Many children go through phases where they're restless or inattentive. This is often completely normal and does not necessarily mean they have ADHD. But you should consider raising your concerns with your child's teacher, or their school's special educational needs coordinator (SENCo) if you think their behaviour may be different from most children their age.

Since October 2022, we have had a referral process in place whereby requests for support for children and young people with possible neurodevelopmental needs (such as ADHD and Autism), are referred to us via the child's school/education provider rather than via a GP.  This is done collaboratively with the school and the child's parents/carers as, together, they will have a fuller understanding of the child's day-to-day challenges/needs in different environments.

Along with the school, you will need to consider:

• the symptoms/manifestations affecting your child 
• when these started
• where they occur – for example, at home or in school or both/all places
• whether the symptoms affect your or your child's day-to-day life 
• if there have been any recent significant events in your or your child's life, such as a death or divorce in the family
• if there's a family history of ADHD
• any other problems or symptoms of different health conditions you or your child may have

Next steps

It may be useful to have a brief period of "watchful waiting" to see if your child's symptoms improve, stay the same, or get worse.

If your child's challenges do not improve, and both you and the school believe it's negatively affecting their day-to-day life, you should work with the school to complete the necessary paperwork for an assessment of need. 

Throughout the process, should you need assistance with some of the manifestations of suspected neurodevelopmental conditions, such as ADHD and Autism, on your child/young person, please call our out-of-hours Neurodevelopmental Helpline on 0300 222 5755 from 5 pm to 11 pm, seven days a week, 365 days a year. 

There are many different specialists you or your child may be referred to for a formal assessment, including:

• a child or adult psychiatrist
• a paediatrician – a specialist in children's health
• a learning disability specialist, social worker, or occupational therapist with expertise in ADHD

Who you're referred to depends on your age and what's available in your local area.

There's no simple test to determine whether you or your child has ADHD, but your specialist can make an accurate diagnosis after a detailed assessment. The assessment may include:

• a physical examination, which can help rule out other possible causes for the symptoms
• a series of interviews with you or your child
• interviews or reports from other significant people, such as partners, parents, and teachers

The criteria for making a diagnosis of ADHD in children, teenagers, and adults are outlined below.

Diagnosis in children and teenagers

Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have 6 or more symptoms of inattentiveness, or 6 or more symptoms of hyperactivity and impulsiveness.

Read more about the symptoms of ADHD.

To be diagnosed with ADHD, your child must also have:

• been displaying symptoms continuously for at least six months
• started to show symptoms before the age of 12
• been showing symptoms in at least two different settings – for example, at home, and at school, to rule out the possibility that the behavior is just a reaction to certain teachers or parental control
• symptoms that make their lives considerably more difficult on a social, academic, or, occupational level
• symptoms that are not just part of a developmental disorder or difficult phase, and are not better accounted for by another condition

The exact cause of ADHD is unknown, but the condition has been shown to run in families. Research has also identified a number of possible differences in the brains of people with ADHD when compared with those without the condition.

Other factors suggested as potentially having a role in ADHD include:

• being born prematurely (before the 37th week of pregnancy)
• having a low birthweight
• smoking or alcohol or drug abuse during pregnancy

ADHD can occur in people of any intellectual ability, although it's more common in people with learning difficulties.

The symptoms of Attention Deficit Hyperactivity Disorder (ADHD) can be categorised into two types of behavioural problems: inattentiveness, hyperactivity, and impulsiveness.

Most people with ADHD have problems that fall into both these categories, but this is not always the case.

For example, some people with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness.

This form of ADHD is also known as Attention Deficit Disorder (ADD). ADD can sometimes go unnoticed because the symptoms may be less obvious.

Symptoms in children and teenagers

The symptoms of ADHD in children and teenagers are well defined, and they're usually noticeable before the age of six. They occur in more than one situation, such as at home and school.

Inattentiveness

The main signs of inattentiveness are:

• having a short attention span and being easily distracted
• making careless mistakes – for example, in schoolwork
• appearing forgetful or losing things
• being unable to stick to tasks that are tedious or time-consuming
• appearing to be unable to listen to or carry out instructions
• constantly changing activity or task
• having difficulty organising tasks

Hyperactivity and impulsiveness

The main signs of hyperactivity and impulsiveness are:

• being unable to sit still, especially in calm or quiet surroundings
• constantly fidgeting
• being unable to concentrate on tasks
• excessive physical movement
• excessive talking
• being unable to wait their turn
• acting without thinking
• interrupting conversations
• little or no sense of danger

These symptoms can cause significant problems in a child's life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

Although not always the case, some children may also have signs of other problems or conditions alongside ADHD, such as:

• Anxiety disorder – which causes your child to worry and be nervous much of the time; it may also cause physical symptoms, such as a rapid heartbeat, sweating and dizziness
• Oppositional Defiant Disorder (ODD) – this is defined by negative and disruptive behaviour, particularly towards authority figures, such as parents and teachers
• Conduct disorder – this often involves a tendency towards highly antisocial behaviour, such as stealing, fighting, vandalism and harming people or animals
• Depression
• Sleep problems – finding it difficult to get to sleep at night, and having irregular sleeping patterns
• autistic spectrum condition (ASC) – this affects social interaction, communication, interests and behaviour
• epilepsy – a condition that affects the brain and causes repeated fits or seizures
• Tourette's syndrome – a condition of the nervous system, characterised by a combination of involuntary noises and movements (tics)
• Learning difficulties – such as dyslexia

Although there's no cure for ADHD, it can be managed with appropriate educational support, advice, and support for parents and affected children, alongside medicine, if necessary.

