Does my child have ADHD?

Emily is almost six. Lately, she has been acting up in her kindergarten class. The teacher says she doesn’t always pay attention, she doesn’t finish her work, and she's often fidgety and overactive. Could she have Attention Deficit Hyperactivity Disorder?

ADHD is a possible explanation for Emily’s behavior, but before jumping to that conclusion, you will need a lot more information. Before worrying about a diagnosis, you need specific details about how Emily is behaving at school.  Is her behavior similar to what you see at home or when she is playing with her friends?  Or is there something in the school environment that is affecting her differently?  Is the behavior the teacher is concerned about present throughout the school day or only at certain times?  Are there times when she can stay on task, sit still, and keep her focus?

After you have a good idea of the behavior that is of concern, it’s important to take a look at possible causes for how she is acting.  Here’s an overview of reasons why a five year old might be inattentive, distracted, or fidgety in school.

• Lack of sleep: Children who are sleep deprived tend to be easily distracted, have shorter attention spans, and have difficulty with self control. These are the same symptoms that lead to a diagnosis of ADHD.  Most 5 year olds need 10 to 11 hours of sleep every night. If she has trouble waking up in the morning she isn't getting enough sleep. Keep in mind that children who stay up too late often get a “second wind” and have trouble falling asleep even though they are tired.

•  Difficulty seeing: If your child has difficulty reading words on the board or on paper, she will not be able to do work.  If she can't see expressions on other people's faces  she might seem to be ignoring the teacher. A child with any school difficulties should have vision evaluated by a optometrist or opthomalogist experienced in working with children.

•  Hearing problems:  Even a minor hearing loss in one ear may make it hard for your child to hear directions when the teacher is speaking to the group. Emily should get a complete audiometric evaluation. 

• Medications:  Some medications, including over the counter medications and supplements, have side effects that may cause your child to fidget or be restless and inattentive. Some medications that cause drowsiness in adults can get children revved up.  Any medications should be reviewed with a pharmacist as well your child's pediatrician.

• Other medical problems: Neurological, endocrinological, and other systemicproblems may influence a child's classroom behavior.  Emily should have a complete "well child" evaluation before getting a specialized evaluation for ADHD.

•  Sensory issues: Some children are very sensitive to the auditory and visual stimulation of the average classroom.  They may act inappropriately because they can’t filter out background stimulation as easily as other children. Surprisingly, some children are bothered by environments that are too quiet!

•  Learning disabilities: Emily may be having difficulties learning to read, to do arithmetic, or in doing other activities required at school.   These difficulties can cause a child to misbehave or to be inattentive or restless because she can't (not won't) do the work. A child may have even have a learning disability in addition to having attentional issues.  It is important to recognize both.   Before evaluating for ADHD it's important to have the teacher rate your child's progress in skills and if necessary have a school psychologist evaluate your child's learning skills.

•  Emotional stress or anxiety:  If Emily is coping with stressful events at home, her behavior at school may be affected.  Serious problems such as divorce or death cause stress, but so do changes such as a move, a new baby, or long hours in childcare.  A conference with the teacher may help sort out these issues.

•  Reasonable expectations:  How does your child’s behavior compare to other children her age?  Is her behavior developmentally appropriate but not in sync with others in her class? Is she being compared with the average student in her class or typical children her age?

It’s understandable to worry when you hear that your child is having difficulties in school.  What is most important is to find the right way to help her. Enlist the help of the teacher, the school psychologist, and other adults at school who know Emily.  Check with her pre-school teachers to find out if the behavior is similar to what they noticed when she was younger.  Schedule a visit with your pediatrician to discuss what your options are for an evaluation. Don’t rush--a careful and thorough evaluation will in the long run yield better results than a quick diagnosis.