FAQ with Dr. Dilip Karnik: Attention Deficit Hyperactivity Disorder (ADHD)

ADHD, or attention deficit hyperactivity disorder, has become one of the most common neurobehavioral disorders affecting children and adolescents. The CDC’s most recent report on ADHD estimates that there are more than 6 million kids affected by this condition in the United States.

Yet for young people living with ADHD, there is still often confusion and uncertainty about it. Most people are aware that it can cause you to lose focus or act impulsively. Some common unknowns include: At what age does it develop? Are you born with it? How is it diagnosed? What should you look for if you suspect your child has ADHD?

One of our board-certified pediatric neurologists, and someone who has diagnosed and treated the condition for decades, Dr. Dilip Karnik, offers some helpful insights here:

Are kids born with ADHD?

There is no clear, definitive cause for ADHD, but we do know that genetics play an important role. There is evidence that anywhere from 30% to 50% of children with ADHD likely inherited the condition from a parent or another family member. There is also evidence that other factors can cause ADHD such as a traumatic brain injury, premature birth, or low birthweight. Studies show that smoking or drinking during pregnancy leads to an increased risk of the child having ADHD. So not all children are born with the condition. Certainly, many have a predisposition to having ADHD, but there are also other possible causes.

How are kids diagnosed with ADHD in preschool?

There is no single test to diagnose ADHD, and some of the signs can also look like other disorders. I always encourage parents to trust their instincts. Many parents often have a “gut feeling” that their child is having difficulty, that something is not right, and if that’s the cause they should ask questions.

Teachers especially can be a valuable tool in recognizing if there is an issue whether in preschool, elementary, middle, or high school. For example, a teacher may notice that a child is smart but not achieving at the expected level. The earlier you diagnose, the earlier you can provide the support that child needs.

In general, I recommend that parents discuss their observations with their family physician or pediatrician first. A primary care physician can recommend a specialist who can do more comprehensive testing and drill down to the specifics of a diagnosis. A child may also have a combination of issues, not just ADHD. A specialist familiar with these types of pediatric conditions such as a child neurologist, psychiatrist, or developmental pediatrician can best identify what’s going on.

What does ADHD look like at different ages?

Preschool: ADHD is most often diagnosed in school-aged children, five years old or older. If ADHD is suspected in children at three or four years old, it’s best to start with behavioral therapy and not medication. In general, children suspected of ADHD at this age are extremely impulsive and hyperactive (much more than you would expect at three years old).

Elementary School: ADHD is easier to identify when in a structured environment like school. Some symptoms we look for at this age are constant daydreaming, very talkative in class, easily distracted, impulsive and demanding, inability to complete a project or assignment.

Middle/High School: As children and teenagers get older, their bodies and hormones are changing. ADHD is tied to weak executive skills which translate into issues such as challenges keeping organized, always late, mood swings (inability to control emotions), and difficulty remembering things. Children with undiagnosed and untreated ADHD tend to do more poorly in school and get involved in high-risk behavior such as drug use. If you suspect your adolescent or teen has ADHD, speak to their teachers, PCP and, if needed, consult a specialist.

There are a wide variety of effective treatment options available including behavioral or psychological therapy, dietary supplements, and medications. Any of these, along with academic accommodations or an IEP (Individualized Education Plan) to help at school, can set your child up for confidence —which is so important when they are young — and ultimately success.


Child Neurology Consultants of Austin has experience treating a wide range of neurological disorders in children and teenagers from 0 to 21 years old. For an appointment with one of our specialists, or to learn more about our services, contact us here.

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