Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects children and often continues into adulthood. ADHD includes a combination of persistent problems, such as sustaining attention, hyperactivity and impulsive behavior.

Typical developmental behavior vs. ADHD

Most healthy children are inattentive, hyperactive or impulsive at one time or another. It's typical for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on level of interest.

The same is true of hyperactivity. Young children are naturally energetic- they often are still of energy long after they've worn their parent out. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Children who have problems in school but get along well at home or friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendship remain unaffected.

Is it ADHD or Trauma?

When kids have behavior and attention issues in school, the first explanation that comes to mind is often ADHD. But exposure to trauma can also cause symptoms that look like ADHD. And trauma is often overlooked when kids are misdiagnosed with ADHD.

Children with ADHD can be fidgety, distracted, and disruptive in class. Kids who have had a traumatic experience- or repeated exposure to violence or abuse- do some of the same things.

If trauma goes undiagnosed and a child is treated with stimulant medication for ADHD, in some cases the medication can increase trauma-related anxiety, making children more hypervigilant and on edge. Most important, when signs of trauma are misdiagnosed as ADHD, children are unlikely to get the specific support they need to deal with the trauma in a health way.

Resources

• Mayo Clinic: ADHD in children

• CDC: ADHD

• CDC: ADHD in the Classroom

• Child Mind Institute: ADHD & Attention

• Child Mind Institute: Is it ADHD or Trauma?

• Child Mind Institute: Not All Attention Problems are ADHD

• Child Mind Institute: Is it ADHD or Immaturity?

• Child Mind Institute: What's ADHD (and What's Not) in the Classroom

• Child Mind Institute: School Success Kit for Kids with ADHD

• Child Mind Institute: How Girls With ADHD Are Different

• Edutopia: Setting Students With ADHD Up for Success

• National Child Traumatic Stress Network: Is it ADHD or Child Traumatic Stress?

Autism spectrum disorder (ASD) is a developmental disorder. It affects children in two big ways. First, it can make it harder for them to communicate and socialize with others. Second, it can cause kids to have repetitive behaviors and limited interests. Children who have autism are born with it. IT's not usually noticed until they start to have trouble interacting with other children their age.

In psychiatry, the thinking about autism has changed over time. In the past, children were diagnosed with one of several different conditions known as pervasive developmental disorders:

• Autism

• Asperger's disorder

• Childhood disintegrative disorder (CDD)

• Pervasive developmental disorder not otherwise specified (PDD-NOS)

Now, these different conditions are all considered autism. Kids with autism can have a range of different symptoms and behaviors, so autism is considered a spectrum instead of just one condition.

Why Many Autistic Girls are Overlooked

Many more boys than girls are diagnosed on the autism spectrum: more than four boys for every autistic girl, according to the latest numbers from the CDC. Clinicians and researchers have also come to realize that many "higher functioning" autistic girls are simply missed. They don't fit the stereotypes or their symptoms are misinterpreted as something else.

Resources:

• CDC: Autism Spectrum Disorder

• Child Mind Institute: Autism

• Child Mind Institute: Complete Guide to Autism

• Child Mind Institute: How Can We Help Kids With Transitions?

• Child Mind Institute: Why Many Autistic Girls are Overlooked

• Scholastic: Teaching Students with Autism Spectrum Disorder

• NEA: Teaching Students with Autism- A Guide for Educators

Post-traumatic stress disorder (PTSD) is a mental health condition that can affect kids who have experienced something very upsetting. They have extreme anxiety that causes issues like trouble sleeping, being easily annoyed, or feeling detached from others.

All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term.

A traumatic event that triggers PTSD may be:

• Something that happened to the child

• Something that happened to someone close to the child

• Something the child saw

Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of ADHD.

Resources

• CDC: Post-traumatic Stress Disorder (PTSD)

• Stanford Children's Health: PTSD in Children

• Child Mind Institute: Quick Guide to PTSD

It is normal for children to be oppositional and defiant at least some of the time. In fact, it's a sign of health development. ODD is typically diagnosed around early elementary school ages and stops being diagnosed around adolescence.

Kids who have ODD have a well-established pattern of behavior problems. Symptoms include: being unusually angry and irritable, frequently losing their temper, being easily annoyed, refusing to follow rules, blaming others for mistakes, being vindictive.

Resources:

• Child Mind Institute: What is Oppositional Defiant Disorder?

• Mayo Clinic: Oppositional Defiant Disorder

• STARR Commonwealth: Oppositional Defiant Disorder or Trauma?

Conduct disorder is a mental health condition that can affect children and teenagers. Kids who have conduct disorder seem to enjoy hurting people and doing bad things. They are unkind and often violent, and they don't care about other people's feelings. This behavior goes beyond normal teasing, bullying, or acting out.

