All that bounces is not ADHD

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Most have heard of ADHD, or attention-deficit/hyperactivity disorder. Do they know how it’s properly identified? ADHD, which was initially acknowledged in 18^th century medical literature, is a neurodevelopmental disorder characterized by hyperactivity, impulsiveness and poor attention control.

This chronic condition, which often begins in childhood and can persist into adulthood, typically involves interactions between genetics and environmental risk factors, such as premature birth, prenatal exposure to illicit drugs, tobacco or alcohol and even congenital heart defects, to name a few. When diagnosing ADHD, specific criteria originating from the Diagnostic and Statistical Manual of Mental Disorders (5^th edition), or DSM-V, are considered. Evaluating a child for ADHD should include a comprehensive look at medical history, a thorough physical examination and information on the child’s functioning at school and home.

ADHD can place a major impact on children and adolescents with the disorder, as many of them are more likely to struggle academically, socially and behaviorally compared to their peers who don’t have ADHD. These kids face higher rates of learning difficulties, which can lead to more grade level repeats, truancy and dropouts. They also tend to be more emotionally immature than their same-aged peers, and often land in trouble from struggling to control their impulses or properly follow instructions. Lifelong consequences could be the result, and ADHD has potential to place a large societal toll on the adolescents it affects.

To make matters more complicated, numerous other conditions can mimic ADHD and as a result make proper diagnosis sometimes more difficult to achieve. In my clinical experience, I’ve evaluated many children for ADHD who ended up not having the disorder. For example, a child with an anxiety disorder might be very inattentive and off-task because they’re worrying so much about something going on at school or home. Similarly, a child who is bullied might struggle to complete assignments and may daydream. For children with poor sleep habits, impulse control and inattentiveness are frequent occurrences. There are also children suffering from developmental delays and intellectual disabilities to consider who are developmentally much younger than peers their age. Some children who have faced trauma or abuse might also display symptoms characterizing a “garden variety ADHD” diagnosis, which conversely are often rooted from the unknown difficulties they’re facing. Therefore, a thorough, holistic medical examination is a critical component of ADHD evaluation.

ADHD is simply more than a checklist of symptoms to look for. The children truly living with ADHD deserve a proper evaluation seeking to better understand their functioning, and I firmly believe this evaluation should actively seek to rule out ADHD rather than reflexively assuming its presence. Do you want to know my adage? “All that bounces is not ADHD; all that flaps is not autism. It’s OK to be quirky!” It can quack like a duck and waddle like a duck, but it’s actually a duck-billed platypus.

I strongly encourage parents, educators and clinicians to reconsider how they perceive children who display ADHD-like symptoms such as hyperactivity, inattentiveness and impulsivity. I’m inviting you to use a comprehensive lens to the child’s biopsychosocial functioning when determining if they have ADHD or another condition. It’s simply respectful to take all of a child’s experiences and stressors into consideration when considering an ADHD diagnosis. In my professional opinion, it’s a disservice to children if they’re mechanically diagnosed with the condition without consideration of several other factors contributing to their behaviors.

All that bounces is not ADHD, and every child is unique. In fact, some adult expectations might need to be adjusted to account for individual temperaments in children. If there are reasons behind a child’s behavior, a comprehensive, interventional approach is most beneficial to these children, their families and hopefully to society as a whole.

If you're interested in learning more about ADHD, click here.