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Paeds Topicsgrowth-development-and-behaviour

Paeds · growth-development-and-behaviour

Attention-deficit hyperactivity disorder

Also known as ADHD · Attention-deficit/hyperactivity disorder · Attention deficit hyperactivity disorder · Hyperkinetic disorder · ADD · Attention deficit disorder

Fellowship guide to paediatric ADHD: multi-setting diagnosis, differentials including sleep and learning mimics, age-banded multimodal care, stimulant and non-stimulant frameworks with monitoring, comorbidity, school partnership, regional pathway differences and exam pearls.

high30 referencesUpdated 11 July 202612 min readVerification in progress

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Target exams

RACP General PaediatricsMRCPCHABP General PediatricsRCPSC Pediatrics

Red flags

  • Suicidal ideation, self-harm or severe mood collapse with comorbid depression or anxiety — safety plan first; do not attribute everything to ADHD alone
  • Personal cardiac symptoms or family sudden cardiac death — complete cardiac review before stimulants or atomoxetine
  • Active substance use or clear diversion risk — prefer supervised long-acting formulations or non-stimulants; treat substance use in parallel
  • New manic, psychotic or severe agitation after stimulant start — stop the agent and reassess bipolar spectrum, substances and medical causes
  • Significant growth faltering or weight loss on stimulants — replot growth, review dose timing, holidays and alternatives
  • Safeguarding, family violence or school exclusion crisis — escalate safety pathways before optimising ADHD labels

Life stages

preschoolschool-ageadolescentyoung-adult-transition

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acuterural-remotetelehealth

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-history-managementmrcpch-communicationmrcpch-developmentrcpsc-structured-oral

Board mappings

  • General and Community Paediatrics
  • Developmental and behavioural paediatrics
  • Attention-deficit hyperactivity disorder
  • Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
  • Developmental-behavioural and school-function competencies
  • Clinical Applications
  • Long Cases
  • Short Cases
  • 4. Professional skills and knowledge: Patient management
  • 5. Professional skills and knowledge: Health promotion and illness prevention
  • General Paediatrics: Assesses development and behaviour and initiates appropriate management
  • Foundation of Practice (FOP)
  • Applied Knowledge in Practice (AKP)
  • Neurodevelopmental and behavioural disorders
  • Clinical
  • History
  • Communication
  • Developmental and behavioural assessment
  • General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
  • General Pediatrics Content Outline — Domain 4: Developmental and Behavioral Pediatrics
  • General Pediatrics Content Outline — Domain 15: Mental and Behavioral Health
  • General Pediatrics EPA: Assess and manage common behavioural and developmental concerns
  • Patient Care 1: History and Physical Examination
  • Patient Care 4: Clinical Reasoning
  • Medical Knowledge 1: Clinical Knowledge
  • Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
  • Systems-Based Practice: coordination with schools and community systems
  • Medical Expert
  • Communicator
  • Collaborator
  • Pediatrics: Foundations EPA — Assessing growth and development
  • Pediatrics: Core EPA — Managing common developmental and behavioural problems
On this page

Related topics

  • Behavioural assessment and functional analysis
  • Autism spectrum disorder
  • School refusal and school attendance problems
  • School-age health supervision
  • School health and school-based care
Study tools

Your progress

Saved on this device.

Practise this topic

  • Short-answer question1
  • Viva station1
  • Clinical case1

Target exams

RACP General PaediatricsMRCPCHABP General PediatricsRCPSC Pediatrics

Red flags

  • Suicidal ideation, self-harm or severe mood collapse with comorbid depression or anxiety — safety plan first; do not attribute everything to ADHD alone
  • Personal cardiac symptoms or family sudden cardiac death — complete cardiac review before stimulants or atomoxetine
  • Active substance use or clear diversion risk — prefer supervised long-acting formulations or non-stimulants; treat substance use in parallel
  • New manic, psychotic or severe agitation after stimulant start — stop the agent and reassess bipolar spectrum, substances and medical causes
  • Significant growth faltering or weight loss on stimulants — replot growth, review dose timing, holidays and alternatives
  • Safeguarding, family violence or school exclusion crisis — escalate safety pathways before optimising ADHD labels

Life stages

preschoolschool-ageadolescentyoung-adult-transition

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acuterural-remotetelehealth

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-history-managementmrcpch-communicationmrcpch-developmentrcpsc-structured-oral

Board mappings

  • General and Community Paediatrics
  • Developmental and behavioural paediatrics
  • Attention-deficit hyperactivity disorder
  • Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
  • Developmental-behavioural and school-function competencies
  • Clinical Applications
  • Long Cases
  • Short Cases
  • 4. Professional skills and knowledge: Patient management
  • 5. Professional skills and knowledge: Health promotion and illness prevention
  • General Paediatrics: Assesses development and behaviour and initiates appropriate management
  • Foundation of Practice (FOP)
  • Applied Knowledge in Practice (AKP)
  • Neurodevelopmental and behavioural disorders
  • Clinical
  • History
  • Communication
  • Developmental and behavioural assessment
  • General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
  • General Pediatrics Content Outline — Domain 4: Developmental and Behavioral Pediatrics
  • General Pediatrics Content Outline — Domain 15: Mental and Behavioral Health
  • General Pediatrics EPA: Assess and manage common behavioural and developmental concerns
  • Patient Care 1: History and Physical Examination
  • Patient Care 4: Clinical Reasoning
  • Medical Knowledge 1: Clinical Knowledge
  • Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
  • Systems-Based Practice: coordination with schools and community systems
  • Medical Expert
  • Communicator
  • Collaborator
  • Pediatrics: Foundations EPA — Assessing growth and development
  • Pediatrics: Core EPA — Managing common developmental and behavioural problems
The fellowship answer

