Are you one of the thousands of parents out there worried that your child may be struggling with Attention Deficit-Hyperactivity Disorder or Attention Deficit Disorder? The diagnosis of ADHD/ADD is not as simple as diagnosing many other medical issues. There is no “test” for ADHD/ADD and many of the symptoms that are used to make the diagnosis are also symptoms of having just a high energy child. In fact, when you look at the list of symptoms it is clear that probably every child will have some of these symptoms at some time in his or her life. I have been working with children and adults with this disorder throughout my over twenty-five years in the field, and I have learned that some symptoms are much more meaningful than others.
The first thing to keep in mind is that there are two basic categories for this disorder, one with hyperactivity and one without. Children with the hyperactive subtype are much easier to spot, especially if he is on the more extreme side of the hyperactivity scale. Most of us have probably known one of these kids in our lives. You know the kid who literally is unable to sit still, keep himself from interrupting, acts out impulsively and gets himself in trouble over and over again. I am saying “he” here because the vast majority of this subtype is male. It is true that these symptoms do not mean that a child has ADHD, maybe his/her parents are in the middle of a high conflict divorce, or maybe he/she lives in an alcoholic family system. However, these more extreme and “in your face” type of behaviors tend to set off warning signals in both parents and teachers early on. These kids tend to get evaluated sooner and receive intervention earlier than children without the hyperactivity component.
The diagnosis can be made when six of these nine symptoms for the Hyperactive/impulsive type of ADD are present, according to The Diagnostic and Statistical Manual of Mental Disorders or DSM-V:
- Fidgets with hands or feet, squirms in seat
- Leave seat in classroom
- Runs about or climbs excessively
- Difficulty playing quietly
- Often seems “on the go” or “driven by a motor”
- Talks excessively
- Blurts out answers before questions have been completed
- Has trouble taking turns
- Interrupts or intrudes on others
According to my experience here are some other Hyperactive/Impulsive symptoms to look for. Although not necessary for the diagnosis, these are some of the extenuating symptoms that I pay attention to clinically when making a diagnosis:
- Tends to get into conflicts with peers
- Can be oppositional with teachers
- Likes to rile up the pets in the house
- Appears to purposefully stir up conflict in the home
- Nicotine and marijuana use at an early age
- Does not seem to learn from consequences
- Gets in trouble during the most unstructured times like PE or after school care
- Struggles with temper in team sports in elementary and middle school
- Emotional development seems to be a year or two behind peers
- Emotionally explosive when losing in any competition
- Inconsistent or poor sleep patterns
- Inconsistent or poor eating patterns (does not eat much)
- Inconsistent or poor hygiene for his/her age
- Chronic resistance to homework
- Chronic lying over homework
- Difficulty during transitional periods of the day like transitioning to bed time.
The inattentive subtype of ADD can look dramatically different than the Hyperactive subtype. Most children with the Hyperactive subtype are going to have a large number of the symptoms of inattention as well, but it does not work other way around. Inattentive ADD children usually get the diagnosis much later than their hyperactive counterparts and very often do not get diagnosed at all. The percentage of females is much higher here but still below the percentage of males. These children can slip through the cracks of the school system and tend to do poorly and receive no help for what they are dealing with.
To the outside world, these students seem lazy and uncaring. Children with ADD/ADHD hear that they are “lazy” thousands of times in their lives and they typically incorporate this outlook of themselves by middle school. Parents can’t understand why their child can be so focused on video games or skateboarding but not on school. Usually, the children themselves do not even realize that something is wrong until high school, if ever. These children can go through life just thinking that they are stupid, lazy and that they won’t ever be able to succeed in school. Their long term outlook for themselves is generally that they can’t do well enough in high school to get into college, and therefore will never be able to get a decent job and be self supportive. It is no wonder that by high school the untreated teens that I see in my office almost all have some level of secondary depression related to this outlook on their lives. Five to ten years of academic struggle and failure will also take it’s toll on a child. This is a major contributor to the high levels of substance abuse that occur in this population, especially if untreated.
Below are symptoms to look for if you are worried that your child or teen is struggling with Inattentive ADD. Six of the following nine symptoms are required for the diagnosis of Inattentive ADD according the DSM-V:
- Poor attention to detail or makes careless mistakes
- Difficulty staying focused (excluding video games or other high intensity activities)
- Does not listen or mind seems elsewhere, even in the absence of obvious distractions
- Difficulty with follow through
- Difficulty organizing tasks or activities
- Avoids, dislikes, or reluctant to engage in activities that require sustained attention (excluding video games)
- Often loses things including things of importance
- Easily distracted by extraneous stimuli
- Forgetful in daily activities
Keep in mind that these symptoms have to be persistent for at least 6 months, have to be inconsistent with the developmental level of the person and are not clearly a reaction to life circumstances like the death of a loved one. The list of symptoms for the diagnosis is very good but is less than what I look for in my clinical setting. As with the Hyperactive subtype, there are other clues that can help us paint an accurate clinical picture:
- Likes learning and used to like school but has increasingly struggled in school and/or severely dislikes school , starting in elementary school
- The student’s academic achievement seems far below his or her intellectual ability
- Has very high levels of anxiety or dread related to the academic portion of school
- Constantly has many missing assignments, no matter how hard you try to help
- Avoids homework
- Very messy
- Looks lazy academically or with chores but is not a lazy person in general
- Thinks of self as unintelligent and unable to keep up academically
- Teachers report that the student is not a behavioral problem in class but that they do not seem to be understanding or remembering what was covered in class
If you are concerned that your child might be struggling with ADHD or ADD, the best course of action is to consult with a professional with expertise in this Diagnosis. Any therapist or medical doctor that works with children on a regular basis should have good working knowledge of the disorder, but I would ask if it is a specialty. Getting multiple opinions from your pediatrician, a therapist and maybe even the school psychologist is probably the wisest choice of action when trying to figure out what is causing your child to struggle.
