ADHD or Immaturity?

ADHD or Immaturity?

Your child’s impulsive behavior may be a sign of ADHD. Treatment can help.

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Young boy sitting at a desk with a bored look on his face

Picture this: your child has been running in circles, talking nonstop all day. They seem incapable of listening to you or following directions. Is your child exhibiting normal childhood behaviors, or does your child have ADHD?

The answer might depend on if you are talking about a three-year-old or a ten-year-old, along with several other factors.

“Most two- to three-year-olds are hyperactive and impulsive — that’s part of normal development,” explains Dr. Catherine Karni, child and adolescent psychiatrist and Medical Director of the Psychiatry Outpatient Service at Children’s Health℠. “We become concerned about ADHD in a child when the symptoms extend beyond that.”

What is ADHD?

ADHD, or Attention Deficit/Hyperactivity Disorder, is a disorder characterized by difficulties with attention and/or impulsivity that exceed normal expectations. A person with ADHD may find it difficult to maintain focus/concentration 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.

Red flags for a possible ADHD diagnosis

Diagnosis of ADHD 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 his/her peers.

Symptoms 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.

How an ADHD diagnosis is made

“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 of the Children’s Health Pediatric Group.

Dr. Johnson stresses that it’s important not to confuse symptoms 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 pediatric psychologist or neuropsychologist 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:

  • Anxiety
  • Depression
  • 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.

Getting treatment for your child’s ADHD

“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.

Learn More

Learn more about ADHD and how Children’s Health can help you find a diagnosis and treatment plan.

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