This question crosses the mind of most parents at one time or another. Your five year old has launched his shirt into the ceiling fan, climbed the furniture, knocked over the potted plant and thrown a ball which gave his little sister a bloody nose; all in the space of twenty minutes. You are at your wit’s end and wonder if this behavior can possibly be normal or if as a parent you are missing something.
The primary symptoms of ADHD: impulsivity, inattention and hyperactivity to some extent describe all normal children. So, how do you know when your child’s behavior crosses the line from normal to abnormal? ADHD is a neurobiological disorder characterized by a pattern of persistent developmentally inappropriate impulsivity, inattention and hyperactivity. Extensive radiologic and other studies looking at brain size and function as well as genetics have extensively proven ADHD is a real disorder.
A key term in the definition of ADHD is “developmentally inappropriate.” All toddlers are incapable of sitting still to do a sedentary activity for 30 minutes. All-eight-year olds should be able to accomplish this task. What is developmentally appropriate at one age is not at another. Diagnosing ADHD below the age of 5 is therefore very difficult. Most medical providers who routinely treat ADHD are hesitant to diagnose ADHD below this age. There are exceptions, especially for at-risk children or children with a strong family history. So, if your child is under 5 and you have concerns, speak with your pediatrician about formal evaluation.
If your child is 6 or older and seems outside the norm for her age, how do determine if she has ADHD?
First, know the symptoms:
ADHD has three subtypes: inattention, hyperactivity and impulsivity. Children can be one subtype or mixed types. For a diagnosis, six (or more) of the following subtype symptoms should have persisted for at least six months to a degree that is inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
(b) often has difficulty sustaining attention in tasks or play activity
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations where it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)
Some symptoms must have been present before age 7 and some impairment from the symptoms must be present in at least two settings (e.g., at school [or work] and at home).
Get a formal evaluation
There is no single medical, physical or cognitive test to diagnose ADHD. Formal evaluation involves input from multiple caretakers including parents, school teachers or daycare providers as well as a medical evaluation to make sure the child doesn’t have other conditions that mimic ADHD. Some pediatricians, psychologists, psychiatrists and social workers specialize in treating ADHD. Talk to your child’s doctor to determine the best place for an evaluation.
Because some children are given the diagnosis of ADHD and medication without appropriate evaluation and the necessary three-pronged approach to treating ADHD, there has been much attention given to the idea the disorder isn’t real or that children are being drugged instead of parented or taught in school.
This emphasizes the importance of making a diagnosis only after an appropriate evaluation and then implementing treatment that involves the correct medication and dosage, behavioral plans and environmental interventions. Instituting this three-pronged approach takes much time and effort as well as trial and error. Children with mild ADHD can sometimes be helped with behavior modification alone.
Children who aren’t getting adequate sleep, nutrition or exercise, who are depressed or abused, who have anemia, lead poisoning, hearing or speech impairment, or who have hypothyroidism, sensory integration disorder or central auditory processing disorder can all exhibit signs of ADHD although they truly do not have ADHD. Children who truly have ADHD also tend to be more symptomatic in these conditions. Part of the evaluation of ADHD should therefore also include excluding these conditions.
Help Starts at Home
There are things that you can do as a parent to improve your child’s behavior and help yourself have a better day (envision the 5 yr old ceiling fan, potted plant and bleeding little sister incident). Whether he has ADHD, these interventions help the behavior of all children:
- Children thrive on routine. Establish standard times for meals, activities and sleep.
- Make sure your child is getting adequate sleep both in number of hours and appropriate naps.
- Set realistic expectations. Have you ever observed a mother and preschooler in the mall shopping for 2 hours? At the end of that time, the child is a terror, pulling things off shelves, screaming and throwing temper tantrums. She likely doesn’t have ADHD; she has a parent whose expectations are outside of what she can reasonably accomplish. Another example is a parent at home working and the same child left to play alone for 2 hours. Unrealistic expectations. We all have days we need to accomplish much more than playing with our child(ren). The key is to break up those long blocks of time into smaller pieces. Shop for 30 minutes, then let her run around at the mall playground for 20 minutes, shop another 30 minutes then break for a snack. When you are shopping tell her you need her help finding 2 red shirts or remembering the words to a favorite song, rent a stroller so she can nap. These all set her up for success and make your day less stressful.
- “Catch him being good.” Studies show that complimenting your child 5-10 times for every time you scold him not only makes him better behaved but smarter. Work hard to point out the times he does the right thing and he will work hard to get more positive attention.
- Make a plan and talk to her about it at the beginning of the day. For younger kids this can be a simple, “We are going to get our shoes on, go to the store and then go to the park.” For older kids who can’t read, this can be a “list” with pictures of shoes, the grocery store and the park. Once she can read, replace pictures with words. Give her a washable marker to check the boxes.
- At the end of those crazy “ceiling fan” days, assess what worked and what went wrong. Make adjustments and congratulate yourself for working hard to help your child be at his best.
Can ADHD medications making my child a “zombie?” Does avoiding artificial dyes and sugars make ADHD worse? Do dietary changes really work?
Can poverty, unstructured lifestyle, too much TV or poor parenting cause ADHD?
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