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January 22, 2024Attention Deficit Hyperactivity Disorder (ADHD) – First Steps
Recognizing the signs
Before discussing the signs, symptoms, and evaluation/diagnosis of ADHD it is important to understand exactly what ADHD means. It is also important to remember that at times all children will have difficulty with maintaining attention or controlling impulsive and hyperactive behaviors. In fact, nearly all pre-school aged children demonstrate these behaviors as part of their normal development. With ADHD these behaviors occur more than just occasionally and impact daily life for the children and sometimes the entire family. ADHD is one of the most common neurodevelopmental disorders of childhood and often lasts into adulthood. Children with ADHD may have difficulty paying attention and/or difficulty controlling impulses or seem overly active.
Because of this ADHD is broken down into three different types:
- Predominantly inattentive
- Predominantly Hyperactive/Impulsive
- Combined Type
Common signs of inattention:
- Frequent daydreaming or not listening when spoken to
- Easily distracted from schoolwork or play
- Careless mistakes, rushing through tasks
- Often forgetting or losing things
- Does not complete or follow through on tasks or instructions
- Seems to be disorganized
Common signs of hyperactivity:
- Always squirming or fidgeting
- Constantly moving or in motion (sometimes referred to as “driven by a motor”)
- Running, jumping, and climbing constantly and at inappropriate times or places
- Talking excessively, difficulty keeping quiet
Common signs of impulsivity:
- Difficulty taking turns or waiting for things
- Difficulty getting along with other children
- Running off frequently (including dangerous situations like in public or around or into streets)
- Interrupts others or calls out of turn
Some other examples of hyperactive/impulsive symptoms in early school age children would include frequently running into people and knocking things down while playing, getting injured frequently, refusal to sit for stories, games, or similar activities.
Difficulty sitting down or sitting still at mealtimes, as well as frequently moving or fidgeting even during stimulating activities such as watching television may also be seen.
Children with ADHD may not have all of the common symptoms above or even all the symptoms within one group or “predominant type”.
When and where to look?
Although symptoms of ADHD occur in multiple settings such as home, school, and/or extracurricular activities, school settings are frequently where ADHD symptoms are most prominently picked up on or highlighted. This happens because of the increased demand for focus, patience, and self-control during classroom activities.
As children get older and advance past pre-school age (5-7 years old), most children begin to outgrow the developmentally normal hyperactive, impulsive, and inattentive behaviors discussed above.
Children with ADHD, however, do not outgrow these behaviors and as they get older the difference usually becomes more clear and obvious.
By age 7 most parents of children with ADHD have noticed that their child’s inattention, activity level, and/or impulse control have become atypical even at home.
What to do next?
If you are concerned your child is overactive, inattentive, impulsive or may have ADHD:
- Speak with your child’s pediatrician. Most pediatricians have extensive experience in evaluating, diagnosing, and treating ADHD and do so using standard practice guidelines set by the American Academy of Pediatrics.
- You may also want to speak with your child’s teacher to see if they have similar concerns. Children with ADHD, by definition, have symptoms in multiple settings, such as home and school. If your pediatrician starts an evaluation, they will likely require input from the child’s teacher, so starting the discussion ahead of time may help to get a sense of what the teacher is seeing or reporting.
Part of the screening and evaluation process typically involves both the parents and teacher(s), completing a standardized assessment form.
Your child’s pediatrician may also screen them for other behavioral health conditions such as depression, anxiety, oppositional defiant disorder, or conduct disorder. These conditions can either present similarly to ADHD or occur more often in children with ADHD.
In cases where the diagnosis is not clear, or where there is concern for multiple diagnoses your child’s pediatrician may refer them to a specialist in diagnosing and treating behavioral disorders such as ADHD.
References and Resources
https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/default.aspx
https://www.cdc.gov/ncbddd/adhd/facts.html
NICHQ Vanderbilt Assessment Scale—PARENT Informant https://www.nichq.org/sites/default/files/resource-file/NICHQ-Vanderbilt-Assessment-Scales.pdf
Clinical Practice Guidelines for the Evaluation and Treatment of ADHD in Children and Adolescents
Pediatrics (2019) 144 (4): e20192528.