ADHD is a neurodevelopmental pattern of impairing inattention and/or hyperactivity-impulsivity that starts in childhood, shows up in more than one setting, and is diagnosed clinically from multi-informant history — not from a single rating scale or blood test. Treat function with psychoeducation, school and behavioural supports, and carefully monitored medication when impairment is moderate to severe, while hunting sleep, sensory, learning, anxiety, trauma and medical mimics first. [1] [2] [9] [11]

Overview & Definition

Picture the child who is bright but cannot finish a worksheet, who loses every jumper, who blurts answers, who is exhausted by homework battles, or who looks “fine” in a quiet clinic and falls apart in a busy classroom. That functional story — not a single teacher email — is the starting point for ADHD assessment. [1] [2]

ADHD is a neurodevelopmental condition. Persistent inattention and/or hyperactivity-impulsivity are inconsistent with developmental level, present for months, appear in two or more settings, and cause clear impairment in learning, safety, relationships or family life. It is not laziness, not a moral failure, and not a score on a questionnaire alone. [1] [9] [11]

Give the examiner a one-sentence problem representation

“School-age child with multi-setting impairing inattention and hyperactivity from early primary school, teacher and parent concordant, sleep adequate, no hearing/vision red flags, with functional impact on learning and peer safety — working diagnosis ADHD combined presentation pending comorbidity screen.” That sentence already shows criteria, informants, mimics and function. [1] [9]

International consensus statements summarise a large evidence base that ADHD is a valid clinical construct with genetic, developmental and functional consequences when untreated. Your job as a general paediatrician is not to debate whether ADHD “exists”, but to diagnose carefully, avoid both under- and over-labelling, and build a plan the family and school can actually run. [11] [12]

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References30ShowHide
  1. [1]Wolraich ML Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 2019.PMID 31570648
  2. [2]Posner J Attention-deficit hyperactivity disorder. Lancet (London, England), 2020.PMID 31982036
  3. [3]Cortese S Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry, 2018.PMID 30097390
  4. [4]The MTA Cooperative Group A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Archives of general psychiatry, 1999.PMID 10591283
  5. [5]Molina BSG The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 2009.PMID 19318991
  6. [6]Polanczyk G The worldwide prevalence of ADHD: a systematic review and metaregression analysis. The American journal of psychiatry, 2007.PMID 17541055
  7. [7]Faraone SV Molecular genetics of attention-deficit/hyperactivity disorder. Biological psychiatry, 2005.PMID 15950004
  8. [8]Willcutt EG Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biological psychiatry, 2005.PMID 15950006
  9. [9]Pliszka S Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 2007.PMID 17581453
  10. [10]Barbaresi WJ Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. Journal of developmental and behavioral pediatrics : JDBP, 2020.PMID 31996577
  11. [11]Faraone SV The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience and biobehavioral reviews, 2021.PMID 33549739
  12. [12]Kazda L Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA network open, 2021.PMID 33843998
  13. [13]Michelson D Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. The American journal of psychiatry, 2002.PMID 12411225
  14. [14]Sallee FR Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 2009.PMID 19106767
  15. [15]Cooper WO ADHD drugs and serious cardiovascular events in children and young adults. The New England journal of medicine, 2011.PMID 22043968
  16. [16]Hennissen L Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine. CNS drugs, 2017.PMID 28236285
  17. [17]Wilens TE Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, 2003.PMID 12509574
  18. [18]Wilens TE Attention deficit hyperactivity disorder and substance use disorders. The American journal of psychiatry, 2006.PMID 17151154
  19. [19]Gorman DA Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015.PMID 25886657
  20. [20]Paruthi S Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2016.PMID 27250809
  21. [21]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
  22. [22]Storebø OJ Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane database of systematic reviews, 2023.PMID 36971690
  23. [23]Sibley MH Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. Journal of child psychology and psychiatry, and allied disciplines, 2017.PMID 27642116
  24. [24]Cortese S Association Between ADHD and Obesity: A Systematic Review and Meta-Analysis. The American journal of psychiatry, 2016.PMID 26315982
  25. [25]Kessler RC The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American journal of psychiatry, 2006.PMID 16585449
  26. [26]Lichtenstein P Medication for attention deficit-hyperactivity disorder and criminality. The New England journal of medicine, 2012.PMID 23171097
  27. [27]Vaa T ADHD and relative risk of accidents in road traffic: a meta-analysis. Accident; analysis and prevention, 2014.PMID 24238842
  28. [28]Kooij JJS Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European psychiatry : the journal of the Association of European Psychiatrists, 2019.PMID 30453134
  29. [29]Cortese S ADHD management during the COVID-19 pandemic: guidance from the European ADHD Guidelines Group. The Lancet. Child & adolescent health, 2020.PMID 32311314
  30. [30]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387

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Related topics

  • Behavioural assessment and functional analysis
  • Autism spectrum disorder
  • School refusal and school attendance problems
  • School-age health supervision
  • School health and school-based care