Is it ADHD or not? Why deciphering the clues can be difficult

Rachel¹ recalls being eager to meet with her son’s psychologist: at last she’d have clear reasons for her son’s challenges in school. But the diagnosis, when it finally came, took her by surprise.

"The psychologist said my son had ADHD, but at first it didn’t seem to add up. He was cooperative in class and at home, and we would never have described him as hyperactive. The issues that concerned us were his problems with staying focused and producing written work. I felt awfully foolish to think that a big part of the mystery we had been trying to unravel had been ADHD all along."

With ADHD – or Attention Deficit Hyperactivity Disorder – showing up in around 10 percent² of North American children, Rachel’s just one of many parents who have wrestled with the question Could my child have ADHD?

A confusing task

All things considered though, that’s not an easy issue to sort out. Sifting through possible symptoms and deciding whether to seek a professional opinion can be a confusing task for parents.

The most characteristic signs of ADHD include unusual inattentiveness, impulsivity and hyperactivity, but there are many other indicators to consider too. What’s more, these three characteristic symptoms are not always present together. Many children with ADHD show little of the impulsivity or hyperactivity commonly associated with ADHD, yet struggle mightily to pay attention in the classroom and keep their thoughts focused on the task at hand.

Contradictory behaviours

To make matters even more confusing for parents, a child who has ADHD very often presents a contradictory set of behaviours. For example, a child with ADHD might:

• be able to stay intensely focused when working on a task that they enjoy, yet seem barely able to concentrate at all when the task is more mundane
• seem to have near limitless, irrepressible energy much of the time, yet also at times be extremely lethargic
• show amazing recall of facts they learned last week, yet frequently forget instructions they were given just a few minutes ago
• sometimes impatiently insist on starting a task "right this minute," although, as a rule, they usually procrastinate terribly – even on vitally important assignments
• show remorse for tormenting a sibling that seems genuine – as indeed it is – yet later that same day be "caught in the act" once again.

Another reason why deciphering the signs of ADHD can be confusing for parents is that ADHD doesn’t typically occur in isolation. Around two-thirds of children with ADHD also have at least one other co-occurring condition. The most common "tandem" condition – showing up in nearly half of all children with ADHD – is some type of learning disability.

ADHD is covert and changes

An additional complicating factor for parents is that the signs of ADHD can change over time. By middle school, ADHD’s characteristic hyperactivity has greatly diminished and may be virtually undetectable in most children. By the high school years, however, "inattentive type" ADHD can begin to show up in children previously unsuspected of having ADHD. These are typically intelligent children who have coped well until this point in time, but can no longer keep up with the increasing demands of school work and the level of personal organization needed to stay on top of it.

Then there’s the covert nature of ADHD to consider. Because ADHD is a hidden and difficult to imagine disability for those who don’t suffer from it, it’s hard for parents to evaluate ADHD’s impact on a child. It’s easy to dismiss the signs of ADHD and mistakenly conclude that a child is simply disobedient, impatient, lazy, intentionally disruptive, a daydreamer or "not trying hard enough." The tragedy and injustice of it all is that, meanwhile, the child may be struggling heroically to resist ADHD’s influence and "be a good kid."

Medical imaging and biochemistry

Fortunately, medical imaging and biochemistry have now offered irrefutable evidence that ADHD is a legitimate, neurodevelopmental condition and that the child – despite good intentions – is being thwarted time and time again by their "ADHD brain." Researchers have identified anomalies in the function of certain neurotransmitters, plus structural differences in at least four regions of the brain. Some of the affected regions are known to be involved in inhibiting specific behaviours – behaviours that include initiating tasks, ceasing unwanted behaviour, understanding consequences, holding information in memory and planning for the future.

One strong indicator of the possibility of ADHD that might help parents is a family history of ADHD. It’s now well established that ADHD is highly heritable. If just one parent has ADHD, the odds of an offspring inheriting it are about 30 percent. If two parents have it, the odds jump to over 50 percent for the child. At the same time, however, very many parents are unaware that they themselves have ADHD. In the United States, it’s estimated that only 15 percent of adults with ADHD have been diagnosed and treated.

