right treatment and support can cause problems that lead to other disorders, such as behavior problems, anxiety, or depression. These issues stem from challenges brought on by ADHD symptoms. An evaluation might be needed if a child with ADHD develops other problems over time.

When ADHD is “complex” – sorting out the symptoms

When a child has difficulty with paying attention, being overly active, or acting without thinking, there is not a single test to find out if it is ADHD. Experts recommend a thorough evaluation using information from the child, parents, teachers, and other adults who know the child well. Primary care providers evaluate and diagnose ADHD based on the best available evidence which usually include these steps:

• Rule out any other possible conditions that can cause similar symptoms.
• Screen for other conditions that might coexist with ADHD, including

Some children have “complex” ADHD symptoms. This means they might have symptoms beyond those that fit the typical description of ADHD. Experts recommend that primary care providers refer children to a specialist if the providers detect other conditions that they are not experienced in treating or diagnosing.

Children with complex ADHD may need treatment that is specific to their needs. Among the most common disorders that coexist with ADHD are

• Anxiety
• Autism spectrum disorder
• Depression
• Disruptive behavior disorders
• Substance use disorders
• Tic disorders

Having complex ADHD can also mean not fitting the typical age description, such as having ADHD symptoms earlier than age 4 years or not showing any ADHD symptoms until adolescence. Children who develop ADHD symptoms at younger or older ages than typical may also need more detailed diagnosis and treatment.

What parents can do

When children experience behavior or emotions that are severe or that last a long time, parents may want to talk with their healthcare provider to get a complete and accurate diagnosis and treatment. The healthcare provider might refer the family to a specialist such as a child psychologist, child psychiatrist, or developmental pediatrician for a detailed assessment. Doctors might also recommend a developmental and educational evaluation most often done at a  local early intervention agency (for children under age 3 years), or public school (for children age 3 years and older).

For ADHD and many other developmental disorders, treatment options involve behavior therapy, and specifically parent training in behavior management, as part of the child’s treatment. In parent training, parents get advice and gain skills for helping their child with the specific symptoms that cause difficulties.

Parents can also talk with their child’s teachers about how to help their child succeed in school. Accommodations and special education services can be tailored to address the different symptoms that the child may experience. Right now, schools and parents can help children who are experiencing changes in their learning environment. Younger children who are making the transition back to in-person learning may need extra support.

The Centers for Disease Control and Prevention (CDC) funds the National Resource Center on ADHDexternal icon (NRC), a program of CHADD—Children and Adults with Attention-Deficit/Hyperactivity Disorder. Visit the NRC for more information and resources for children with ADHD and their families. The NRC also operates a call center (1-866-200-8098) with trained staff to answer questions about ADHD and related disorders.

CDC also provides many resources to assist families with helping children cope with stress. In response to the COVID-19 pandemic, CDC funded the National Academies of Science, Engineering, and Medicine to develop online tools to promote emotional well-being and resilience in children and adolescents. The tools use web-based, interactive, short, and focused learning approaches along with graphic novel-style documents and are based on evidence-based cognitive behavioral therapy strategies. These tools can be used by children and adolescents with ADHD, and their parents, to help children reduce stress and anxietyexternal icon.