Every healthy young child is restless, distractible and impulsive. That is not a symptom; it is a description of being five. So how does anyone tell the difference?
Not by the behaviour itself. By three things around it.
Where it happens
Attention difficulties that are part of ADHD show up in more than one setting — home and school, not only one. A child who concentrates well at school and falls apart at home, or vice versa, is telling you something about the environment rather than about their attention.
This is why clinicians insist on school input and will not diagnose from a parent account alone. It is not distrust. It is that a single setting cannot answer the question.
How long it has been true
A pattern that has been there for years, visible before school and continuing through it, is different from something that appeared this term. Difficulties that started recently point at something that happened recently — a bereavement, a house move, bullying, a change at home, anxiety, poor sleep.
What it costs
The threshold is impairment. Is this getting in the way of learning, friendships, safety, family life? A child who is lively and thriving is lively. A child whose restlessness means they have no friends, cannot access the lesson, or is constantly in trouble is impaired, and that is the part worth doing something about.
The things that look identical
This is the part that makes assessment worth doing properly rather than quickly.
- Poor sleep. Tired children are inattentive and irritable, and in children tiredness often looks like overactivity rather than sleepiness.
- Hearing difficulty. A child who mishears instructions looks like a child who ignores them.
- Anxiety. A mind that is busy being worried is not available for the lesson.
- An unrecognised learning difficulty. A child who cannot read the worksheet will find something else to do. That is not an attention problem; it is a reading problem with an attention-shaped shadow.
- The work being wrong for them. Too hard, or too easy.
A good assessment is largely the business of ruling these in or out. If nobody asked about sleep, hearing or reading, the assessment was not thorough.
The quiet ones get missed
The picture most people carry is the child who cannot sit still. But inattentive difficulties without hyperactivity are easy to overlook entirely — the child who is dreamy, disorganised, loses things, drifts off mid-instruction, and is described as “away with the fairies” rather than disruptive.
They are not a management problem, so nobody raises them. They are often struggling more, and for longer.
What an assessment involves
A developmental and family history, information from school as well as home, standardised questionnaires from more than one observer, and consideration of everything on the list above. Rating scales are part of it and never the whole of it — they measure how observers perceive the child, which is useful information about the child and also about the observers.
Where we fit
Our page on ADHD covers the clinical background, and how we assess explains the process, including how we gather school information. How we work with schools covers what happens after. We see children at our centres in India and the UK.
This article is general information. It is not a diagnosis and not advice about your individual child.