For some, the first report card or meeting with the teacher can turn something you’ve been wondering about into a legitimate worry. If you’ve recently learned that your child needs to “stay on task,” or if you’ve wondered if your child has ADHD, keep reading.
First, the reality: Children, by nature, are wiggly, distractible, and seemingly allergic to staying on task. Some of them also have ADHD. Identifying which is which is a big part of what pediatricians do.
Attention is a skill which develops along a curve, and that curve is rather broad. They break off what they’re doing mid-task. They lose their jackets. They have to be asked three times to finish a task. None of these things alone signals a problem; they are simply part of what is expected of a child at that age.
Studies conducted in a number of countries have shown that the youngest children in a class are diagnosed with ADHD at rates noticeably higher than the oldest children in the same class. A child with a birthday in late summer is therefore being compared each day with classmates who could be almost a whole year older. By age seven, this developmental gap can be considerable, and what seems like an attention disorder might actually be normal for that particular age.
Children are at times inattentive or impulsive, and adults can be too. When pediatricians conduct an ADHD evaluation, they look for patterns, as the American Academy of Pediatrics (AAP) directs. The following are what we are looking for:
A child who can't sit still in Ms. Patel's class but can at home, at soccer, and at Grandma's might be indicating something about the classroom or a difficult year, rather than their brain. The pattern that pediatricians look for appears in a variety of situations: at home and at school, or at school and at activities, or at home and at the grocery store.
A rough stretch after a move, a new baby, a divorce, or illness is not typically a pattern of ADHD. However, six months of the same thing may be.
ADHD doesn't just show up suddenly in middle school; when you look back, most families can remember early signs even if the problems weren't obvious until school became more demanding.
It is entirely normal for a child to be busy or to be absent-minded. However, trouble arises when this pattern affects their ability to learn, their friendships, their family routines, or their own sense of self. If a seven-year-old has begun to call themselves 'the bad kid,' further investigation is necessary, since that label may stick and we do not want that to happen.
Sleep difficulties, problems with vision or hearing, anxiety, a difficulty with reading or mathematics, and a great deal of stress at home can all appear to be ADHD from the outside, so checks are carried out for these before a diagnosis is given.
People who search for "ADHD testing near me" often imagine a single test with a score at the end. However, it doesn't work that way.
There is no blood test, brain scan, or computer game that diagnoses ADHD. The evaluation involves collecting information from the people who see your child most, then letting your child’s pediatric provider interpret the findings.
Here are the steps we take at Little Oaks Pediatrics:
We begin by having a conversation; we ask you what you're seeing, when it started, what a tough day looks like and what an easy day looks like, as well as about your child's sleep, the amount of time spent on screens, their family history, how their time in preschool and kindergarten went, and about any major events that have occurred in their life. We include your child in the conversation in an age-appropriate way.
You and your child's teacher each complete a standardized questionnaire (the most commonly used by pediatric clinics is the Vanderbilt). These questionnaires are not pass-or-fail tests; instead, they compare observations from two adults in different situations with the typical behavior expected of a child that age. The teacher's questionnaire is particularly helpful because the classroom environment is where attention is assessed most effectively.
Before the term ADHD is used, we should look at other possible conditions that could cause ADHD-like symptoms. This might involve checking vision or hearing, discussing sleep, asking questions about anxiety or mood, or referring for a learning evaluation through the school.
After reviewing the history, rating scales, and other relevant information, your provider goes over the results. In some cases this leads to an ADHD diagnosis; in other cases it is "this seems normal for their age, so we'll follow up in the spring"; in some instances it is "this appears to be anxiety" or "let's have the school look into the child's reading". All of these are valuable conclusions. We want families to see the evaluations as providing information rather than assigning a label.
The next steps you take if your child has an ADHD diagnosis will vary according to their age and your family situation. In the case of children under six, the AAP suggests beginning with parent training in behavior management and classroom support before turning to medication. For school-age children, a combination of medication and behavioral strategies generally proves most effective. We work with families to make sure that everyone is on the same page.
It is important to consider the school aspect of the matter for each child, whether or not they are assessed. If a 504 plan or an IEP is needed, it may include accommodations such as extra time, movement breaks, or a seat closer to the teacher. We can help you find out what your child might be eligible for and fill out the required forms so they receive the support they need at school.
If the response is 'this is normal for their age,' you'll better understand your child and have a strategy for following up.
You do not need a letter from school before you start the conversation. A few signs that it is worth an appointment:
The most helpful thing to bring to that first visit is two weeks' worth of notes listing what you observed, when you saw it, and how the situation developed. If they are willing, ask your child's teacher to prepare similar notes.
Little Oaks Pediatrics in Raleigh evaluates and cares for children with attention and behavior concerns, from ages four through the teen years. If your child's report card raised a question, or you have your own suspicions, schedule a visit or call (919) 720-4876, and let the front desk know it is an ADHD or behavior concern so we can build in enough time.