Attention deficit hyperactivity disorder in children

Last reviewed: 26 Aug 2023
Last updated: 14 Jul 2022



History and exam

Key diagnostic factors

  • failure to give close attention to details or making careless mistakes in schoolwork, work, or other activities
  • difficulty sustaining attention in tasks or play activities
  • does not seem to listen when spoken to directly
  • does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
  • often has difficulty organizing tasks and activities
  • avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  • often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
  • easily distracted by extraneous stimuli
  • forgetful in daily activities
  • fidgets or taps with hands or feet or squirms in seat
  • leaves seat in classroom or in other situations in which remaining seated is expected
  • runs about or climbs excessively during inappropriate situations
  • difficulty playing or engaging in leisure activities quietly
  • often "on the go" or acts as if "driven by a motor"
  • often talks excessively
  • often blurts out answers before questions have been completed
  • often has difficulty awaiting turn
  • often interrupts or intrudes on others (e.g., butts into conversations or games)
More key diagnostic factors

Other diagnostic factors

  • mild mood symptoms (dysphoria, mood lability, irritability, boredom)
  • difficulty with peer interactions
  • low self-esteem
  • working memory (i.e., short-term memory) impairment
  • processing speed impairment (i.e., the rate at which information is dealt with)
Other diagnostic factors

Risk factors

  • family history of ADHD
  • male sex
  • low birth weight
  • epilepsy
  • maternal nicotine use during pregnancy
  • tic disorders
  • maternal alcohol use during pregnancy
  • stress during pregnancy and labor
  • psychosocial adversity
  • lead exposure
  • traumatic brain injury
  • severe early deprivation
  • iron deficiency
More risk factors

Diagnostic investigations

1st investigations to order

  • no formal laboratory or imaging studies
More 1st investigations to order

Investigations to consider

  • neuropsychological testing
More investigations to consider

Treatment algorithm


preschool-age children: 4-6 years

school-age children: 6-18 years



Mark Wolraich, MD

Professor Emeritus, Pediatrics

Section of Developmental and Behavioral Pediatrics

University Oklahoma Health Sciences

Oklahoma City



MW is on the steering committee and is a faculty member in the REACH Institute, a nonprofit organization training primary care physicians in diagnosing and treating mental health conditions in children. He does not receive remuneration for the steering committee, but does receive compensation for remote training time.


Dr Mark Wolraich would like to gratefully acknowledge Dr Lawrence W. Brown, Dr Kristin S. Russell, Dr Howard Y. Liu, and Dr Michael S. Jellinek, previous contributors to this topic.


LWB was reimbursed by Sunovion for participation in a Medical Advisory Board. KSR, HYL, and MSJ declare that they have no competing interests.

Peer reviewers

Brian P. Daly, PhD

Assistant Professor

College of Health Professions

Temple University




BPD declares that he has no competing interests.

Mohammed Munib Haroon, MBChB

Academic Specialist Registrar

Academic Department of Paediatrics and Obstetrics and Gynaecology

Leeds University




MMH declares that he has no competing interests.

  • Differentials

    • Learning/language disorder
    • Oppositional defiant disorder
    • Depression
    More Differentials
  • Guidelines

    • Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR)
    • Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents
    More Guidelines
  • Patient leaflets

    ADHD: what is it?

    ADHD in children: what treatments work?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer