ADHD WHY TO TREAT WITH MEDICINES

Restlessness in Children: An Early Warning Sign Parents Should Not Ignore

Many parents proudly say,

“My child is not hyper… he is just active.”

Some say he is only fidgety, always walking, running, climbing, or jumping. While activity is normal in toddlers, persistent, excessive restlessness that disturbs functioning may be an early sign of Attention-Deficit/Hyperactivity Disorder (ADHD) (1,2).

ADHD is a well-recognized neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity (1). Global prevalence studies show that ADHD affects a significant proportion of children worldwide (3).

The journey toward hyperactivity often begins quietly—with fidgeting.

Fidgeting: The Beginning of Restlessness

Fidgeting may appear harmless:

Constant hand or foot movement

Shifting positions repeatedly

Tapping, touching, roaming

Climbing excessively

But a restless body often reflects a restless mind. ADHD involves deficits in executive functioning and inhibitory control, which impair the child’s ability to regulate motor behavior (4). We my call it DCD.. DEVELOPMENTAL COORDINATION DISORDER.

The body does not move without the brain directing it. When impulse control systems are underdeveloped or dysregulated, movement becomes excessive (4).

When Is It Normal — And When Is It Not?

High activity is developmentally appropriate in very young children. However, concern arises when:

The child cannot sit even briefly

Classroom functioning is impaired

Peer relationships suffer

Instructions are not followed consistently

Diagnostic criteria emphasize that symptoms must be persistent, impairing, and present across settings (1,14).

ADHD is not occasional excitement. It is chronic dysregulation.

The Problem With Physical Restriction

Parents often respond with:

Shouting

Scolding

Forcing the child to sit

Holding tightly

Physically restraining

While this may stop movement temporarily, it often increases emotional dysregulation.

Research shows that children with ADHD have higher rates of emotional reactivity and poor frustration tolerance (6). When physically restrained, the child’s “fight” response may activate, leading to:

Pushing

Throwing

Hitting

Biting

Aggression in ADHD is often linked to impulse dysregulation and comorbid behavioral disorders (7,17).

Thus, physical restriction may escalate, rather than reduce, aggression.

Understanding the Neurobiology

ADHD is not a moral failure or parenting problem. It is a neurobiological condition involving dysregulation of dopamine and norepinephrine pathways in the brain (2,4).

Longitudinal research confirms that untreated ADHD can persist into adolescence and adulthood (5,15).

Emotional dysregulation is a major component of ADHD and contributes to restlessness, irritability, and aggression (6).

Verbal Ability Determines Treatment Approach

Children can be broadly divided into two groups:

1️⃣ Children Who Understand Verbal Reasoning

These children benefit from structured psychological interventions such as:

Cognitive Behavioral Therapy (CBT)

CBT helps children recognize triggers, develop coping strategies, and improve self-regulation. Evidence supports behavioral and psychosocial interventions as effective treatments for ADHD (11,12,13).

CBT works best when the child can process verbal explanations and reflect on behavior.

2️⃣ Children With Verbal Delay or Limited Comprehension

In children who cannot understand verbal counseling, purely behavioral explanation may not be sufficient.

In such cases, pharmacological treatment is often required to regulate neurochemical imbalance and reduce agitation, aggression, and impulsivity (14,15).

Clinical guidelines recommend medication as a first-line treatment in moderate to severe ADHD (14).

Role of Medication

Medication helps:

Improve attention

Reduce hyperactivity

Decrease impulsivity

Reduce aggression

The landmark NIMH Multimodal Treatment Study (MTA) demonstrated that medication management significantly improves ADHD symptoms and functional outcomes (10).

Properly treated ADHD improves classroom performance and behavioral control (10,16).

Medication does not suppress personality; it enhances self-regulation by stabilizing neural pathways (2,4).

Importance of Dose Adjustment

Children grow. Brain demands change. Academic pressure increases.

Clinical guidelines emphasize ongoing monitoring and dose titration for optimal symptom control (14).

If under-treated:

Restlessness lingers

Aggression may reappear

Academic difficulties persist

Regular follow-up is essential to prevent partial treatment response.

Parental Behavior Therapy

Parent training is an evidence-based component of ADHD management (11,13).