Why a sure diagnosis is important

For a helpful checklist of potential signs of ADHD, BC Children’s Hospital provides a good explanation of the condition on their website at Aboutkidshealth.ca. However, if you have any concerns at all about the possibility of ADHD in your child – particularly if your child is elementary school age or older – you should certainly consult a medical professional. A developmental pediatrician, pediatric neurologist or child psychiatrist is a good choice. Your family doctor will likely serve you well too, provided he or she has expertise in diagnosing and treating ADHD.

Besides the relief of putting your mind at rest, there are several compelling reasons why you should not delay in seeking an assessment of your child.

Firstly, a thorough assessment is important because other conditions beginning to manifest in childhood can look like ADHD. Supposed symptoms of ADHD can instead be signs of bipolar disorder, autism, hypoglycemia, hypothyroidism, sensory processing disorders, sleep disorders, hearing problems, stress or one of a number of other issues.

Secondly, as discussed earlier, your child may have an unsuspected co-occurring condition that needs attention. There’s the high frequency of learning disabilities among children with ADHD to consider. As well, and not surprisingly, children with ADHD may hide deep emotional wounds – a natural consequence of struggling with a condition that so often leaves them feeling frustrated, misunderstood, incompetent, out of control or even unloved. Counted together, significant anxiety or depression is diagnosed in nearly one third of children with ADHD.

Taking that last point into consideration highlights one more good reason to seek diagnosis sooner rather than later: early and sustained intervention by parents changes the trajectory for a child with ADHD, pointing them toward a much more positive future.

Long-term studies of families show that medication alone is not sufficient, but when parents become well-informed, intensively involved, and show mature, unconditional love, ADHD’s intrinsic weaknesses tend to become inconveniences rather than barriers to success.

Managing weaknesses well

Parents play a winning hand by teaching their child coping strategies and a sense of responsibility to manage weaknesses well. Two additional and vital strategies for parents – according to Edward Hallowell, a psychiatrist specializing in ADHD – are protecting their child’s self-esteem, and helping their son or daughter build confidence by focusing on the things they do well and the enviable gifts that commonly come along with ADHD.

Those gifts, as described in Hallowell’s book Delivered From Distraction, commonly include "originality, creativity, charisma, energy, liveliness, an unusual sense of humour, areas of intellectual brilliance and spunk."

"[T]he development of talent is a crucial but often neglected goal of the process," advises Hallowell. "You build a life on your talents and strengths – what is right and good about you – not on your weaknesses, however skillfully they might be corrected."

A turning point

If your child is eventually diagnosed with ADHD, don’t consider it a low point. Rather, it’s an important turning point. ADHD is one of the most intensively studied childhood conditions, and if you’re willing to do the work, you’ll discover excellent insights into the condition, and effective strategies.

For your child, there’ll be tremendous relief in being better understood by those he or she loves most. You’ll bring reassurance to your child too – reassurance that can be life changing – when they realize that God did not create them lesser than others, but in fact has entrusted them with extra responsibilities. They have areas of weakness that others don’t have, in addition to wonderful strengths. Managing their weaknesses well – perhaps not perfectly, but to the best of their abilities – is an offering that honours the Lord just as legitimately as fabulous strengths.

1. Name changed by request

2. Estimates are based on surveys of children in the U.S. The incidence of ADHD varies according to age group. CHADD.org gives rates of 11.4% for ages 8-12, 8% for ages 13-18 and 5% for ages 19 and above.

For further reading:

Aboutkidshealth.ca, provided by BC Children’s Hospital

CHADD.org, provided by the advocacy group Children and Adults With Attention-Deficit/Hyperactivity Disorder

CADDRA.ca, provided by the Canadian ADHD Resource Alliance