Children with attention deficit hyperactivity disorder (ADHD) have lasting difficulty directing their attention, putting the brakes on impulses and adjusting their level of activity. What matters is not that a child fidgets or daydreams, but that the signs go beyond what is usual for their age, have been present for some time and cause problems in several areas of life.¹,²
ADHD is not a question of willpower or character. What is affected is self-regulation — the functions we use to start tasks, filter out distractions and hold back impulses. Once you understand that, you read a forgotten exercise book not as carelessness but as a symptom.
This article is about childhood and adolescence. For many people ADHD does not disappear on their 18th birthday, but it changes its face — hyperactivity more often turns into inner restlessness and procrastination at work. That is covered in ADHD in adults. Here the focus is on school, family and development.
Lively or ADHD?
Many children are restless at times — after a house move, when there is conflict in the family, when they are short of sleep, or simply because they are six years old. Three questions help:
Duration and breadth: Have the signs been present for many months and in several settings — or only since a particular event and only during homework?
Extent: Does the child stand out clearly compared with children of the same age? The youngest in a school year quickly seem immature next to older classmates.
Distress: Are the child, the family or the child's progress at school clearly suffering? Without impairment there is no diagnosis.
2. The three presentations
ADHD does not look the same in every child. Three presentations are distinguished, and they can shift as the child develops.
Presentation
What is in the foreground
Typical in everyday life
Why it is overlooked
Predominantly inattentive
Distractibility, forgetfulness, trouble starting and finishing things
Daydreams in class, loses things, takes forever over homework
Disturbs no one. Particularly common in girls, often recognised only when marks drop
Predominantly hyperactive-impulsive
Urge to move, impatience, acting before thinking
Gets up during lessons, blurts into conversations, cannot wait
Rarely overlooked — more likely to be misread as a parenting problem
Combined type
Both clearly pronounced
The most common in childhood
Usually recognised at primary school age
Table scrolls to the right
The blind spot: the quiet child. A child who disturbs no one does not get reported — and without a report there is no assessment. Especially with girls, years can pass in which the children think of themselves as “lazy”, even though they are making an enormous effort. Persistent concentration problems that cause distress are a reason for an assessment even without fidgeting.
3. How ADHD shows up in everyday life
At home the morning takes an hour for three simple steps, instructions have to be repeated several times, and homework that should take twenty minutes drags on for two hours, with tears. Transitions regularly lead to conflict.
At nursery and school tasks are started and not finished, and answers are called out. Performance varies widely: one day everything works, the next day nothing does. This is read as proof that the child “could if they wanted to” — in fact, this inconsistency is typical of ADHD.
Sleep and tension:Sleep disorders intensify inattention and irritability — and can even produce ADHD-like signs on their own. Older children often describe inner restlessness better than the visible fidgeting.
Self-esteem and co-occurring conditions: Children with ADHD hear a lot of criticism; anxiety and low mood are common. Dyslexia or dyscalculia, tics and conduct disorders should also be assessed at the same time.
4. Causes — and what is not true
ADHD arises from an interplay of several factors. The best-established is a strong hereditary component. Added to this are factors in early development, such as being born very prematurely, a very low birth weight, and exposure to nicotine and alcohol during pregnancy. Neurobiologically, it is about differences in how the networks for attention, impulse control and reward processing mature.¹,³ The environment does not cause ADHD — but it does influence how much a child suffers from it.
Three stubborn explanations that are not backed by evidence. 1. Sugar makes children hyperactive. Controlled studies have not been able to confirm this; the guideline also does not recommend elimination diets or dietary supplements as standard treatment. 2. Screen time causes ADHD. What has been shown is an association, not a cause — children with ADHD are especially drawn to fast-paced media. Sensible limits on media use are still a good idea. 3. Bad parenting is to blame. The most hurtful and least justified explanation. Parent training does not work because parents did something wrong, but because ADHD needs particular strategies.
5. Diagnosis: not a five-minute job
There is no test that proves ADHD — neither a blood test nor an EEG. The diagnosis is built from many pieces and usually needs several appointments at a child and adolescent psychiatry practice, a paediatric practice or a social paediatric centre (SPZ). If it is settled after ten minutes, scepticism is in order — in both directions.¹,⁴
History and questionnaires: development, how nursery and school have gone, the family situation, sleep, screen time, stresses — plus standardised questionnaires for parents and school or nursery. Only this shows whether the signs occur across different situations.
Observing behaviour and testing: In a quiet one-to-one setting, many children seem unremarkable — that does not rule out ADHD. Tests reveal whether a child is under- or over-challenged and uncover specific learning disorders.