Parents are taught to:

Avoid physical restraint

Use calm, consistent commands

Reinforce positive behavior

Provide structured routines

Implement reward systems

Studies show that parent training improves child behavior and reduces parental stress (12,18).

When parents change their approach, outcomes improve significantly.

If Not Physical Restriction, Then What?

Safer alternatives include:

1️⃣ Environmental Structuring

Reducing distractions and creating predictable routines improves executive functioning (4).

2️⃣ Scheduled Movement Breaks

Planned activity reduces impulsive movement.

3️⃣ Short Task Blocks

Breaking work into manageable segments improves task completion (16).

4️⃣ Positive Reinforcement

Reward-based systems improve compliance (11).

These methods reduce conflict and aggression.

Long-Term Consequences of Untreated ADHD

Untreated ADHD is associated with:

Academic underachievement (16)

Behavioral disorders (7)

Emotional dysregulation (6)

Antisocial tendencies (7)

Increased substance abuse risk (8,9)

Meta-analyses show a strong association between childhood ADHD and later substance use disorders (9).

Longitudinal studies demonstrate that impulsivity in childhood predicts risk-taking behaviors in adolescence (8).

When parents frequently nag without structured intervention, adolescents may seek validation from peers, increasing vulnerability to risky behavior (8).

Academic Impact

Children with untreated ADHD experience:

Poor attention span

Incomplete work

Falling grades

Low self-esteem

Research confirms that ADHD significantly affects academic achievement and school performance (16).

However, treated children show marked academic improvement (10,16).

Personality and Emotional Development

Repeated criticism shapes self-concept negatively.

Chronic behavioral struggles may result in:

Low confidence

Social rejection

Oppositional attitudes

Emotional dysregulation plays a major role in long-term personality outcomes (6).

Early treatment improves emotional stability and social integration (10).

Treatment in Time Saves Nine

Early identification and intervention prevent:

Escalating aggression

School failure

Substance misuse

Antisocial behavior

Personality complications

Evidence strongly supports early, multimodal treatment combining medication and behavioral therapy (10,13,14).

Key Messages for Parents

Persistent fidgeting may signal underlying ADHD (1,2).

Restless mind leads to restless body (4).

Physical restriction increases aggression (6,7).

CBT works when verbal comprehension is adequate (11,12).

Medication is essential in moderate to severe cases (10,14).

Dose titration and monitoring are crucial (14).

Parent training significantly improves outcomes (13,18).

Untreated ADHD increases substance abuse risk (8,9).

Academic outcomes improve with treatment (16).

Early intervention protects future personality development (5,10).

References

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. 2013.

Faraone SV, et al. Neurosci Biobehav Rev. 2021;128:789-818.

Polanczyk GV, et al. Int J Epidemiol. 2014;43(2):434-42.

Barkley RA. ADHD: A handbook for diagnosis and treatment. 4th ed. 2014.

Biederman J, et al. Psychiatry Res. 2010;177(3):299-304.

Shaw P, et al. Am J Psychiatry. 2014;171(3):276-93.

Connor DF, et al. J Dev Behav Pediatr. 2010;31(5):427-40.

Molina BS, Pelham WE Jr. J Abnorm Psychol. 2003;112(3):497-507.

Lee SS, et al. Clin Psychol Rev. 2011;31(3):328-41.

Jensen PS, et al. J Am Acad Child Adolesc Psychiatry. 2007;46(8):989-1002.

Pelham WE Jr, Fabiano GA. J Clin Child Adolesc Psychol. 2008;37(1):184-214.

Chronis AM, et al. Clin Psychol Rev. 2006;26(4):486-502.

Daley D, et al. J Am Acad Child Adolesc Psychiatry. 2014;53(8):835-47.

Subcommittee on ADHD. Pediatrics. 2019;144(4):e20192528.

Wilens TE, Spencer TJ. Postgrad Med. 2010;122(5):97-109.

Loe IM, Feldman HM. J Pediatr Psychol. 2007;32(6):643-54.

Hinshaw SP. J Clin Psychiatry. 1992;53(Suppl):34-43.

Chronis-Tuscano A, et al. J Abnorm Child Psychol. 2011;39(7):1047-57.