All kids act out sometimes, so conduct disorder is only diagnosed when this extreme behavior shows up over a long period of time and isn't caused b the child's environment.

Resources:

• Child Mind Institute: Quick Guide to Conduct Disorder

• CDC: Children's Mental Health- Behavior or Conduct Problems

• American Academy of Child & Adolescent Psychiatry: Conduct Disorder

Anxiety is a very general term used to describe a feeling of extreme worry or unease. Feeling anxious is natural after something upsetting happens. But when a child feels anxiety that lasts a long time and prevents them from doing things like going to school or seeing friends, then it becomes and anxiety disorder.

Separation anxiety disorder

Children feel extremely upset when they have to be away from their parents or caregivers. The anxiety goes beyond what other kids their age normally feel.

Social anxiety disorder

Children with social anxiety disorder feel extremely self-conscious are other people. They are so afraid of being embarrassed that the avoid social situations and even speaking in class.

Selective mutism

Children with selective mutism have a hard time speaking in some situations, like school. These kids aren't just shy. Their anxiety is so bad that they feel frozen and are not able to speak.

Generalized anxiety disorder

Children with generalized anxiety disorder worry about a lot of everyday things. Their worry is not caused by anything specific and it is bad enough to get in the way of daily life.

Panic disorder

Children with panic disorder have frequent, unexpected panic attacks. Panic attacks cause physical feelings that can make kids think they are dying or having a heart attack.

Specific phobia

Kids with specific phobias are very afraid of one or more specific things. This fear is of something that isn't normally considered dangerous. Phobias disrupt kids' lives when they go out of their way to avoid the things they're afraid of.

Resources:

• Child Mind Institute: Quick Guide to Anxiety in Children

• Child Mind Institute: How Anxiety Leads to Problem Behavior

• Child Mind Institute: How Does Anxiety Affect Kids in School?

• Child Mind Institute: How to Help Kids With Math Anxiety

• Child Mind Institute: Tips for Beating Test Anxiety

• Child Mind Institute: Mindfulness in the Classroom

• American Academy of Child & Adolescent Psychiatry: Anxiety and Children

• CDC: Anxiety and Depression

Many children have times when they are sad or down. Occasional sadness is a normal part of growing up. However, if children are sad, irritable, or no longer enjoying things, and this occurs day after day, it may be a sign that they are suffering from major depressive disorder, commonly known as depression. Some people think that only adults become depressed. In fact, children and adolescents can experience depression, and studies show that it is on the rise.

We usually think of someone who's depressed as being sad or "down" for a very long time. But children and teenagers who are depressed can also be irritable or angry a lot of the time. They may seem on edge. Some depressed kids are irritable instead of sad. Others are both: they alternate between sad and irritable.

Resources:

• CDC: Children's Mental Health- Anxiety and Depression

• American Academy of Child & Adolescent Psychiatry: Depression in Children and Teens

• Child Mind Institute: Quick Guide to Depression

• Child Mind Institute: Depression and Anger

• Child Mind Institute: What Are the Kinds of Depression?

Disruptive mood dysregulation disorder (DMDD) is a mental health disorder in which children are angry most of the time and have a lot of temper tantrums in reaction to things that don't seem like a big deal. Children with DMDD are not able to control their emotions like other children their age.

Kids with DMDD have huge feelings that they find hard to control. They often misread faces and think people are mad at them when they're not. They are still having tantrums at school age, when most kids have outgrown them, and over things that don't seem important.

Sometimes DMDD gets confused with oppositional defiant disorder (ODD) or autism, since big tantrums happen with all three. For kids with ODD though, tantrums signal a problem with authority, like parents and teachers. For kids with autism, tantrums happen when they're overwhelmed big big sounds or busy places. In DMDD, tantrums are triggered by a big feeling.

Resources:

• American Academy of Child & Adolescent Psychiatry: Disruptive Mood Dysregulation Disorder

• Child Mind Institute: Quick Guide to Disruptive Mood Dysregulation Disorder

• Child Mind Institute: DMDD- Extreme Tantrums and Irritability

Tourette's disorder is a neurological disorder that causes children to make movements and sounds they cannot control. These are called tics. Tics happen suddenly and quickly. Kids with Tourette's disorder have both motor tics (movements) and vocal tics (sounds). If a child has just one or the other, they are diagnosed with chronic motor or vocal tic disorder instead.

Common ticks include blinking, twitching, barking, coughing, and repeating words. A very small number of children have a vocal tic that causes them to curse or say inappropriate things. This is called coprolalia.

