Possibly no parent of a young child has ever uttered the words, “Wow, my kid is always so calm and focused.” But when do hyperactive, inattentive or impulsive behaviors cross the line from “normal” to ADHD, or Attention Deficit/Hyperactivity Disorder, a common and often treatable mental health condition?
The most basic answer: when the behaviors don’t only happen at home, and when they’re severe enough to impact a child’s ability to function well in his or her family, academic and social life.
“If a kid is wild or doesn’t listen at home, but teachers are saying he’s an angel at school, that’s probably not ADHD,” says Dr. John Harrington, division director of General Academic Pediatrics at Children’s Hospital of the King’s Daughters in Norfolk, Va. “He might not have good boundaries at home, or he may simply like to irritate Mom. With ADHD, usually it involves trouble in multiple settings.”
Attention disorders affect an estimated 8 percent of kids in the United States, according to the American Psychiatric Association. They are more common in boys and often are first diagnosed in school-aged children, although characteristics can surface earlier. They also can run in families.
Some symptoms are more obvious. Kids with ADHD often struggle to sit still — the proverbial “ants-in-the-pants” cases. They might be very intelligent, but have difficulty following directions, or focusing on and finishing tasks. Many submit messy, error-filled work or repeatedly take risks such as jumping off playground equipment or accepting dangerous dares.
A child with ADHD also tends to stand out in a group. “Let’s say 19 other kids are sitting still and the 20th one is bouncing, tapping his hands and feet, getting out of his seat, twiddling with something or not waiting his turn,” Harrington says. “He’s the one who’s driving the teacher insane.”
Yet some pieces of ADHD are less recognized or understood. The social aspect is one major example; in fact, children can be misdiagnosed as autistic because their minds race ahead so quickly that they don’t notice other people’s feelings or interest level in a conversation, says Dr. Kenneth Richmond, a psychiatrist with TPMG Behavioral Health in Newport News.
A child with ADHD tends to blurt out comments without thinking, interrupt people and grow frustrated or angry if others don’t understand him immediately, or if they respond differently than what he has anticipated in his mind.
“They typically have nicknames in school like ‘Spaz’ or ‘Squirrel’ — like their head is always on ‘swivel mode’,” Richmond says. “They just don’t know what to do with all their thoughts and energy, and it can be very hard for them to make or keep friends.”
As for the kids dubbed “Space Cadet” because they don’t seem to be paying attention at all, the opposite can be true. Instead, they might be noticing everything — a flickering light, a buzzing heater, a ticking watch, construction equipment moving outside a window. Focusing on a teacher or assignment, then, is virtually impossible.
At some point, kids with ADHD also realize that keeping up with their peers involves more effort and mistakes. “They often procrastinate on getting started,” Richmond says. “What can look like defiance or laziness is really a fear of failing again. They are hard on themselves.”
Another lesser-known fact is that ADHD may not surface until middle or high school, or even adulthood. “Kids have seemed fine before, often because they’re very intelligent, but their ability to accommodate it is suddenly overwhelmed by the amount or complexity of what they have to do,” Harrington explains.
To diagnose ADHD, doctors study questionnaires from patients, parents, teachers, church leaders and other outside sources. They also consider conditions that can mimic or co-exist with attention issues, such as autism, mood and sleep disorders, and stress from a childhood trauma or family stressors.
Behavioral therapy and possibly medication can help prevent self-esteem issues that can lead to depression, anxiety or substance abuse, experts say. Over time, maturation and brain development may ease or even erase symptoms of ADHD.
“Every case is unique,” Harrington says. “We all have little bits of ADHD in us, after all. What parents should know is that there is help. In fact, helping these kids is one of the most satisfying things I do.”
Common Signs of Attention Deficit/Hyperactivity Disorder
There are three types of attention disorders: inattentive, hyperactive/impulsive and combined. Diagnosis generally requires five or six symptoms in either or both categories.
- Doesn’t pay close attention to details, often making careless mistakes such as putting a decimal in the wrong position in a math problem.
- Has problems staying focused on tasks, activities or conversations.
- Doesn’t seem to listen when spoken to.
- Starts but doesn’t complete tasks such as chores or school assignments, or forgets about them entirely.
- Struggles with organization, time management and meeting deadlines.
- Avoids or dislikes tasks that require sustained mental effort.
- Often loses items needed for daily life, such as school papers, keys or wallets.
- Is easily distracted by surrounding activity or noises.
- Fidgets with or constantly taps hands or feet, or squirms in seat.
- Not able to stay seated.
- Runs around or climbs where it is inappropriate.
- Unable to play or participate in leisure activities quietly.
- Always “on the go,” as if driven by a motor.
- Talks too much, or blurts out answers before a question has been finished.
- Has difficulty waiting his or her turn, whether in a line or conversation.
- Intrudes on others, such as interrupting or using personal items without permission.
Source: American Psychiatric Association