According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the prevalence rate for Attention-Deficit/Hyperactivity Disorder (ADHD) “occurs in most cultures in about 5% of children” (p.61). But if you talk to anyone, you’d start thinking that these numbers are much higher. So, what’s going on?
Even though we’ve probably all at least heard of ADHD, do we really know what it’s all about? When we think about ADHD, we think about the child who’s busy… running around, not thinking before acting, climbing on stuff, fidgety, talks a lot, can’t sit still, plays loudly, and so on. This is the behavior we can see and that’s most disruptive to everyone around. When children are being described this way, this is when talk about ADHD often starts. There’s another kind of ADHD; the kind that’s not as obvious. This kind describes the child who might stare blankly, doesn’t seem to be listening, needs to have instructions repeated, is not paying attention to details, seems careless, is forgetful, loses things, is disorganized, avoids some tasks, and is easily distracted. We don’t hear about these children quite as often because they’re not particularly disruptive. Although these are some of the behaviors that describe a child with ADHD, there are a lot of other factors that need to be taken into consideration before a diagnosis can be made.
Instead of thinking right away that all behavior might be explained by ADHD, it’s important to take the time to make sure that something else is not happening. Children don’t have the same degree of language that adults do. Their primary way to communicate to us that something is going on is through their behavior. Although this is especially true for young children, it also holds true as children get older. They don’t always have the skills to articulate exactly what’s happening… even if they know.
Children with allergies can be very uncomfortable in their bodies. Sometimes this accounts for the inattention and squirminess we see. Children who are feeling sad and disconnected also struggle to pay attention and give their full energy to school. Aggression, irritability, and anger can be masking a depressive disorder. With all the pressures and demands that children face in school, and particularly at this very unusual time in our lives, it is not surprising that a number of them are experiencing anxiety.
Anxiety can look like inattention, irritability, fidgety behavior, and even withdrawal. Maybe the child is intellectually advanced, which can look a lot like inattention, and even a lack of motivation or ‘laziness.’ There might be an unidentified learning disorder that is contributing to some demoralization and reduced self-confidence. What looks like inattention might really be related to memory challenges. Sometimes there are language processing disorders. Just because a child speaks well, doesn’t necessarily mean that they fully understand all that they’re hearing. It could be that there are problems with the child’s hearing that are not immediately obvious. Individual temperament, illness, nutrition, developmental stage, family and/or peer conflicts, and other people’s tolerance for different levels of behavior are examples of other factors that also need to be considered. Even though this isn’t a comprehensive list of all the things that might be going on, it gives a sense of the scope of alternative explanations for behavior that might appear to be consistent with ADHD.
Understanding children’s behavior is a complex business. Just because it looks like ADHD, doesn’t necessarily mean that it is. For parents, it’s important to ensure that a comprehensive course of evaluation occurs before any choices that would impact your child are made. Regardless of any potential diagnostic outcome, however, therapeutic intervention is an important component for increased health and calm, not only in the child’s life, but in the functioning of the family.
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