Resources:

• Child Mind Institute: Quick Guide to Tourette's Disorder

• Boston Children's Hospital: Tourette's Syndrome

• Children's National Hospital: Pediatric Tourette Syndrome

Obsessive-compulsive disorder (OCD) is an anxiety disorder that can affect children and teenagers. Kids with OCD experience unwanted thoughts, worries, or impulses called obsessions. Obsessions are very upsetting and hard to control. Child with OCD develop repetitive actions - called compulsions - to calm the anxiety caused by their obsessions.

Often, compulsions are not not connected to obsessions in a realistic way. For example, a child might have an obsessive fear that their parents will be in a car accident. To deal with that fear, they might turn a light on and off five times. Even if they know it doesn't make sense, they feel that the ritual will keep their parents from getting hurt.

Children as young as five can develop OCD. At that age, they may not even realize that their thoughts and fears are exaggerated or unrealistic.

Resources:

• CDC: Children's Mental Health- Obsessive Compulsive Disorder

• Child Mind Institute: Quick Guide to Obsessive-Compulsive Disorder

• Cedars Sinai: Obsessive-Compulsive Disorder in Children

Fetal Alcohol Spectrum Disorders (FASDs) are a group of conditions that can occur in a person who was exposed to alcohol before birth. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems.

Conditions on the FASD Spectrum

Fetal Alcohol Syndrome (FAS)

• FAS is on the most severe end of the FASD spectrum. It describes people with the greatest alcohol effects, causing signs and symptoms so distinct that the diagnosis is based on special measurements and findings in each of the 3 following areas:

  • Three specific facial abnormalities: smooth philtrum (the area between nose and upper lip), thin upper lip, small palpebral fissures (the horizontal eye openings)

  • Growth deficit (lower than average height, weight, or both)

  • Central nervous system abnormalities (structural, neurologic, functional, or a combination)

Partial Fetal Alcohol Syndrome (pFAS)

• When a person does not meet the full diagnostic criteria for FAS but has a history of prenatal alcohol exposure and some of the facial abnormalities, as well as a growth problem or central nervous system abnormalities that person is considered to have partial FAS (pFAS)

Alcohol-Related Neurodevelopmental Disorder (ARND)

• People with ARND do not have abnormal facial features or growth problems, but do have problems with how their brain and nervous system were formed as well as how they function. These individuals may have:

  • Intellectual disabilities

  • Behavior or learning problems

  • Nerve or brain abnormalities

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)

• In addition to confirmed prenatal alcohol exposure, these individuals have impairment of neurocognition, self-regulation, and adaptive functioning. ND-PAE combines deficits in these three areas in conjunction with the following:

  • Evidence of prenatal alcohol exposure

  • Childhood onset of symptoms

  • Significant distress or impairment in social, academic, occupational, or other important areas of function

Alcohol-Related Birth Defects (ARBD)

• People with ARBD have problems with how some of their organs were formed and/or how they function, including:

  • Heart

  • Kidney

  • Bones

  • Hearing

  • Vision

• These individuals also may have one of the other FASDs

Impact of FASDs

FASDs can affect multiple domains of functioning, including: working memory, attention, impulsivity, learning, social skills, and language development. The most common impact is on the brain's executive functions- the ability to plan, learning from experience, and control impulses.

Diagnosis

It is difficult to diagnose FASDs because there is no single or simple test that can cover the broad range of FASD signs and symptoms.

People with FASD may be misdiagnosed, underdiagnosed, or present with another diagnosis with the following disorders: Autism Spectrum Disorder, ADHD, Reactive Attachment Disorder, Conduct Disorder, and Oppositional Defiant Disorder.

FASDs and ADHD

Children with FASD are often described as hyperactive, distractible, and impulsive, with short attention spans. ADHD is the most commonly reported mental health diagnosis in individuals with prenatal alcohol exposure.

The prognosis and treatment responses for children with ADHD and FASD differ to those of children with ADHD alone. Children with FASD often present with early onset ADHD with predominant inattentive symptoms.

Individuals with FASD may respond differently to stimulant medication than other children with ADHD.

Resources:

• CDC: Fetal Alcohol Spectrum Disorders (FASDs)

• American Academy of Pediatrics: Fetal Alcohol Spectrum Disorders

• Kids Health: Fetal Alcohol Syndrome

• US National Library of Medicine National Institutes of Health: Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: clinical guidelines

• FASD United: Video- The Relationship Between FASD and ADHD

• National Organization on Fetal Alcohol Syndrome- South Dakota: Fetal Alcohol Spectrum Disorders- Education Strategies

• Yukon Department of Education: Making a Difference- Working with students who have FASDs

• Duke University: Understanding Fetal Alcohol Spectrum Disorders- A Comprehensive Guide for PreK-8 Educators