Does my child have ADHD?

"Does my child have ADHD?" is one of the most common questions parents bring to us, and it usually comes after months, sometimes years, of the same worries. School reports that say "could try harder". Mornings that fall apart. A child who is bright and kind but cannot seem to get started, or cannot seem to stop. This guide explains how a paediatrician thinks about that question, what is part of normal childhood, and when it makes sense to ask for an assessment.

How do I know if my child has ADHD?

ADHD (attention deficit hyperactivity disorder) affects how a child focuses, how active they are and how well they can stop and think before acting. Doctors look at three areas:

• Inattention: drifting off, losing things, not finishing tasks, seeming not to listen, forgetting everyday steps like brushing teeth or packing a bag.
• Hyperactivity: fidgeting, getting up when they are meant to sit, always on the go, talking a lot.
• Impulsivity: interrupting, blurting out answers, finding it very hard to wait their turn, acting before thinking.

Most children with ADHD have difficulties in all three areas. Some, often girls, have mainly the inattentive kind, which is quieter and easier to miss.

Every child does these things sometimes. What makes a doctor think about ADHD is the pattern:

• the difficulties are there most of the time, not just on a bad day
• they show up in more than one place, usually home and school
• they are more than you would expect for your child's age and stage
• they started in childhood, usually before age 12
• they are getting in the way of learning, friendships or family life

What is normal, and what might be ADHD?

Young children are meant to be busy, distractible and impulsive. Learning to sit still, wait and concentrate takes years, and children get there at different speeds. A lively child who can settle to something they enjoy, calms down with routine and is getting on at school is very unlikely to have ADHD.

It is worth looking more closely when your child seems to be working much harder than their friends just to keep up, when the same comments come up at every parents' evening, or when life at home revolves around managing their behaviour. Many parents describe a feeling that their child is capable of far more than they are managing to show.

Signs of ADHD at different ages

Does my 3 or 4 year old have ADHD?

At this age it is very hard to separate ADHD from ordinary toddler behaviour. NHS guidance points out that many children under 5 are easily distracted and full of energy without having ADHD. Doctors tend to wait and watch, and offer support in the meantime. Our guide to ADHD in young children covers this in more detail.

Does my 5 or 6 year old have ADHD?

Starting school often brings things into focus, because school asks children to sit, listen and follow instructions for longer. Teachers may mention a child who cannot stay on the carpet, wanders during tasks, struggles with phonics despite being bright, or is often in trouble for touching others or calling out.

Older children and teenagers

As schoolwork gets more demanding, inattention often becomes the bigger problem: unfinished homework, lost belongings, missed deadlines, and a growing sense of "I'm just stupid". Hyperactivity may turn into inner restlessness. Some children cope well in primary school and only struggle after the move to secondary, when there is less structure. You can read more in our page on ADHD assessments for teenagers.

Does my daughter have ADHD?

Girls are more likely to have the inattentive type of ADHD, which is easy to overlook because it rarely disrupts a classroom. A girl may be a daydreamer, chatty, disorganised, anxious or exhausted after school, while her teachers see a quiet, polite pupil. NICE guidance asks professionals to be aware that ADHD is under-recognised in girls. Our guide to ADHD in girls explains what to look for.

What else can look like ADHD?

This is where a paediatrician's training matters. A number of things can make a child inattentive or restless:

• poor or disrupted sleep
• hearing or vision problems
• anxiety, low mood, or stress at home or school
• a specific learning difficulty such as dyslexia
• autism, tics or Tourette's syndrome, or coordination difficulties such as dyspraxia

Some of these sit alongside ADHD rather than replacing it. Because our doctors are consultant paediatricians, they look at your child's general health as well as their attention and behaviour, including things like sleep, hearing and other conditions. If something other than ADHD needs exploring, they will tell you and signpost you to the right service.

Is there a "does my child have ADHD" quiz?

Our free ADHD questionnaire lists the behaviours doctors ask about, split into attention and hyperactivity or impulsivity, and you score how often you see each one. If your answers are mostly "often" or "very often", it is worth talking to a professional.

A quiz cannot tell you whether your child has ADHD. NICE is clear that a diagnosis should never rest on questionnaires alone. It needs a full assessment by a specialist, such as a paediatrician or child psychiatrist, who takes a detailed history and gathers information from home and school.

What if my partner does not think it is ADHD?

It is very common for one parent to be worried and the other to be unsure, or firmly against an assessment. Often the parent who is not convinced is worried about a label, about medication, or about what it says about the family. Sometimes they recognise themselves in the child and feel defensive. Those worries are understandable, and they are worth talking through rather than arguing over.

A few things that help:

• Separate the assessment from the decisions after it. An assessment is a way of understanding your child. It does not commit you to medication or to anything else. Every decision afterwards is yours, together.
• Look at the same evidence. Fill in our ADHD questionnaire separately, then compare. Ask school for their view too. Seeing the same pattern from different people is often what changes minds.
• Come together if you can. Both parents are welcome at the appointment, and hearing a doctor explain what they see can settle a lot of doubt, whichever way the answer goes.
• Put blame aside. ADHD is not caused by parenting, by either parent. Dr Zoric has written about how families, mothers especially, are too often made to feel at fault: see when parents feel blamed in ADHD pathways.

What to do if you think your child has ADHD

1. Write it down. Note what you see, when, and where. Examples from school reports, teachers' comments and homework battles are all useful.
2. Talk to school. Ask your child's teacher whether they see the same things. The school's SENCO (special educational needs co-ordinator) can put support in place without a diagnosis.
3. Speak to your GP. Your GP can rule out other causes and refer you to NHS services. GPs do not make the diagnosis themselves.
4. Consider a private assessment. If you would prefer a private assessment, you can contact us directly. No GP referral is needed, and we send your GP a letter afterwards.

At BZ Clinic, a private ADHD assessment for your child is a 90-minute, face-to-face appointment with a consultant paediatrician in West Byfleet, for children and young people aged 5 to 18. It includes questionnaires from you and school, and a QbCheck, a computer-based test of attention, activity and impulsivity. In many cases the doctor can give you an answer on the day, with recommendations for home and school. You can read what to expect, or call Camille on 07957 909754 to talk it through.

Questions parents ask