There are a variety of reasons a child may have trouble sitting still, following directions or paying attention. Often, this behavior could be due to age or maturity level. However, frequent hyperactivity or trouble concentrating could be a sign of attention deficit hyperactivity disorder (ADHD). So how can you tell if your child is exhibiting normal childhood behaviors, or if they are exhibiting symptoms of ADHD?
The answer might depend on if you are talking about a 3-year-old or a 10-year-old, along with several other factors.
"Most 2- to 3-year-olds are hyperactive and impulsive – that's part of normal development," explains Dr. Catherine Karni, Medical Director of Outpatient Services at Children's Health℠ and Professor of Psychiatry at UT Southwestern. "We become concerned about ADHD in a child when the symptoms extend beyond that."
What is ADHD?
ADHD is a neurological disorder characterized by difficulties with attention and/or impulsivity that exceed normal expectations. A person with ADHD may find it difficult to maintain focus in certain situations. Some people with ADHD may be impulsive and restless, finding it hard to sit still, but this is not always the case.
Most symptoms of ADHD begin in childhood and become more noticeable when a child begins school. A child with ADHD who demonstrates impulsivity and difficulties sitting still may become less hyperactive as he/she grows older. Difficulties with focus and attention also can improve as the brain matures. However, symptoms of ADHD sometimes can continue into adolescence and adulthood.
Signs of ADHD in children
Diagnosing ADHD in children is based on several factors, including attention levels and activity levels. A child with ADHD may have the following symptoms beyond what most children their age demonstrate:
- Trouble sitting still
- Difficulty following directions
- Poor planning and organizational skills
- Disruptive in a classroom setting (e.g., talking, leaving seat)
- Forgetful (due to inconsistent attention)
- Hard time keeping hands to oneself
- Impulsive behavior
Many times, a child who has ADHD may be described as the class clown. Symptoms of ADHD can affect not only a child's academic performance but also a child’s social development. For example, if a child is not carefully focusing on subtle facial cues or tone of voice, he/she may not react appropriately in some social situations. A hyperactive child also may annoy peers.
Signs of ADHD are not limited to the classroom or particular instances. To meet criteria for a diagnosis of ADHD, symptoms must have been ongoing for at least six months and must be interfering with your child's ability to function.
"Evidence has to be present in multiple settings, and we want to see a pattern of difficulties that are affecting function over a period of time, not just in the context of a stressful situation," explains Dr. Alice Ann Holland, a board-certified pediatric neuropsychologist and the Research Director for the Neuropsychology Service at Children's Health.
Diagnosing ADHD in Children
“There are studies that show that the rates of diagnosis are increasing; however, it’s not clear if that’s relative to greater incidence, or if it’s because of more awareness – for example, schools implementing screening measures,” says Dawn Johnson, M.D., Associate Medical Director at Children’s Health.
Dr. Johnson stresses that it’s important not to confuse signs of ADHD with immaturity. “Maturity level must be considered when evaluating for an ADHD diagnosis,” she says. Pediatricians often offer screenings for ADHD and then, if necessary, may refer your child for a comprehensive evaluation by a developmental pediatrician or pediatric psychologist to confirm the diagnosis.
It is important to recognize that attention problems may not always be a sign of ADHD. Attention problems can also be caused by other factors, including:
- Sleep problems
- Stressful life events
“It often may not be clear what is causing the symptoms, so a comprehensive evaluation can be helpful to determine if an ADHD diagnosis is appropriate,” says Dr. Johnson.
Treatment for ADHD in children
"Although there is no 'cure' for ADHD, currently available treatments may help reduce symptoms and improve functioning," says Dr. Karni. "ADHD is commonly treated with medication, education, training, therapy or a combination of treatments."
One treatment that has been supported by research is behavior modification, which involves a behavioral therapist working with the child to identify certain behaviors that need to be addressed. A reward system may be established, such as a sticker chart or bestowing privileges, in order to encourage the child to work on the behavior. Parents are actively involved in this process, with the therapist teaching them how to most effectively reinforce positive behaviors for their child.
There are also different medications – both "stimulants" and non-stimulants –that have been shown to reduce symptoms of ADHD. These medications are considered the first line of treatment for ADHD but should always be supplemented with behavioral supports and interventions. ADHD medications may have some side effects, including decreased appetite and problems with sleep. Each child responds to medications differently, so talk to your doctor about what to expect if your child begins medication for ADHD.
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