ADHD in Children: Signs, Diagnosis, and Modern Management Approaches

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent difficulties with attention, hyperactivity, and impulsivity. These symptoms significantly impact a child's social, academic, and emotional development. However, diagnosing ADHD is often challenging because its manifestations can overlap with symptoms of other conditions. Understanding these nuances is critical for making an accurate diagnosis and choosing an appropriate management strategy.

What is ADHD and Why Is It Difficult to Diagnose?

ADHD is characterized by three main symptom clusters: inattention (difficulty concentrating, forgetfulness, inability to follow instructions), hyperactivity (excessive motor activity, restlessness), and impulsivity (hasty decision-making, interrupting others). These manifestations must be pronounced in multiple areas of life (e.g., at home and at school) and present for a prolonged period to meet diagnostic criteria.

The complexity of diagnosis lies in the fact that many of these symptoms are not unique to ADHD. Increased activity, difficulty concentrating, or impulsive behavior can be caused by stress, lack of sleep, school or family problems, and other medical or neurological conditions. Therefore, it is crucial to conduct a thorough differential diagnosis to rule out other causes of behavioral disturbances.

When Hyperactivity Is Not ADHD: Differential Diagnosis

Certain conditions can mimic the symptoms of ADHD, especially hyperactivity and restlessness. It is important for pediatricians and pediatric neurologists to consider these possibilities:

• Benign movement disorders. Benign movement disorders are common in children and can be mistaken for seizures or manifestations of hyperactivity. Conditions such as tics, myoclonus, or other nonepileptic paroxysmal events can lead to misdiagnosis and unnecessary treatment if not properly recognized [5].
• Epileptic encephalopathies. Certain forms of epilepsy, particularly epileptic encephalopathy with spike-wave activation in sleep (EE-SWAS or D/EE-SWAS), can manifest not only with seizures but also with significant behavioral and cognitive impairments. These impairments include attention problems, hyperactivity, and cognitive decline, which may be mistakenly interpreted as ADHD [4, 6].
• Genetic neurodevelopmental disorders. Mutations in specific genes, such as the DHDDS gene, are associated with a wide spectrum of neurodevelopmental disorders, including epilepsy, movement disorders (e.g., myoclonus), and varying degrees of intellectual disability [1]. The clinical picture of such conditions can be highly variable, emphasizing the need for genetic testing when such syndromes are suspected.

Genetic Factors and ADHD: What Do Studies Say?

ADHD has a strong genetic predisposition. Research shows that genetic factors play a significant role in the development of not only ADHD but also other neurodevelopmental and psychiatric disorders.

Although specific "ADHD genes" have not been definitively identified, studies point to polymorphisms in genes related to neurotransmitter systems. For example, a systematic review on genetic markers of depression and anxiety mentions polymorphisms in dopaminergic genes (such as DAT, DRD, COMT) and serotonergic genes (such as 5-HTTLPR), as well as the BDNF gene [8]. These same genes are actively studied in the context of ADHD, as dopamine and serotonin are key neurotransmitters regulating attention, motivation, and behavior.

Furthermore, as mentioned earlier, mutations in the DHDDS gene are associated with neurodevelopmental disorders, epilepsy, and movement disorders [1]. This demonstrates the complex genetic basis that may underlie various conditions presenting with similar behavioral symptoms.

Comorbid Conditions: ADHD and Associated Problems

ADHD rarely occurs in isolation. Many children with ADHD also suffer from other psychiatric or neurological disorders, which complicates the clinical picture and requires a comprehensive approach to treatment.

• Anxiety disorders and depression. These conditions frequently coexist with ADHD. Genetic factors, including polymorphisms in dopaminergic and serotonergic genes, may contribute to the development of both ADHD and anxiety/depression [8].
• Epilepsy and movement disorders. Epileptic encephalopathies, such as D/EE-SWAS, can cause behavioral problems and learning difficulties that may be mistaken for ADHD or exacerbate its manifestations [4, 6]. Mutations in the DHDDS gene are also associated with epilepsy and movement disorders, often accompanied by intellectual impairments [1]. In such cases, behavioral symptoms may be a direct consequence of the underlying neurological disease.

A Comprehensive Approach to Managing ADHD in Children

Effective management of ADHD requires an individualized and multimodal approach, which may include pharmacotherapy, behavioral therapy, psychoeducation, and school support.

1. Accurate diagnosis and treatment of the underlying condition. First and foremost, it is essential to rule out or treat other conditions that can mimic ADHD. For instance, in epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS), the use of ethosuximide or immunotherapy can significantly improve both electroencephalographic parameters and behavioral and cognitive outcomes [4, 6]. In cases of movement disorders caused by genetic mutations, such as in the DHDDS gene, specific triple therapy can significantly improve the patient's condition [1].
2. Pharmacotherapy. For many children with ADHD, medication (stimulants or non-stimulants) is an effective way to control core symptoms.
3. Behavioral therapy and psychoeducation. Behavioral strategies help children develop self-regulation, planning, and organizational skills. Psychoeducation for parents and teachers helps create a supportive environment.
4. Supportive methods.
   • Omega-3 fatty acids. Although study [3] demonstrated the efficacy of omega-3 supplements in controlling heart rate in pediatric inappropriate sinus tachycardia, omega-3 fatty acids are also known for their general positive impact on nervous system development. They can be considered part of comprehensive supportive care, although their direct impact on core ADHD symptoms requires further research.
   • Healthy lifestyle. Regular physical activity, a balanced diet, and adequate sleep play a crucial role in a child's overall well-being and can help manage ADHD symptoms.

It is important to remember that every child is unique, and the treatment plan must be developed individually by a multidisciplinary team of specialists, including a pediatrician, pediatric neurologist, psychiatrist, and psychologist.

References

• [1] Case Report: Recurrent pathogenic mutation c.110G>A in the DHDDS gene. (Frontiers in neuroscience, 2026) https://pubmed.ncbi.nlm.nih.gov/42200043/
• [3] Potential role of omega-3 supplementation in modulating symptoms and Holter parameters in children with inappropriate sinus tachycardia. (Indian journal of pediatrics, 2026) https://pubmed.ncbi.nlm.nih.gov/42518088/
• [4] Impact of immunotherapy on seizure severity and spike-wave index in epileptic encephalopathy with spike-wave activation in sleep: The value of EEG spikes in monitoring treatment response. (Epilepsy research, 2026) https://pubmed.ncbi.nlm.nih.gov/42407303/
• [5] Benign movement disorders mimicking seizures in children: A retrospective cohort study. (Children (Basel, Switzerland), 2026) https://pubmed.ncbi.nlm.nih.gov/42194176/
• [6] Electro-clinical and behavioral outcomes of add-on ethosuximide in children with developmental and epileptic encephalopathy with spike-wave activation in sleep (D/EE-SWAS): A prospective observational study. (Seizure, 2026) https://pubmed.ncbi.nlm.nih.gov/42485909/
• [8] Are there genetic markers and mutations of depression and anxiety? A systematic review. (Journal of affective disorders, 2014) https://pubmed.ncbi.nlm.nih.gov/25106036/

The information presented in this article is for reference purposes only and cannot replace professional medical advice. Always consult qualified specialists for the diagnosis and treatment of any medical conditions.