Distracted or ADHD? Akemi Watkins, M.D., Guide for Parents
It can be hard to know the difference between typical childhood behavior and signs that a child may need additional support. In the latest episode of For Kids' Sake, Akemi Watkins, M.D., a child psychiatrist at Cook Children's, discusses ADHD, early intervention, school accommodations and how families can advocate for their children while tuning out the noise and focusing on what matters most. Here's an edited Q&A version of the conversation.
Q: How can parents tell the difference between a child who is occasionally distracted and one who may have ADHD?
Dr. Watkins: The biggest difference is consistency across multiple settings. Children with ADHD often struggle not just at home, but also at school, during extracurricular activities and in other environments.
Parents and teachers may notice difficulties staying seated, following directions, waiting their turn, staying organized or completing tasks. Teachers often report that these children require more redirection to stay focused and on task.
Q: What are some common signs of ADHD that caregivers and teachers may notice?
Dr. Watkins: ADHD symptoms generally fall into three categories: inattention, hyperactivity and impulsivity.
Signs may include:
- Frequent daydreaming
- Becoming distracted easily
- Needing repeated reminders to stay on task
- Excessive fidgeting
- Difficulty remaining seated
- Trouble standing in line or waiting their turn
- Blurting out answers
- Interrupting conversations or activities
- Difficulty organizing schoolwork or belongings
These behaviors occur more frequently and persistently than what would typically be expected for a child's age.
Q: At what age can ADHD be diagnosed?
Dr. Watkins: According to the American Academy of Pediatrics, ADHD can typically be diagnosed starting around age 4. Before that age, many behaviors associated with ADHD, such as impulsivity, high energy and short attention spans, are also normal parts of early childhood development.
Most children in the United States are diagnosed between ages 6 and 7, often after concerns are raised by teachers.
Q: If parents are concerned about ADHD, where should they start?
Dr. Watkins: Start by gathering information from the people who spend the most time with your child. Teachers are often the first to notice patterns because they work with many children and can compare developmental behaviors across age groups.
Parents know their children best, though, and their observations matter too. Coaches, dance instructors, childcare providers and other trusted adults can also provide valuable insight.
Once concerns are identified across multiple settings, families should talk with their pediatrician or primary care provider about an evaluation.
Q: What if a child is homeschooled?
Dr. Watkins: It can be more challenging because there are fewer opportunities for comparison. However, parents can still look for patterns.
Is your child taking significantly longer to complete assignments than siblings or peers? Are they becoming distracted more frequently during lessons? If they participate in homeschool co-ops, sports, church activities or other group settings, do they require more redirection than other children their age?
Looking at behavior across different environments remains important.
Q: What is a 504 Plan?
Dr. Watkins: A 504 Plan provides accommodations that help students access learning more successfully in the classroom.
Examples may include:
- Preferential seating near the teacher
- Modified assignments
- Frequent check-ins for understanding
- Small-group testing
- Additional support with organization
Creating a 504 Plan typically involves collaboration among parents, teachers, school staff and the child's healthcare provider.
Q: How is an Individualized Education Program (IEP) different from a 504 Plan?
Dr. Watkins: An IEP, or Individualized Education Program, falls under special education services and is intended for students who require more comprehensive support.
While a 504 Plan focuses on accommodations, an IEP provides specialized educational services and goals tailored to a student's needs. The process is more involved and often includes formal evaluations from educational specialists, school psychologists or speech-language pathologists.
Because of those evaluations and planning requirements, IEP implementation typically takes longer.
Q: What is the Child Find program, and how can it help families?
Dr. Watkins: Child Find is part of the Individuals with Disabilities Education Act and requires public schools and charter schools to identify and evaluate children who may need special education services.
The program serves children from birth through age 21. Younger children may qualify for early intervention services, while school-aged children can receive evaluations and support through the public school system.
Parents who have concerns can discuss them with their child's pediatrician or teacher to begin the process.
Q: Are children being overdiagnosed with ADHD?
Dr. Watkins: Parents are exposed to an overwhelming amount of information, and much of it can be contradictory.
Rather than focusing on debates about overdiagnosis, it's important to focus on the child in front of you. If a child is struggling academically, socially or emotionally, an evaluation can provide answers and guidance.
On the other hand, not every energetic, daydreaming or quirky child has a disorder. Every child has unique traits and develops differently.
Q: What's the biggest misconception about ADHD?
Dr. Watkins: One of the biggest misconceptions is that children with ADHD are behaving badly on purpose.
ADHD is a neurodevelopmental disorder. Many of the behaviors associated with it stem from impulsivity and difficulty regulating attention, not deliberate defiance. These children are not trying to be disruptive. Their brains simply process information differently.
Q: Is it better to wait and see or ask questions early?
Dr. Watkins: Both.
If you're concerned, ask questions early. Gathering information helps you understand what to watch for and what may be developmentally appropriate. Then you can continue observing your child with better context and guidance.
There's no harm in learning more.
Q: Should parents worry if their child learns differently than other children?
Dr. Watkins: No. Every child learns differently.
Differences in learning styles do not automatically signal a problem. The key question is whether the child is thriving and progressing or struggling significantly compared to expectations for their age and environment.
Q: What's one thing you wish every child could hear from the adults in their life?
Dr. Watkins: “You're doing a good job.”
It's easy for adults to focus on correcting behaviors, improving grades and helping children meet expectations. But being a kid is hard. Children need encouragement, reassurance and reminders that they're loved and valued for who they are, not just for what they accomplish.
Q: What's your message to parents who worry they're not doing enough?
Dr. Watkins: If you're concerned about your child, showing up, asking questions and looking for ways to support them, you're doing enough.
Parents often put tremendous pressure on themselves, but perfection isn't the goal. Being a caring, engaged and "good enough" parent matters far more than having all the answers.
Final Thoughts?
Dr. Watkins: In today's world, it's easy to assume every challenge means something is wrong with your child. But sometimes kids are simply kids. They may be energetic, distracted, imaginative or a little wiggly, and that's perfectly normal.
Pay attention to patterns, trust your instincts and seek guidance when concerns arise. Most importantly, remember that every child develops in their own way and deserves support, understanding and encouragement along the way.