Looking after a child with ADHD can be challenging, but it's important to remember that they cannot help their behaviour.

Some issues that may arise in day-to-day life include:

• getting your child to sleep at night
• getting ready for school on time
• listening to and carrying out instructions
• being organised
• social occasions
• shopping

•  ADHD Resource pack (parents/carers)
• ADHD Guide for teenagers
• Explaining ADHD to young people
• ADHD Post diagnostic support pack (child/young person)
• ADHD Medication Advice

Autism (also known as Autism Spectrum Condition (ASC) and Autism Spectrum Disorder (ASD)) is a lifelong developmental condition that affects how people communicate and interact with the world. One in 100 people are on the autism spectrum and there are around 700,000 autistic adults and children in the UK. Autism is a form of neurodiversity which means that those with autism move, interact, sense, and process differently to those who are neurotypical.

Autism is a spectrum condition that affects people in different ways. Like all people, autistic people have their strengths and areas of difference. Below is a list of differences that autistic people may share. 

Autism is a spectrum condition that affects people in different ways. Like all people, autistic people have their strengths and weaknesses. Below is a list of difficulties autistic people may share, including the two key difficulties required for a diagnosis. 

Social communication

Autistic people can have differences in interpreting both verbal and non-verbal language like gestures or tone of voice. Some autistic people are unable to speak or have limited speech while other autistic people have very good language skills but struggle to understand sarcasm or tone of voice. Other areas of difference include:

• Taking things literally and preferring concrete language rather than abstract.
• Need extra time to process information or answer questions.
• Repeating what others say to them (this is called echolalia).

Social interaction

Autistic people can have differences with 'reading' other people which includes recognising and understanding others' feelings and intentions, as well as responding to these. This can also include differences in expressing their own emotions. Autistic people may also:

• Appear to be insensitive without intentionally meaning to be.
• Seek out time alone when socially overloaded.
• Prefer alternative self-soothing methods, other than seeking comfort from people.
• Appear to behave in a way thought to be socially inappropriate without intentionally meaning to.
• Find it hard to form and/or maintain friendships.
   

With its unwritten rules, the world can seem a very unpredictable and confusing place. Autistic people often prefer to have routines as a way to manage this and make the world feel more predictable, for instance wanting to travel the same way to and from school, wear the same clothes, or eat the same food for breakfast. 

Change to routine can be very distressing for autistic people and can cause anxiety, for instance having to adjust to big events like Christmas or changing schools, facing uncertainty at work, or something like a bus detour.
Autistic people may also repeat movements such as hand flapping, rocking, or the repetitive use of an object such as twirling a pen or opening and closing a door. Autistic people often engage in these behaviours to help calm themselves when they are stressed or anxious, but many autistic people do repeat movements because they find it enjoyable.

Autistic people may experience over- or under-sensitivity to sounds, touch, tastes, smells, light, colours, temperatures, or pain. For example, they may find certain background sounds like music in a restaurant, which other people ignore or block out, unbearably loud or distracting. This can cause anxiety or even physical pain. Many autistic people prefer not to hug due to discomfort.

Many autistic people avoid everyday situations because of their sensitivity issues. Schools, workplaces, and shopping centres can be particularly overwhelming and cause sensory overload. Many simple adjustments can be made to make environments more autism-friendly.

Many autistic people have intense and highly focused interests, often from a young age. These can change over time or be lifelong. Autistic people can become experts in their special interests and often like to share their knowledge. Like all people, autistic people gain huge amounts of pleasure from pursuing their interests and see them as fundamental to their well-being and happiness.

Being highly focused helps many autistic people do well academically and in the workplace but they can also become so engrossed in particular topics or activities that they neglect other aspects of their lives.

Anxiety is very common for many autistic individuals, particularly in social situations or when facing change. It can affect a person psychologically and physically and impact the quality of life for autistic people and their families.  

It can be helpful for autistic people and those around them to learn to recognise their triggers and find coping mechanisms to help reduce their anxiety. However, many autistic people have difficulty recognising and regulating their emotions and might need additional support with this.

When everything becomes too much for an autistic person, they can experience a meltdown or shutdown. These are very intense and exhausting experiences.

A meltdown happens when someone becomes completely overwhelmed by their current situation and temporarily loses behavioural control.  This loss of control can be verbal (e.g. shouting, screaming, crying) physical (e.g. kicking, lashing out, biting), or both. Meltdowns in children are often mistaken for temper tantrums. 

A shutdown appears less intense to the outside world but can be equally debilitating. Shutdowns are an involuntary response to being overwhelmed, and can appear more passive - e.g. an autistic person going quiet or 'switching off'. 

• ASD post diagnostic pack (parents/carers)
• Explaining ASD to young people 12+

• Pathological Demand Avoidance (PDA) Support: The Panda on PDA by Dr Gloria Dura Vila