Most experts agree that the tendency to develop ADHD is present from birth, yet ADHD behaviors are often not noticed until children enter elementary school. One reason for this delay is the fact that nearly all preschool-aged children frequently exhibit the core behaviors or symptoms of ADHD—inattention, impulsivity, and hyperactivity—as part of their normal development. As other children gradually begin to grow out of such behaviors, children with ADHD do not, and this difference becomes increasingly clear as the years pass.
School settings can highlight a child’s problems relating to inattention, impulsivity, and hyperactivity because classroom activities demand an increased amount of focus, patience, and self-control. These types of demands are not as prevalent at home or in playgroups, so in those settings, the child may have had fewer problems.
Usually by the time a child with ADHD reaches age 7 years, his parents have already become aware that their child’s inattentiveness, level of activity, or impulsiveness is greater than is typical. You may have noticed that your child finds it nearly impossible to focus on a workbook for even a very short period, even when you are there to assist him. Or you may still feel as worn out at the end of a day with your overly active 8-year-old as you did when he was 2.
Your child may ask adults questions so often that you have begun to suspect it is not “normal.” Or, you may have noticed that he does not seem to be picking up the nuances of social interaction (respecting others’ personal space, letting other people have a turn to talk) that his playmates are beginning to adopt. Yet it is difficult for a parent to tell whether such behaviors are just part of the normal process of growing up (“Plenty of six-year-olds get bored with workbooks!”), whether they are more frequently problematic because of parenting difficulties (“Maybe I’ve been too inconsistent with setting limits.”), or whether this child’s temperament puts him far to one end of the spectrum (“He’s always been a handful.”), but not so far as to represent a disorder such as ADHD.
This is why, for a child to be diagnosed with the disorder, the AAP advises pediatricians to gather information about the child’s behavior in at least one other major setting besides his home—including a review of any reports provided by teachers and school professionals. By comparing the child’s behavior across 2 or more settings, the pediatrician can begin to differentiate among such varied reasons for attentional problems as a “difficult” but normal temperament, ineffective parenting practices, inappropriate academic setting, and other challenges. She can also clarify whether the child’s behavior is preventing him from functioning adequately in more than one setting—another requirement for diagnosis.
What Parents Notice When ADHD Behaviors Emerge
It is sometimes hard to match the behavior we observe in our children with the formal terms used by pediatricians and other medical professionals. We rarely think of our children as having “hyperactive-impulsive problems.” Instead, we think, “Why can’t he ever settle down?” To confuse matters, the terms that doctors use for these behaviors have changed in recent years. The term “ADD” (attention deficit disorder) was once commonly used, and referred primarily to the form of ADHD with “inattentive only” symptoms. These children are not overly active, and their symptoms may even go unnoticed by many adults because their behavior is not disruptive. But more recently, the umbrella term “ADHD” is typically used when describing all types of ADHD. When reviewing the list that follows of typical remarks made about children with ADHD, ask yourself how many times per day or week you say or think the same things yourself. It is true that all parents make such comments now and then, but parents of children with ADHD continue to see the same behaviors on a daily basis, and for extended periods—long after other children have progressed.
Parents of Children With Predominantly Inattentive-Type ADHD Say
“He seems like he’s always daydreaming. He never answers when I talk to him. I wonder if he hears me.”
“He loses everything. I’ve had to buy four new lunchboxes since school started.”
“I’ll ask him to go up to his room and get dressed, and ten minutes later I find him playing with his toys with only his shirt on.”
“He can’t remember what he learns because he misses instructions and explanations in school. Even though we work so hard on his schoolwork at night, by the next day he’s forgotten everything.”
“One teacher called him her ‘space cadet,’ and another her ‘random student.’ ”