All toddlers and young children are active, excitable, and less than 100 percent attentive to what Mom and Dad have in mind -- you'd be worried if they weren't. But some children are dramatically more active, impulsive, and inattentive than other kids their age are, and that's when you might start to wonder, as a parent, if what you're seeing is attention-deficit hyperactivity disorder (ADHD).
The stereotype of kids who have ADHD is that they have trouble in school -- they can't sit still, can't wait their turn to talk, can't follow the teacher's directions, are always losing their jacket or backpack, and can't seem to get their homework done. In fact, the symptoms of ADHD show up in all the parts of a child's life.
There are three sets of behaviors that define ADHD: hyperactivity, impulsivity, and inattention. Here are some key signs that a child might be hyperactive and impulsive:
- He fidgets and squirms a lot
- He often gets up out of his seat
- He run or climbs excessively
- He has trouble playing quietly
- He always seems to be on the go or driven by a motor
- He talks excessively
- He blurts out answers
- He has trouble waiting for his turn
- He interrupts or intrudes often
Symptoms of the third set of behaviors -- inattention -- include:
- She makes careless mistakes
- She has trouble paying attention to a task
- She doesn't seem to be listening when spoken to directly
- She doesn't follow instructions
- She has trouble organizing
- She avoids or dislikes sustained effort
- She's always losing things
- She's easily distracted
- She's forgetful
ADHD behaviors usually become apparent when a child is between 3 and 6 years old. Parents often notice the hyperactive/impulsive behaviors first, when a child is a toddler. Signs of inattention may not be picked up until children go to school, when they are expected to focus for longer periods of time than they may be at home.But isn't that stuff normal?
There is obviously no child who doesn't display these behaviors occasionally, so the rule of thumb is that kids with ADHD display them three times more frequently than their peers do. Each child's behavior must be considered relative to others at her developmental level. And it's important to note that a child should be compared to others of her age -- not in her grade in school -- because a typical classroom has a spread in ages that may be significant developmentally.
One reason ADHD can be difficult to understand, and diagnose, is that it's what we call a "dimensional" disorder, which is to say that the behaviors involved are present in all children; the difference in a child with ADHD is one of degree. Think of them as the extreme end of a spectrum.
For instance, any child may want to borrow or use other kids' toys, but a child with ADHD constantly grabs toys from other children. Any child calls out or interrupts every once in a while, but a child with ADHD does it so often it's disruptive or annoying. Any child will occasionally fall down or have accidents, but a child with ADHD will have frequent accidents and may end up in the emergency room. Any child might occasionally dart away from a parent on impulse; a child with ADHD is so impulsive, parents need a leash to keep him from running into the street.
Another way to think of the difference is that although all kids may exhibit these behaviors, highly energized, active children without ADHD can usually focus when it is necessary to accomplish a goal. Kids with ADHD can't.