All children can exhibit inattention or be fidgety or impulsive from time to time. How can you tell whether your child’s behavior is within the normal range, or if they might have attention deficit hyperactivity disorder (ADHD)?
One helpful starting point is to compare your child’s behavior to that of other kids their age, advises Mark Wolraich, MD, professor emeritus of pediatrics at the Oklahoma University Health Sciences Center in Oklahoma City. For example, if your child hasn’t learned to sit still when all their friends have, it could be a sign of a problem. “It is why teachers are very helpful, because they are seeing multiple children of the same age in the same setting,” he says.
Warning Signs of ADHD in Children
Children with ADHD show specific signs of the three major ADHD symptoms: hyperactivity, impulsiveness, and inattention. According to the Centers for Disease Control and Prevention, 18 core behaviors could indicate that your child has ADHD. There are two groups of behaviors: inattention, with nine behaviors; and a combined hyperactive and impulsive group, with six hyperactive and three impulsive behaviors, explains Dr. Wolraich, who was the lead author of the recently updated ADHD diagnosis guidelines.
Boys are more than twice as likely as girls to receive a diagnosis of ADHD, possibly because hyperactive behaviors are easily observable and are seen more frequently in boys, according to the updated guidelines.
The 18 behaviors are as follows:
The 9 Signs of Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
- Often has trouble holding attention on tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, gets sidetracked)
- Often has trouble organizing tasks and activities
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
- Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
- Is often easily distracted
- Is often forgetful in daily activities
The 9 Signs of Hyperactivity and Impulsivity
- Often fidgets with or taps hands or feet, or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations when it is not appropriate (adolescents or adults may be limited to feeling restless)
- Is often unable to play or take part in leisure activities quietly
- Is often on the go, acting as if driven by a motor
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has trouble waiting their turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
To confirm a diagnosis of ADHD, six or more symptoms must be identified in a child 4 to 17 years old; in a child 17 or older, five or more symptoms must be identified. Symptoms must begin before the child reaches age 12 and must have continued for more than six months. Symptoms must also occur in two or more settings — such as home, school, and social situations — and cause some impairment, according to the American Academy of Pediatrics. Symptoms occurring in only one setting may be indicative of another diagnosis, like a learning disability or stress at home.
Do ADHD Symptoms Differ Between Young Children and Teenagers?
The symptoms of hyperactivity frequently diminish in teenagers and adults with ADHD, but most of the criteria do not change with age, explains Wolraich. However, as noted above, individuals 17 years old or older require only five instead of six symptoms to confirm a diagnosis of ADHD. “They also have to not be due to another cause, such as anxiety or substance abuse,” adds Wolraich.
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When to Seek Professional Help for Your Child
The first thing parents should be looking for when it comes to identifying ADHD is functional impairment — that is, interference in daily functioning in any important area of the child’s life, including at home, in school, with peers, and in other important activities (sports, recreational activities, camps).
This interference in functioning should be directly related to problems with inattention, hyperactivity, and/or impulsivity, says Yamalis Diaz, PhD, a child psychologist specializing in ADHD at NYU Langone and a clinical assistant professor in the department of child and adolescent psychiatry at NYU Grossman School of Medicine.
“For example, at home this could be daily conflict with parents or siblings, disruption to the family’s functioning (e.g., really challenging mornings), high parent stress or frustration,” explains Dr. Diaz. “At school, parents may hear that their child is not completing work, missing instruction time due to inattention or difficulty staying seated, or general disruptive behavior (e.g., calling out, being silly, making noise) that is making it hard for the child to participate effectively in the classroom. And with peers and friends, children with ADHD may experience social challenges that make it difficult for them to make friends, maintain friendships, or participate in social activities appropriately, which can lead to social rejection.”
Diaz says parents should review the list of ADHD symptoms and ask themselves two important questions:
- Does my child do this or have trouble with this at a higher level than would be expected for a child their age?
- Does this get in the way of important daily tasks or activities?
If you identify concerns related to even a few of the symptoms that seem to be increasing or persisting, it would be a good idea to consult a professional so that they can assess further, says Diaz.
Where Do I Have My Child Evaluated for an ADHD Diagnosis?
If you suspect that your child might have ADHD, Diaz suggests first discussing your initial concerns with your pediatrician, who can give you guidance about what to do next. However, an accurate diagnosis of ADHD requires a more comprehensive approach to assessment conducted by a mental health professional such as a child psychologist or psychiatrist, a licensed clinical social worker, or a licensed mental health counselor, explains Diaz. “The assessment often includes completion of standardized ratings scales by parents and teachers, developmental and diagnostic interviews with parents, and a clinical interview or observation directly with the child, depending on age,” she says.
While many health professionals often assess and diagnose ADHD, they may not always conduct an assessment that also reviews other emotional and behavioral concerns (like mood, anxiety, or trauma) that could mimic or exacerbate symptoms of ADHD, Diaz warns. “Parents really should see a mental health professional to assess ADHD if there are significant concerns that are causing increasing disruption to the child’s functioning,” she says.
If your child is diagnosed with ADHD, Diaz says parents should ask the professional who provided the diagnosis to help them through these stages:
- Identify priority areas of concern.
- Plan next steps. Simply knowing your child has ADHD provides only a first step toward understanding your child’s difficulties, says Diaz, adding that it’s perhaps more important to know how ADHD affects your child’s functioning and what will help reduce and manage these challenges.
Possible next steps may include these actions:
- Working with a mental health professional who practices behavioral or cognitive behavioral therapy. “This person can help parents learn and practice parenting strategies that are most effective for managing the challenges related to ADHD, including how to structure daily tasks, give effective instructions the child can more readily follow through on, reinforce positive behaviors and skills development, and use effective discipline strategies in response to negative behaviors like oppositional behavior, says Diaz.
- Combining behavioral therapy and medication. A combined approach that includes both behavioral therapy and medication can often be most effective for treating ADHD, says Diaz. Parents should also discuss medication options with a child psychiatrist or their child’s pediatrician.
- Reaching out to your child’s school. Children with ADHD often have a number of challenges at school that impact their academic functioning, notes Diaz. Parents should talk with their child’s school behavioral support staff, school counselor, or school psychologist about the various levels of school-based support available.
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