Physical examination and ruling out other causes:Hearing and eye tests are essential — a child who hears poorly seems inattentive. Thyroid problems, iron deficiency, epilepsy with brief absences and sleep disorders are also considered. Medicines count too: some asthma medicines or antihistamines increase restlessness — see Medication side effects.
Take concrete examples to the first appointment, along with school reports, feedback from teachers and a list of medicines (Prepare for a doctor's appointment).
6. Treatment: what the guideline recommends
The most important message for parents: medication does not automatically come first. The guideline grades treatment by severity and always starts with information and counselling. The reverse is just as true: when symptoms are pronounced, treating early and effectively is not a compromise but good medicine.¹
Always firstPsychoeducation and counselling
Information for parents, child and school
Simply reframing “won't” as “can't right now” lowers the pressure of conflict. This step is a must at every level of severity — even if medication is added later.
Mild symptomsParent training and behavioural therapy
Parent training
Clear, short instructions, immediate feedback, reward systems, reshaping situations that lead to conflict. For mild to moderate symptoms at primary school age, the recommended first step in treatment.
Behavioural therapy and routine
Self-instruction, planning tasks, dealing with frustration, social skills — plus enough sleep, exercise and a reliable daily structure.
Moderate to severeMedication in addition to counselling
Stimulants as first-choice medicines
Methylphenidate is the best-studied active substance in childhood; before primary school age, medicines are used only in exceptional cases. The combination with behavioural approaches has the best evidence — the decision is made together with the treating practice.
7. Methylphenidate in daily life
Methylphenidate strengthens the signalling of messenger substances that are important for directing attention and controlling impulses. The point that often confuses people: a stimulating substance does not make children with ADHD more restless, but typically improves their ability to regulate themselves.²,³ It is prescribed only once the diagnosis is confirmed, is subject to special prescribing rules and needs specialist supervision.
Form
Duration of action according to the prescribing information
Typical use
What this means in everyday life
Immediate-release
Works quickly, only for a few hours
Finding the right dose, top-up in the afternoon
Several doses a day — including at school; exact times matter
Prolonged-release
Depending on the product, covers a large part of the day
Standard in long-term treatment
One dose in the morning is usually enough — no taking tablets in front of the class
Table scrolls to the right
The reason prolonged-release products are so popular is less pharmacological than social: a child who has to collect a tablet from the school office at lunchtime ends up explaining themselves to the whole class.
A fixed time in the morning — the effect needs time to kick in; taking it only after the school bell wastes the first few lessons. Have breakfast beforehand, because appetite often drops afterwards.
Do not split capsules without checking — with prolonged-release forms this destroys the delayed release. What is allowed is stated in the package leaflet.
Agree on handovers — after-school club, grandparents, school trip: a written plan prevents double doses and missed ones.
Most unwanted effects appear at the start or after a dose increase and can be eased by making adjustments. The important thing is to mention them rather than quietly stopping the treatment.
Appetite and growth.Loss of appetite is the most common side effect; many children eat hardly anything at lunchtime. Persistently low food intake can lead to weight loss and slow growth. That is why regular checks of height and weight are part of the treatment, usually on a percentile chart. In practice, it helps to have a substantial breakfast, small high-calorie portions at lunchtime and a second evening meal.
Sleep and rebound. Problems falling asleep are often linked to the timing of the dose and the type of product. Rebound is also typical: when the effect wears off in the late afternoon, some children seem more irritable for one to two hours. This is not a deterioration and not withdrawal, but a transitional phenomenon — and a good reason to describe what you have observed. Adjusting the timing, the product or how the doses are spread can make a big difference.
Headaches and tummy aches — mostly at the start, and they often ease off.
Changes in mood — low spirits or tearfulness should definitely be discussed.
Heart rate and blood pressure — can rise slightly; they are checked before starting and during treatment, and heart disease in the family is asked about beforehand.
Do not change things on your own. Increasing the dose, leaving out doses or switching products is a matter for the treating practice. Instead, keep a short dated note: what did you notice, at what time of day, and since when? What matters here is shown in Medication side effects.
Treatment breaks — weighed up honestly. In favour of breaks: appetite and sleep recover, and you can see how the child manages without the medicine. Against them: ADHD does not take holidays — road traffic, family, friendships and the sports club also depend on self-regulation. Breaks are therefore usually used in a targeted way, for example as a planned trial without medication once a year. That is something different from spontaneously leaving it out.
9. Non-stimulants and other approaches
If stimulants do not work well enough or are not tolerated, non-stimulants such as atomoxetine and guanfacine are available. Important for everyday life: they do not work within an hour, but build up their effect over weeks and then work throughout the day. That calls for patience. Their side-effect profile is different — depending on the substance, tiredness, stomach and bowel complaints or effects on the circulation; they too should not be stopped abruptly without medical advice.
