Whether your child is struggling to focus during class or they just can’t sit still, you’ve probably wondered: Could it be ADHD?
According to a 2016 study by the Centers for Disease Control and Prevention, 9.4% of U.S. children have been diagnosed with attention-deficit/hyperactivity disorder, or ADHD. And the number continues to rise. In fact, ADHD is the most commonly diagnosed childhood behavioral disorder. So, chances are, you know someone, you love someone, or you are someone who has been diagnosed with ADHD. And yet, there are still a lot of misconceptions about the disorder. Here’s what you should know.
It's not just distractibility
“Children with ADHD can present clinically in myriad ways,” child and adolescent psychiatrist Dr. Jess Shatkin says. So, two people with the same diagnosis may have completely different challenges. But overall, we can think about ADHD in three main categories: broad focus, hyperactivity and impulsivity, Shatkin says. A child with ADHD may struggle in one – or all – of these categories, but oftentimes, people will zero-in on the issue of focus, or a child’s inability to pay attention. However, this isn’t totally accurate.
“‘Attention-deficit’ is a bit of a misnomer because ADHD isn’t about not being able to pay attention,” Dr. Kirsten Sharma, a clinical neuropsychologist who specializes in ADHD, says. “Instead, it’s about struggling to regulate and manage attention.” It may sound minor, but it’s actually an important distinguisher because the emphasis on the inability to focus can cause parents to overlook a main aspect of ADHD: hyper-focus, which is defined by ADDitude Magazine as “sustained, intense concentration on a single interest or project for an extended period of time.”
“People with ADHD have an incredible ability to focus when they’re stimulated or interested,” Sharma says. So, if a child can hyper-focus, that doesn’t eliminate the possibility that they have ADHD. In fact, it may just be further evidence suggesting they have it.
It doesn't correlate to intelligence
Sometimes a child doesn’t get recognized for having ADHD because of their intelligence or ability to do well in school. That was the case for Jessica McCabe, founder of HowToADHD. “Very early on I was scattered, disorganized, and kept losing things, but I was smart, so no one was worried,” McCabe says. “In fact, the first doctor I went to didn’t think I had ADHD because I was able to get good grades.”
It’s true that children with ADHD often have a difficult time in school because the qualities of a “good student” – attentiveness, organization, ability to stay on-task – are the very same qualities children with ADHD struggle to possess. But just because a child does well in school, or is considered “gifted,” does not mean they don’t have ADHD. “A child’s ability to manage and regulate their attention and how bright they are not the same skills,” Sharma says.
Children with ADHD aren't lazy
A child with ADHD may be labeled as lazy, or as someone who procrastinates, but “that is a total misunderstanding of what ADHD is about,” journalist Yashar Ali recently wrote in a viral Twitter thread. “Procrastination has a connotation of intentionally putting something off for various reasons… but for people with ADHD, the issue is often the difficulty starting things,” and it very well might be something seemingly “simple” like cleaning your room or folding your laundry. While very few people might enjoy these tasks, for a person with ADHD they can “be exhausting and feel impossible to begin or finish,” Ali writes. But why? As it turns out, it has a lot to do with brain chemistry.
“The inconsistency in motivation and performance is the most puzzling aspect of ADHD,” Dr. Thomas E. Brown, clinical psychologist and author of "Outside the Box: Rethinking ADD/ADHD in Children and Adults: A Practical Guide," writes in his piece, The Mystery of ADHD Motivation, Solved. And understandably so. “It seems like a child or adult [with ADHD] who can show strong motivation and focus for some tasks should be able to do the same for most other tasks that they recognize as important,” Brown says. But that’s often not the case.
Think about moments when you’re especially motivated. How are you feeling? Probably excited, interested, maybe even a little intimidated, but still optimistic. “Emotions — mostly unconscious emotions — are powerful and critically important motivators of human thought and actions,” Brown says. Read that sentence again: mostly unconscious emotions = critically important motivators. As it turns out, those emotions we aren’t totally aware we’re feeling can “cause us to act in ways that are inconsistent with our recognized conscious intentions,” Brown says.
