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It’s Not Always ADHD

It’s Not Always ADHD

Some children really struggle to keep focused, follow instructions, remain seated, wait their turn, keep organized and finish tasks on time, especially at school. These are common symptoms of Attention-Deficit Hyperactivity Disorder (ADHD).

WHAT IS ADHD? According to the National Institute of Mental Health, Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder featuring an on-going pattern of inattention and/or hyperactivity-impulsivity that can interfere with development or function.

ADHD is NOT caused by bad parenting or a lack of willpower or desire, and it is NOT a measure of how smart someone is. ADHD has a biological basis and it reflects dysfunction in specific brain networks.

According to the Centers for Disease Control and Prevention (CDC), ADHD is the most commonly-diagnosed behavior disorder for kids in the United States, affecting 4.5 million children under the age of 18. There are currently no official statistics regarding prevalence rates of ADHD in Trinidad and Tobago and the Caribbean region. Nevertheless, awareness and diagnosis of ADHD is certainly increasing throughout the region.

However, just because a child demonstrates ADHD symptoms (e.g., inattention, hyperactivity or impulsivity) does not necessarily mean that they have ADHD. Firstly, the symptoms must significantly impair their daily functioning and be significantly above what would be expected for their age. Also, these behaviors must be present across more than one setting (e.g., not just at school or at home), though symptoms do vary depending on context within a given setting.

The symptoms of a variety of other medical, psychiatric, and developmental disorders, as well as environmental factors also often mimic symptoms of ADHD. Some of these factors are discussed below.

  • ANXIETY AND EMOTIONAL PROBLEMS: Children with anxiety often present as inattentive and restless. Their minds may be elsewhere since they may be consumed by worry, fear and distress. Stress, anxiety, depressed mood and other sources of emotional distress can also result in disruptive behaviors such as emotional outbursts and “lashing out.” This is often the case for children with traumatic histories such as those who have been exposed to abuse and violence, as well as children who have grown up in chaotic or neglectful home environments. Children with other mood disorders such as bipolar disorder can also present with symptoms similar to ADHD such as distractibility, increased energy, risk-taking behaviors, and mood instability.

Although behaviors due to emotional/mood issues are often confused with ADHD, it is important to know that many children with ADHD also struggle with emotional issues, particularly anxiety and depressed mood. Professional consultation is necessary to determine the root cause of the issue.

  • LEARNING DIFFICULTIES: Often children do not focus during class time because they do not understand the work being taught. They may become “lost” because it is simply too difficult for them to keep up. In these cases, children may have undiagnosed learning disorders such as problems with reading (dyslexia), math (dyscalculia) or writing (dysgraphia). Their learning struggles are often accompanied by anxiety and frustration which further compromise their ability to focus. It is important to note that ADHD and learning disorders often occur together, even though they are separate conditions.
  • LANGUAGE AND AUDITORY PROCESSING PROBLEMS: Children who struggle to make sense of language and words have great difficulty following instructions and staying focused. Imagine being an English speaker sitting in a class being taught in German – you would probably zone out very quickly. Auditory and language processing problems often result in children “missing” information and getting lost in all of the words being spoken to them.
  • SENSORY PROCESSING PROBLEMS: Children learn by getting information from their senses. However, some children have trouble handling this information. They may be oversensitive or undersensitive to sights, touch, sounds, and smells. Sensory sensitive children may become overwhelmed or distracted by noises, bright lights, colors and so on which may result in restlessness and “acting out” behaviors.
  • MEDICAL CONDITIONS: There are many medical conditions which can interfere with a child’s attention and behavior. Some conditions include thyroid issues, anemia, seizure disorders, and abnormal blood sugar levels. Certain medications can also have side-effects which result in ADHD-like behavior. Checking in with your child’s pediatrician is often a good first step in the process of understanding your child’s behavior. Additionally, all children should undergo vision and hearing testing since vision and hearing problems will certainly affect attention, behavior, and learning.
  •  PROBLEMS WITH COMPLIANCE/DEFIANCE: Some children have some degree of control over their attention and behavior yet often intentionally refuse to follow rules and be cooperative with others. In most cases, these children are reacting to factors such as emotional distress, family dysfunction, inconsistent discipline, or a lack of structure and routine at home.
  • AGE: Sometimes, children who are younger than their classroom peers may look like they have ADHD symptoms when really, they are just more immature than their peers.
  • INTELLIGENCE: Children of all levels of intelligence can have ADHD. However, children both high and low in intelligence can demonstrate symptoms which look like ADHD even when there is no ADHD. Firstly, children who are high in intelligence may struggle with inattention and restlessness because they are bored with the level of work presented. On the other hand, children with intellectual disabilities often face a range of difficulties including difficulty controlling their attention and behavior. Therefore, assessment of a child’s level of intelligence is an important component of an ADHD evaluation.In summary, evaluating for and diagnosing ADHD must be done carefully in order to reduce the chance of misdiagnosing children and providing them with the wrong type of support. An evaluation for ADHD should be performed by a medical or mental health specialist such as a neuropsychologist or psychologist who is specifically trained in evaluating and diagnosing ADHD. Any professionals seeing your child should take the time to thoroughly evaluate the reasons why your child may be struggling. The more accurate the diagnosis, the more effective the recommended treatment is likely to be.

Parents are encouraged to learn more about ADHD via reputable resources including websites such as CHADD—Children and Adults with ADHD (chadd.org).

Local resources can also provide parents with contact information for professionals who can assist children and adults with ADHD (or suspected ADHD). These include The ADHD Foundation of Trinidad and Tobago, the Trinidad and Tobago Association of Psychologists, and Child Space.

Take Away Message: 

Being careful about defining and treating your child’s struggles when they are young will help you understand them better so that you can assist them in reaching their full potential and achieving success.

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