Does My Kid Have ADHD? 9 Signs to Look Forby Sheila M. Eldred Health Writer
One of the amazing things about little kids? Their energy, of course. They're here! They're there! They're everywhere all at once! Which is exactly why it’s not always easy to know when a child has attention-deficit hyperactivity disorder (ADHD), especially at younger ages when many of the symptoms are typical, age-appropriate behaviors. So when should you be concerned?
We talked to Flora Howie, M.D., a developmental and behavioral pediatrician at the Mayo Clinic in Rochester, MN, to find out.
The Key Feature of ADHD Symptoms
Keep in mind that to indicate ADHD, the symptoms that we'll discuss next must be pervasive, Dr. Howie says. In fact, the most recent guidelines state that a child must display symptoms in at least two different settings (school and home, for example), and they must interfere with their ability to function, Dr. Howie says.
So when your 5-year-old gets squirmy after sitting with adults at a 45-minute dinner, no need to rush to the pediatrician. Here's what to watch for instead.
Parents often describe the “H” in attention-deficit hyperactivity disorder as having a kid who seems to be the Energizer Bunny, Dr. Howie says. It’s typical for children to go through waves of energy and rest, but if a child appears never to rest and is always in motion over the course of the entire day, let your doctor know.
Take your child’s age into account, too, Dr. Howie says. A 5-year-old fidgeting and squirming through an appointment is different from a 10- or 12-year-old displaying the same behaviors.
Similarly, consider the setting. If a child is climbing up the windows in a doctor’s office, that’s different from non-stop motion at the park.
Inability to Sustain Attention
Many parents don’t have any concerns about their children until they head off to school, where the structured setting tends to highlight the challenged of ADHD, Dr. Howie says.
Take sustaining attention, for example. Young children typically have a short attention span. But by first grade, a child should be able to focus on something for 25 to 30 minutes, Dr. Howie says. If your school-age child has extreme difficulty paying attention to anything—even enjoyable activities—for that long, you may want to talk to your doctor. It’s especially important to bring this to a doctor’s attention if it’s interfering with school, she says.
All kids lose focus sometimes, but kids with ADHD may be so easily distracted, by, say, the birds in the tree outside, that they don't hear what the teacher is saying. At home, you may find that it takes your child an excessively long time to finish school work, routine chores, or even meals.
That was the case in Sara’s house before her daughter with ADHD left for college. If her daughter got into talking, dinnertime would easily last two hours. “On the positive side, we had really great conversations,” says Sara, who asked that we only use her first name.
At a young age, a highly impulsive child may be the kid who can’t resist poking the cactus or squeezing the kitten. Even a neurotypical toddler can be taught not to touch a hot stove, Dr. Howie says.
“But in a kid with ADHD, it’s very tough to teach that because you’re fighting against the fact that they’re doing it first and thinking later,” she says. “They don’t have that filter to pause.”
In a school environment, it may take the shape of blurting things out without waiting to be called on. At home, it may be frequent interruptions while you’re on the phone.
Prone to Accidents
Are you on a first-name basis with the nurses at urgent care?
Bumps and bruises are part of growing up, but kids who struggle with impulse control are much more accident-prone. If stitches, concussions, and broken bones seem as common in your household as coughs and runny noses, this could be one sign of ADHD.
They may be the kids getting in bike accidents at younger ages, and motor vehicle accidents at older ages, Dr. Howie says.
Though it may seem like your little bundle of energy should crash into a deep sleep every night, ADHD is actually associated with sleep problems. “At the end of the day, bringing that motor down can be difficult,” Dr. Howie says.
Once they do conk out, they’re more likely to have trouble staying asleep, often due to nightmares, bedwetting, or other sleep disorders.
And poor sleep can exacerbate ADHD symptoms, according to the National Sleep Foundation. That's why having an accurate diagnosis is key. Fatigue is associated with inattentiveness and restlessness, so sometimes a child will appear to have ADHD when they actually have a sleep disorder, Dr. Howie says.
Difficulty Reading Social Cues
When Sara’s daughter was in elementary school, she struggled to interact with the other kids, Sara says.
“She would repeat things over and over until others would react,” Sara remembers. “She couldn’t give up, and she couldn’t intuit how kids were reacting to her, and how annoying she was being. When I would volunteer in the classroom, I would gasp and think, ‘Stop doing that! That kid is so irritated.’ She didn’t see it.”
If a child struggles with this type of social interaction by the time they start school, it could be a sign of the uniquely impulsive behavior of ADHD, Dr. Howie says.
Other Complicating Factors
There are several other conditions that mimic ADHD, Dr. Howie cautions. Take a child who has anxiety and a phobia of thunderstorms. If his mind is obsessed with worry that it’s going to rain, he may appear inattentive.
Girls with ADHD often also have a mood disorder, Dr. Howie notes. And sometimes that disorder is recognized, but not the underlying ADHD.
There's also a link to autism. Between 30% to 50% of children with autism-spectrum disorder also have ADHD, and that can make each diagnosis more challenging. It’s helpful to work with someone familiar with both disorders to get a complete diagnosis, ADDitude magazine notes.
What to Do Next
If you're concerned about ADHD, your first step, as always, is to talk to your pediatrician. He or she will want to gather feedback not only from you and teachers, but also any counselors and coaches, says Dr. Howie. That input helps establish that symptoms are pervasive in multiple settings.
And once there is a diagnosis, it’s often a relief, she adds. “It gives parents a name for what’s going on and it opens up a whole world of services and behavior interventions,” she says. “And a child who can put a name to what’s going on is better equipped to work on it.”