Your child with ADHD probably knows they should put their books in their backpack before bed. After all, if they don’t do it the night before, they’re likely to forget in the morning and get a zero on their homework. And yet, no matter how many warnings you give, getting them to actually do it can feel like Mission Impossible. We all feel unmotivated from time to time, but for children with ADHD, it’s not just a lack of motivation, general disinterest, or even desire to rebel. In fact, this aversion to certain tasks can feel much heavier – and much more difficult to explain – than any of those possibilities.
Researchers still have a lot to discover about the neurotypical brain, and even more to understand about how the ADHD brain differs, but studies suggest individuals with ADHD “chronically have insufficient release and reloading of dopamine,” the brain chemical responsible for memory, attention and yes, motivation. Furthermore, one study found dopamine transporters were lower in parts of the left brain – where we process logic, reasoning and time awareness.
But motivation is not just a matter of emotion. It also has a lot to do with memory. “Individuals with larger working memory capacity are generally better able to deal with emotions, pleasant and unpleasant, without getting excessively caught up in them,” Brown says. But “those with ADHD tend to have less ‘bandwidth’ in their working memory functions,” making it harder to piece together information and process the full picture. Brown says it’s like watching a sports game through a telescope, “unable to consider the rest of the action on the court, the threats and/or opportunities that are not included in the small circle of focus.”
It can cause social issues and emotional distress
Because of the misconceptions about ADHD, people can often make light of it. Those with ADHD might be portrayed as lovingly spacy or endearingly forgetful. Or maybe even as silly, or a spaz. But the truth is, “it's a frustrating, infuriating disorder,” Ali writes.
Children with ADHD who struggle with hyperactivity or impulsivity are often “falsely believed to be willfully dismissive of others’ needs and desires,” Shatkin says. As a result, “they’re increasingly ostracized as they age.” McCabe felt this was true of her experience growing up, saying she had difficulty navigating certain social scenarios, leading her to feel “lonely, left out, different and less than.”
While these are feelings any person can experience – whether they have ADHD or not – the particular symptoms of ADHD and subsequent social isolation can have a significant impact on a child’s self-esteem, which only “compounds the feelings that these children already have about themselves, as they also wonder why they cannot focus, stay seated, and control their impulses like their peers,” Shatkin says.
Learning how to deal with it can be a process
“I had been diagnosed with ADHD for 20 years before I understood how it affected me,” McCabe said. This is true for many children with ADHD because there’s no clear path to figure out what works and what doesn’t for each child. Still, that doesn’t mean they’ll never find a way -- and parents can be a big help. Here’s what you can do.
1. Pay attention to symptoms. The fact is, the symptoms of ADHD are not exactly unique to those with ADHD. “Most children will be impulsive or hyperactive at times,” Sharma says. Since these “symptoms” don’t only affect people with ADHD, it may be difficult to know what’s normal behavior and what’s worth noting.
Consider your child’s symptoms and when they experience them. In school? At home? With friends? “ADHD does not simply show up in one place,” Shatkin says. “Instead, it’s spread throughout a child’s life.” So, it’s not just that your child is struggling to manage their attention in school, but you also might observe impulsive behavior, or a tendency to hyperfocus, at home. Additionally, these symptoms are usually clear from a young age. According to the Centers for Disease Control and Prevention, the average age of an ADHD diagnosis is seven.
But it’s not just an issue of frequency; it’s also a matter of intensity. Every person has their moments when they’re having difficulty managing their focus, or staying on-task, but if it’s getting to a point where “the child’s functioning is impaired,” that’s when you should consider getting your child evaluated for ADHD, Sharma says.
2. Get a professional evaluation. Meeting with a professional – whether they’re your longtime pediatrician or a child psychologist – is an important step because they’re more likely to pinpoint what’s giving your child a difficult time. “You might think your child is having an attention problem, but, it could be something totally different,” Sharma says. For example, they might be acting out, or struggling to focus, but really, it’s a deeper issue of trauma, or a learning disability. On the other hand, Sharma says undiagnosed ADHD could resemble – or even cause – a learning disability.