What does not work as a substitute. For neurofeedback, elimination diets and omega-3 supplements, the evidence is not strong enough to regard them as a substitute for the recommended treatments. They can be considered alongside treatment if they do no harm — but they should not delay effective therapy. Dietary supplements should be mentioned to the doctor, see Supplements and medications.
10. School and exam adjustments (Nachteilsausgleich)
For most families, school is where ADHD hurts the most. A lot can be improved with small agreements that are put in writing. The Nachteilsausgleich (compensation for disadvantages) evens out the conditions without lowering the requirements: the same performance is assessed, only under adjusted circumstances. The rules are a matter for each federal state; typical examples are:
More time in class tests, or working in two blocks.
A low-distraction workspace — a seat at the front, exams in a separate room.
Breaking tasks into portions — one worksheet instead of five, clear intermediate steps.
Making structure visible — a daily plan on the board, a checklist in the exercise book, a reminder to write down homework.
How to make the conversation with the school work. Go into the conversation with concrete situations rather than diagnoses: “In the third lesson his concentration drops off, and then half the task is missing from the exercise book.” Bring a suggestion, ask what the teacher thinks is realistic, and put the result in writing — with a date for reviewing it.
For homework: a fixed time, a fixed place, the phone out of sight, tasks broken into portions, movement breaks — and an agreed upper limit on how long it takes. If a family regularly spends two hours on something that should take twenty minutes, that is an issue for the school, not a matter of more stamina at home.
11. Easing the load on parents — without blame
Parents of children with ADHD hear a lot from other people — much of it is well meant and still hurts. So, to be clear: you did not cause this condition. What you can influence is the framework — and there is a lot of power in that.
Few, clear rules and immediate feedback — three rules that apply are better than ten that get debated. With ADHD, praise and consequences work above all when they are immediate; rewards at the end of the month have no effect.
Announce transitions — “five more minutes, then we tidy up” prevents a large share of the escalations.
Keep strengths in view and organise support for yourself — children with ADHD are often enthusiastic, creative and direct; these sides get lost in everyday stress. Parent training, self-help groups and family counselling centres help: exhausted parents cannot provide structure.
And: write down, with the date, what you observe — effects, side effects, good and bad days. That leads to better decisions than memories of the last difficult week.
Simply note down effects and side effects
Appetite, sleep, rebound — recorded with the date, ready for the next appointment.
No. At every level of severity, the guideline provides for information and counselling first. For mild to moderate symptoms at preschool and primary school age, parent training and behavioural approaches are the recommended first step. When symptoms are pronounced, however, early treatment with medication makes sense and is well supported by evidence.
When used as intended at the dose prescribed by a doctor, there is, according to current evidence, no sign that it leads to dependence. Studies tend to suggest that well-treated ADHD does not increase the later risk of addiction. It is different when the medicine is misused — that is why special prescribing rules apply and the medicine must be stored safely.
That is neither the aim nor the typical effect. Stimulants improve self-regulation; they do not dampen personality. If a child seems noticeably subdued, joyless or absent during treatment, this points to an unsuitable dose or an unsuitable product and must be discussed.
Because they more often have the predominantly inattentive presentation. These children do not disrupt lessons; instead they daydream, lose things and take a very long time over tasks. Without disruptive behaviour, nobody reports a suspicion. Persistent concentration problems that cause distress are therefore a reason for an assessment even without fidgeting.
That is an individual decision, not a general rule. Appetite, sleep and growth speak in favour of breaks. Against them is the fact that ADHD also has an effect outside school — in road traffic, in friendships, at the club and in the family. Planned trials without medication are often carried out once a year; agree on this with the practice rather than leaving doses out spontaneously.
In some children the symptoms decrease markedly during adolescence. In many they persist but change their form: the visible hyperactivity decreases, while problems with organisation, procrastination and inner restlessness come to the fore. How this shows up in adulthood is a topic of its own.
German S3 guideline on ADHD in children, adolescents and adults (AWMF reg. no. 028-045) — German source. awmf.org
Gesundheitsinformation.de, German Institute for Quality and Efficiency in Health Care (IQWiG): ADHD. Accessed 2026 — German source. gesundheitsinformation.de
gesund.bund.de, the national health portal of the German Federal Ministry of Health: ADHD. Accessed 2026 — German source. gesund.bund.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. ADHD may only be diagnosed after a thorough assessment; stimulants and non-stimulants need specialist supervision and must not be increased or reduced on your own or stopped abruptly. In the case of persistent weight loss, marked low mood or heart symptoms, contact the treating practice promptly; it decides on the active substance and the dose. Last updated: September 2026.
