Obvious and Not so Obvious Signs of ADHD in Children
By Dr. Cheryl Andaya
Is it ADHD or Not?!🤷🏻♀️
Your child wear you out? Does he/she seem to have SO MUCH energy that you feel tired just watching him? Or do you feel like you’ve repeated yourself for the millionth time? Is he/she just lazy? Sound familiar?
One of the most common questions that come up in behavioral health and in primary care is whether a child has Attention-Deficit/Hyperactivity Disorder (ADHD). It is a worrisome thought for parents and often it is brought up by teachers who see problems in the classroom. Other times parents may suspect their child has ADHD but is unsure. Here are some signs of ADHD in Children to help you determine whether you should have your child formally evaluated.
*Disclaimer: Please note this is meant to be a starting point and should not be used as a way to finalize any kind of diagnosis. Although I’m a professional, I have not examined your child. Each case and child is different. If you wish to have a free 15 minute consultation, please book it below.
What is ADHD?🤔
The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines Attention-Deficit/Hyperactivity Disorder (ADHD) as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (American Psychiatric Association, 2013). Basically, if your child is struggling with attention and/or impulsiveness more than most children his/her age then this may be signs of ADHD. If this is your first child (so have nothing to compare them to) or if you are still not sure, OR if you’re sure but still want to get a better understanding of signs of ADHD in children, read on.
3 Types of ADHD
1. ADHD - Inattentive Type
These children are often missed and will fly under the radar because they sit quietly in the classroom and daydream. They just mostly chill. Signs of ADHD in children with primarily inattentive type tend to be more girls than boys. They are discovered only when grades come in or when they are struggling with learning. Parents get frustrated because they are constantly repeating themselves. They start to believe that their child is intentionally ignoring them or being defiant. Think about it though, why would your child purposefully defy you? What would they gain by disappointing you? There may be something else going on.
2. ADHD - Hyperactive/Impulsive Type
Signs of ADHD in children who are diagnosed with primarily hyperactive/impulsive type (inattention criteria not met) are usually the very young children who are unable to be assessed for attention due to their age. Typically, these children will fall into the Combined type when they become old enough to assess for attention.
3. ADHD - Combined (Hyperactive & Inattentive) Type
This tends to be what most people think about when ADHD is mentioned. The child who seems to have enough energy to power the whole electrical grid of New York City (sorry, I like to exaggerate) has challenges with being hyperactive/impulsive as well as challenged with maintaining attention.
DSM Criteria for ADHD
Here are the criteria for ADHD adapted and broken down from DSM (American Psychiatric Association, 2013. This is the way I typically explain it to my patients who ask about symptoms of ADHD.
- Tons of energy. This is the child that is constantly moving and getting into things when the rest of the group is following the leader.
- His backpack and/or desk is the messiest in the classroom.
- She loses schoolwork or other items she needs to accomplish a task.
- She is frequently running and climbing on things, jumping off things, or will bolt out into the street no matter how many times you told her about the danger.
- He frequently misplaces things or you are always helping her find something.
- He has difficulty following daily routines.
- She is always fidgeting, can’t sit still (I once had a patient that fell off his chair three times during a one-hour session because of his fidgeting).
- He is always getting up from his seat.
- Playing quietly is practically non-existent.
- Talking and talking and talking and talking.
- Jumps at giving an answer before you finish asking the question.
- Waiting for her turn is torture.
The Not so Obvious
- He makes careless mistakes or misses details.
- She loses attention easily.
- He has difficulty listening when spoken to or seems to be distracted even when there is no obvious distraction.
- She has difficulty following through with things – easily sidetracked.
- He has difficulty with things that require mental effort like schoolwork and tends to avoid them.
- Easily distracted.
- She frequently interrupts others despite repeated reminders to wait their turn.
Other key components:
- Behaviors/symptoms need to be present in at least two settings! The behaviors cannot just be present at school or just at home. You have to see the behaviors in multiple settings.
- Interferes with functioning. Symptoms must be severe enough where the child is negatively impacted in their academics, peer relationships, home functioning or in any other area of their life.
HOWEVER, there are times when a child diagnosed with ADHD IS ABLE TO SIT STILL! This is when they are doing something of interest. They become HYPERFOCUSED. This confuses parents who feel that if the child is able to sit still for video-game play or television, then they should be able to sit still for everything. That’s not how it ADHD works.
The other difficult part about diagnosing is that ADHD symptoms could be signs of other issues: such as trauma reaction, autism, mood disorders, etc.
When it’s likely NOT ADHD
- It’s age appropriate: Children younger than 4 years are expected to have impulsive, hyperactive behaviors and their attention span is very short. Many parents will be worried that their two-year-old is unable to sit still for story time. At this age, it’s quite normal, especially if the story does not include animated voices. That’s why baby books are short. On the other hand, if it’s a 7-year-old who has difficulty sitting for a short story, that may be more of a concern.
- History of trauma: This is a tricky one. Children with abuse/trauma history will often exhibit symptoms that look like ADHD. The emotional dysregulation sometimes needs to be addressed as well as processing the trauma to have the symptoms addressed.
- Sudden significant change: Children who have or are currently going through significant changes (deployment of parent, new sibling, death of a loved one, move to new school or home) may result in regressed behaviors or ADHD-like behaviors.
- Abusive/unhealthy environment: If the child is in an abusive home or is exposed to domestic violence, this would cause anxiety, depression, trauma reaction that could look like ADHD.
Signs could also be subjective, which is the reason to seek professional opinion from a provider who is experienced with recognizing, diagnosing and treating ADHD. To find out what to expect from an assessment from a psychologist, please stay tuned for the next post where I will discuss the process of being assessed for ADHD.
Thanks so much for reading this crazy vent. As always, please free to provide feedback/comments below. It helps me narrow the topics I research and write about and lets me know that this information is helpful. Aloha 🤙
*American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
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I’m a mother and a Clinical Psychologist who works with children and their families as well as individuals reaching for their goals. Born and raised in Hawaii, I embrace diversity and help individuals find their strengths.
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