So if you suspect your child has ADHD the only way to be sure is to have them evaluated by a professional you trust. Since there are a variety of conditions that might resemble ADHD, and a certain amount of this behavior is perfectly normal in children, getting a professional evaluation will give you a better understanding of what next steps you and your child should take.
3. Consider medication. Once a child is diagnosed with ADHD, many parents might have a difficult time deciding whether they should put them on medication. And if they do, it can be hard to know which medication, and what dosage. And medication – while it can drastically help some people – isn’t always a guaranteed cure-all and may not be the right fit for your child. And even if it is, it can be incredibly expensive, and it might not be covered by insurance. So, it’s complicated – and there’s no perfect solution. But there is, however, a lot of information that can help you navigate this decision.
Consider how often your child struggles, and how negatively it impacts their daily life. “Every parent has to help their child develop life skills, such as checking their homework and filing it away in their backpack,” Sharma says. “The possibility of medication comes up when children cannot absorb these skills.” Since these skills – such as organization and time management – are critical to a student’s academic performance, medication can often help.
In fact, for some people with ADHD, medication can be an absolute game changer. “It changed my life,” Ali wrote on Twitter – and many responded feeling the same. But it isn’t for everyone. “A lot of parents say, ‘I don’t want to put [my child] on medication,’” Sharma says. And this reluctance is understandable. After all, ADHD medication reduces ADHD symptoms by changing – and improving – the brain’s neurotransmission, which can have some potential side effects.
One helpful note? “The medicine is in and out of the body in the same day,” Sharma says. So, it doesn’t stay in the system like other medications, such as SSRIs, which are prescribed to treat depression. “Hearing this can make some parents more open to trying it.”
4. Consider behavioral strategies. While medication can help many children, it doesn’t mean they’ll suddenly be “cured.” Moreover, it’s not a parent’s only option when it comes to helping their child with ADHD.
Children with ADHD can often be strong-willed, or even defiant, depending on the severity of their symptoms. This defiance may lead them to reject the structure they actually need, creating frustration for parents. One option to consider is a parent-training program, which equips parents with strategies to navigate this behavior.
But there are other everyday options too. For example, does your child with ADHD struggle to use a planner? According to McCabe, bullet journaling can help. Or what about when they need to clean their room? Asking for their input – or giving them options (i.e., do you want to organize your closet or pick up your toys first?) – can make it more manageable. And when they need to manage their time? McCabe recommends Brili, a visual timer created to “help families with children stay on task and on time every day.” (And yes, it was created by a parent whose child has ADHD!)
Another solution? Immediate positive feedback. Throughout the day, children with ADHD are constantly given very specific instructions to stop talking or stay seated. While this direction is necessary, it can also have an impact. According to experts, children with ADHD receive “20,000 more negative messages by age 12 than those without the condition,” which can be detrimental for their self-esteem. So, when you can, tell your child what they’re doing well, right as they’re doing it. “People with ADHD can have shorter time horizons, so knowing we’ll have an immediate response can make us more effective,” McCabe says. And since their corrections are often so specific, it helps to make your positive feedback specific, too.
Navigating behavioral strategies for children with ADHD isn’t always straightforward; it requires a delicate balance of accountability and flexibility. “Give your kids agency, independence, structure and support,” McCabe says. “That can help them invest and take ownership.
5. Talk to your child. Of course, the single most important thing you can do is talk to your child. While Shatkin points out it’s “not the way to diagnose ADHD,” it will give you insight into how they’re feeling and can help you decide how to proceed.
ADHD can be a challenge for both parents and children but working together and learning how to deal with the idiosyncrasies can make all the difference. In the words of Ali, “We need you to understand that we don't intend to upset you with what seem like failures to you. We don't mean to let you down. When you have ADHD it's like seeing what you want in a glass case you don't have access to. We want to accomplish so much, we just need the keys.”
As a parent of a child with ADHD, you can help them find those keys. Or, more likely, you can support and encourage them as they invent a completely new way to open the glass case.
From treatments and approaches to managing everyday challenges, check out Understood.org for more information on how to help your child with ADHD thrive.
*Disclaimer: This piece is not meant to replace advice or recommendations from a medical professional. If you have any questions about your child's health, please seek advice from a doctor.