Your child daydreams a lot at school and is easily distracted when they are doing homework or chores. Maybe they fidget constantly. You might wonder if they have attention-deficit/hyperactivity disorder (ADHD). Or is it attention deficit disorder (ADD)?
Is there a difference?
Not anymore. In 1994, doctors decided all forms of attention-deficit disorder would be called "attention-deficit/hyperactivity disorder," or ADHD, even if the person wasn't hyperactive. Now it's called ADHD, inattentive type, or ADHD, hyperactive/impulsive type, or ADHD, combined type.
Which term is right for your family to use depends on your child's specific symptoms and diagnosis. It's important to talk with an experienced mental health provider to make sure your child gets the right diagnosis.
Daydreamer or Fidgeter?
ADHD is a brain-based disorder. It can interfere with your child's everyday activities at home and at school. Kids who have it have trouble paying attention and controlling their behavior, and are sometimes hyperactive.
Before they are diagnosed, you will want to note your child's symptoms. The CDC offers an ADHD checklist for children that may help you keep track of them.
Here are the signs to look for:
- Inattention: Includes disorganization, problems staying on task, constant daydreaming, and not paying attention when spoken to directly.
- Impulsivity: Includes spur-of-the-moment decisions without thinking about the chance of harm or long-term effects. They act quickly to get an immediate reward. They may regularly interrupt teachers, friends, and family.
- Hyperactivity: Involves squirming, fidgeting, tapping, talking, and constant movement, especially in situations where it's not appropriate.
Mental health professionals in the United States use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose all psychiatric conditions, including ADHD. The latest version divides it into three types:
- ADHD predominantly inattentive presentation (what used to be called ADD)
- ADHD predominantly hyperactive-impulsive presentation
- ADHD combined presentation (both inattentive and hyperactive-impulsive symptoms)
Your child's diagnosis will depend on their specific symptoms.
ADHD Inattentive
Kids with this condition aren't hyperactive. They don't have the high energy level seen in others with ADHD. In fact, children with this form may seem shy or "in their own world."
ADD is diagnosed if a child under age 16 has 6 or more symptoms of inattention (5 or more for older teens) for at least 6 consecutive months but no signs of hyperactivity/impulsivity.
The symptoms include:
- Trouble paying attention (easily sidetracked)
- Doesn't like or avoids long mental tasks (such as homework)
- Trouble staying on task during school, at home, or even at play
- Disorganized and seems forgetful
- Doesn't appear to listen when directly spoken to
- Doesn't pay close attention to details
- Loses things often
- Makes careless mistakes
- Struggles to follow through with instructions
Children with this subtype of ADHD may go undiagnosed because the symptoms may be chalked up to daydreaming.
ADHD Predominantly Hyperactive-Impulsive Presentation
Children with this form of ADHD have tons of energy and are constantly moving in a way that causes problems. It's diagnosed if a child under age 16 has 6 or more hyperactive/impulsive symptoms for at least 6 months (5 or more for older teens). This form is more noticeable than the inattentive type.
Symptoms include:
- Blurting out answers before a question is finished
- Constantly interrupting others
- Trouble waiting for their turn
- Talks too much
Fidgeting, tapping, and squirming
- Gets up when it's not appropriate (such as when the teacher is talking or in the middle of dinner)
- Running or climbing in inappropriate situations
- Unable to play quietly
- Always "on the go"
ADHD Combined Type
A child with this type has symptoms of both inattention and hyperactivity/impulsivity.
ADHD Diagnosis
Health care professionals such as pediatricians, psychiatrists, and child psychologists can diagnose ADHD with the help of standard guidelines from the American Academy of Pediatrics or the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).
You can also find a professional who specializes in ADHD diagnosis through your health plan, your child’s teacher or school counselor, other parents of children with ADHD, or nonprofit organizations such as Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
The diagnosis involves gathering information from several sources, including schools, caregivers, and parents. The health care professional will consider how a child's behavior compares with that of other children the same age, and they may use standardized rating scales to document these behaviors.
To diagnose ADHD, your child should have a full physical exam, including vision and hearing tests. Also, the FDA has approved the use of the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a noninvasive scan that measures theta and beta brain waves. The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it. The scan, approved for use in those ages 6 to 17 years, is meant to be part of a complete medical and psychological exam.
The evaluation may also include interviewing you, your child's teachers, and any other adults who are a big part of your child's life. The evaluator may ask each of you to fill out standardized forms, known as “behavior rating scales,” to rate different aspects of your child’s behavior. These scales may also be used later to track progress with treatment.
The health care professional should take a complete medical history to check for other conditions that may affect a child's behavior. Certain conditions that could mimic ADHD or cause the ADHD-like behaviors are:
- Recent major life changes (such as a divorce, a death in the family, or a recent move)
- Undetected seizures
- Thyroid problems
- Sleep problems
- Anxiety
- Depression
- Lead toxicity
Though many children show some of the behaviors of ADHD, they do not necessarily have the disorder. An ADHD diagnosis requires that these behaviors have been around for at least 6 months, that some symptoms began before age 12, that symptoms are present in two or more settings (such as school and home), and that they significantly affect the child in at least two places (social life, school, etc.).
