Does my hyperactive child have ADHD?

It’s hard for most children to sit still even for a little while. But how do you tell the difference between normal and hyperactivity? Furthermore, parents may wonder, “If my child is hyperactive, does that also mean that he or she has Attention-Deficit Hyperactivity Disorder (ADHD)?”

The American Academy of Pediatrics (AAP) says that while hyperactive behavior can be considered normal for some children, hyperactivity can, but doesn’t have to, be indicative of a neurological-developmental condition, such as ADHD.

ADHD is a diagnosis given when a person shows a persistent pattern of inattention and/or hyperactivity-impulsivity that negatively impacts his or her life.

“A hyperactive child is one who is more physically and/or verbally active than other children his or her age,” said Carolyn Cruse, PsyD, a licensed psychologist at Cook Children’s. “It is important to remember that what qualifies as hyperactivity in one age group may not be called hyperactivity in another.”

In addition, it's crucial for parents to note that having a hyperactive child does not necessarily mean the child has ADHD. When hyperactivity presents as a single symptom, it’s probably incorrect to assume the child has ADHD.

There are different subtypes of ADHD that could be part of a child’s diagnosis:

• Predominantly Inattentive Type - only symptoms of inattention are present and there are no or very few symptoms of hyperactivity.

• ADHD Predominantly Hyperactive-Impulsive Type- mainly symptoms of hyperactivity-impulsivity and a few symptoms of inattention.

• ADHD Combined Type - symptoms of both inattention and hyperactivity-impulsivity.

What Is Hyperactivity?

Hyperactivity shows itself in children as talking excessively, fidgeting or squirming in their seat at school or church, running or wandering when expected to walk or be still and having trouble sitting still for calm leisure activities like coloring or doing puzzles.

Parents sometimes describe their hyperactive children as constantly in motion or always on the go. The overactivity should be more than what is typically seen in other children that age and should negatively impact the child’s ability to function in school, home or other situations in order for it to be considered an indicator of ADHD. Thus, hyperactivity may be the first concern that is noted by parents or teachers.

“Parents should be concerned when their child’s overactivity is negatively affecting his or her ability to learn and behave appropriately in school, complete homework or follow the rules at home and/or participate in extracurricular activities,” Cruse said.

For example, a 5-year-old girl who is starting kindergarten may be observed having trouble sitting still in her seat and constantly wandering the room during “circle time,” but this would generally be seen as age appropriate. However a 7-year-old second grader who moves so much that he falls out of his chair and repeatedly gets out of his seat when he should be completing class work is more likely displaying symptoms of hyperactivity.

Hyperactivity can be seen in very young children or toddlers, but a diagnosis of ADHD should be made cautiously. In very young children, hyperactivity may appear as though the child is having difficulty functioning at home or school. These children are constantly shifting from activity to activity, jumping on furniture, climbing up cabinets and unable to sit still—even briefly—for quiet activities.

Again, the overactivity should be more than what is seen in other children their age. Younger children are also likely to display their hyperactivity and impulsivity as aggressive behavior. These children have not fully learned to respond appropriately to frustration or irritability and may impulsively respond with aggression. Older hyperactive children may also behave aggressively because of their hyperactive/impulsive tendencies.

Hyperactivity is seen in both boys and girls, though boys are more likely to experience hyperactivity at a heightened level that indicates ADHD, according to Cruse.

What Can You Do?

A hyperactive child will benefit from the chance to hand out papers in class, take a note to the teacher in the next room or simply walk to get a drink from the drinking fountain every so often.

Some hyperactive children actually function better when allowed to stand at their desk rather than sit. This cuts down on fidgeting and squirming in the chair. Parents may need to let their child have a chance to run and play once he or she get home from school to release pent up energy before starting chores or homework.

Parents can channel their hyperactive child’s energy into positive outlets such as sports, dance or karate. They can also use their child’s energy by making games out of small chores (make putting away toys a beat-the-clock game, putting laundry in the washing machine into a basketball game or sweeping the floor as a dance routine).

“Hyperactive children are often seen as very charismatic and fun-loving,” said Cruse. “They can often find fun in whatever they are doing and tend to be creative. When that hyperactivity is channeled appropriately, these children can grow up to be very high-achieving adults.”

Getting a Diagnosis

If parents believe their children’s hyperactivity is severe enough to be interfering with their daily functioning, and increasing their children’s involvement in appropriate physical activities has not improved the problem, they can contact their pediatrician or Cook Children’s Psychology department regarding a possible evaluation for ADHD.

Once a diagnosis of ADHD has been made, there are various treatment options to help improve a child’s functioning. A therapist/psychologist can help by teaching children to monitor their own behavior and learn to think before acting. They can also help parents learn more effective ways to handle their child’s hyperactivity. Schools can also make accommodations that will help with school performance.

Finally, medication is another treatment option that parents can discuss with their pediatrician or a child psychiatrist.