Hyperactivity-Is It Normal or ADHD?
Debra Burdick, LCSW
Have you ever wondered if your active, fidgety child is hyperactive, has ADHD, is immature, or is perhaps within normal ranges? I was standing in the grocery line the other day behind a family with two young boys. The boys were talking to each other, moving around constantly, hopping up and down, looking at the candy on the shelf, asking their mom questions, and fiddling with the food in the cart. Their mom told them several times to put something back on the shelf and to stop touching the food. They listened to her and did what she asked but then kept right on doing more of what they were doing and needed to be asked several more times.
At first I thought maybe the boys were hyperactive. Since I am a psychotherapist with lots of experience working with kids I wondered if perhaps they both had Attention Deficit/Hyperactivity Disorder (ADHD). But the more I watched them, the more I asked myself how much of their behavior is simply normal for healthy boys their age.
Many wiggly, fidgety, smart, and enthusiastic children are incorrectly labeled as having Attention Deficit Hyperactivity Disorder (ADHD). Often they are simply not yet ready for the structured learning environment and the behavior required in the preschool and early elementary school years. I have observed preschool and kindergarten students in their classroom and have found a wide range of activity amongst the children. All kids need to move and they do so naturally. This need to move seems to decrease naturally with age and maturity.
I often work with children who are referred for an evaluation for ADHD simply because they have trouble sitting still in the classroom or even during circle time. This can vary depending upon the perspective of a particular school system or teacher regarding childhood development and behavior. It may also depend on how tolerant a teacher is of a child who is constantly on the move.
Hyperactivity may be the result of a number of medical, lifestyle, or behavior problems. So how can we tell whether a child is simply active or truly hyperactive? Children as well as adults may be hyperactive and distractible if they are suffering from food sensitivities, too much sugar or caffeine, allergies, chemical sensitivities, food additives, chronic illness, heavy metal exposure, chronic stress, anxiety, fear, a chaotic home life, or sleep deprivation including sleep apnea. Consult a holistic health practitioner and a pediatric allergist for a full assessment to rule out these possible causes of hyperactivity.
In order to qualify for a diagnosis of ADHD Hyperactive-Impulsive Type (or Combined Type - must also meet the criteria for inattentive type) the following criteria must be met:
Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
- Often fidgets with hands or feet or squirms in seat.
- Often gets up from seat when remaining in seat is expected.
- Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
- Often has trouble playing or enjoying leisure activities quietly.
- Is often "on the go" or often acts as if "driven by a motor".
- Often talks excessively.
- Often blurts out answers before questions have been finished.
- Often has trouble waiting one's turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
Also, the following must be true:
- Some symptoms that cause impairment were present before age 7 years.
- Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
- There must be clear evidence of significant impairment in social, school, or work functioning.
- The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental Disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or Personality Disorder).
Keep track of these characteristics of ADHD to monitor how your child does over time.
It it's due to immaturity, you will notice steady improvement as your child matures and learns to settle into a school routine. On the other hand, true ADHD, if left undiagnosed and untreated, can become worse with time, resulting in your child developing a poor attitude about learning.