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.

In the eight counties served by Cook Children’s Health Care System in North Texas, approximately 237,000 children between the ages of 6 and 17 have received a mental health diagnosis. According to the 2024 Community Health Needs Assessment (CHNA), ADHD remains one of the most reported conditions, affecting children’s educational and social development. 

Yet behind those numbers is a troubling reality: not all children have equal access to diagnosis and care. Data provided by the CHNA shows that 18% of Hispanic children and 16% of White children have been diagnosed with ADHD, while only 10% of Black children and 6% of Asian children have received a diagnosis.

“Many parents hesitate to seek therapy or mental health services due to feelings of stigma or guilt. Mental health challenges are common and treatable medical conditions—not a reflection of parental failure,” said Cook Children’s psychiatrist Akemi Watkins, M.D. “Early intervention improves outcomes and many families benefit from the additional support offered through the mental health system.”

Debunking Common Myths 

Early diagnosis is crucial to a child’s well-being and overall health. Debunking myths about ADHD and viewing therapy as a proactive strategy are important first steps toward providing children with the care they need, while also making parenting a child with ADHD a bit more manageable.

Some of the most common myths are:

• Myth: “It’s bad parenting.”
  Fact: ADHD is not the result of poor discipline; it is caused by differences in brain development and brain activity that affect how children focus, sit still, and behave.
   
• Myth: “It’s just hyperactivity.”
  Fact: While many children are naturally active, ADHD is diagnosed when behaviors significantly impact daily functioning at home and at school. 
   
• Myth: “They’ll grow out of it.”
  Fact: ADHD symptoms don’t simply disappear over time. Without support, they can lead to anxiety, academic struggles, and low self-esteem.

Why Early Intervention Matters 

An early diagnosis can give children with ADHD the tools they need to succeed academically and socially.

Untreated ADHD is not just a childhood phase that children will “grow out of it”. Without proper support, they may face long-term consequences including higher rates of school absenteeism, grade retention, an increased risk of substance abuse, involvement with the criminal justice system and potential self-harm or suicide.

Early intervention can significantly improve outcomes and provide families with the resources they need to support their child’s well-being.

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When 12-year-old Deacon Swaim sits at his desk in math class, his peers might notice how focused he is. What they don't see is the journey that led him there.

Deacon is one of just 16 students selected out of 332 to participate in his grade’s accelerated math and science program. He also has Attention-deficit/hyperactivity disorder (ADHD)—a fact that might surprise people given his academic achievements.

"I'm always the quiet kid, but I'm really smart," Deacon says, prompting a laugh from his mother Jennifer Swaim. She adds, "Yes, and humble!"

Early Signs of ADHD

Jennifer, who has worked in the Cook Children's psychology department for almost 17 years, said she recognized signs of ADHD in Deacon when he was still a toddler.

"He's always been a kid that is full of energy," Jennifer said. "We have videos of him sitting on the ottoman in front of the TV, constantly bouncing because he couldn't physically contain himself."

According to Deacon’s psychiatrist—Kristen Pyrc, M.D., medical director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s Medical Center – Fort Worth—ADHD presents in three different ways.

"One is the inattentive type where you have trouble with details and staying on task. The second kind involves hyperactivity and impulsiveness. These are the kiddos who you can spot from across the room because they have a ton of energy," she explains. “The third type combines both characteristics.”

The Path to Diagnosis

While Jennifer recognized the signs early, she waited to pursue formal testing until Deacon’s ADHD began affecting his daily life. His early elementary school years were manageable thanks to a brain-based learning environment that incorporated group work, frequent breaks, and movement.

However, by fourth grade, Deacon started encountering challenges. "If it got too loud in class my ears would start to ring and it made it difficult for me to concentrate and get work done," he recalls.

In 2021, Deacon had a full psychological evaluation at the Cook Children’s Denton Psychology clinic, which confirmed his ADHD diagnosis. At the time of his diagnosis, Jennifer worked in the same building as Dr. Pyrc and asked her if she would be comfortable seeing Deacon, since she was already seeing his older brother Joshua. Dr. Pyrc agreed and has been working with Deacon ever since.

"We tell parents we would think about treating ADHD if it causes impairment in functioning," Dr. Pyrc said. "So if your child is constantly getting in trouble at school or it's really affecting their academic performance, that's when we think about starting treatment."

Both Jennifer and Dr. Pyrc added that consulting with a pediatrician can help parents make an educated decision on if, and when, to pursue a formal diagnosis.

The Power of Understanding and Support

Before his diagnosis, Deacon often felt like he was doing something wrong.

“For a lot of kids who are on the hyperactive end of ADHD, they are told ‘no’ all the time. Don't do this, don't do that,” Dr. Pyrc explains. “As a result, many of these kids can start to feel defeated and stop caring about school.” 

“I think part of it is just validation,” Jennifer said. "It helps Deacon to know he’s not doing anything wrong, his brain is just wired this way.”

After Deacon’s diagnosis, he was met with nothing but support and compassion from his teachers at school. One of his teachers has a child with ADHD and was able to work with him on a game plan to support him in the classroom.

Now, Deacon even has several friends with ADHD, including a buddy from kindergarten who has since moved out of state. The pair stay in touch by playing video games together, bonding over their shared experiences. Deacon also finds support in hanging out with his dog Winston, who he says helps him regulate his emotions.

Finding The Right Treatment

For Deacon, medication has been an effective tool for managing his ADHD and staying focused at school. According to Dr. Pyrc, medications are highly effective in treating core ADHD symptoms like hyperactivity and impulsivity and can give kids a sense of autonomy.

An ADHD brain, Dr. Pyrc explains, has a tendency to explore mental “rabbit trails”—which can be great for creativity, but not for subjects like math. Medication can help kids stay on task by providing helpful mental guardrails for clarity and focus.

Though some parents worry about medication dependency, Dr. Pyrc notes that untreated ADHD actually poses a higher risk for future substance abuse issues than the medications themselves. She emphasizes that therapy can also help kids regulate and process their emotions and develop coping skills.

“There's a whole host of other skills that these kids need to be successful in school, like an organizational system or being able to finish tasks,” she explains. “For those types of skills and systems, therapy can be a helpful supplement to medication.” 

ADHD as a Superpower

Dr. Pyrc commonly reassures her patients that ADHD can be like a superpower.

"Kids with ADHD tend to be more creative because their brain takes those rabbit trails,” she explains. “They work really well in groups because they think outside of the box, and they're very energetic."

Deacon's creativity shines through in multiple ways. He plays euphonium in his school's honors band, dabbles in ukulele and guitar, and enjoys sketching. He also loves challenging video games and all things science—especially learning about space and the universe. Deacon’s passion for building with Legos without instructions shows his innovative thinking.

"It's really cool to see what people can do with just their mind and a couple of bricks," he said.

In fact, Deacon feels his ADHD has actually improved his ability to focus.

"I learned to work hard at getting myself to do better and pay attention," he explains. "In certain subjects, I am one of the most focused ones in my class."

Over the years, Dr. Pyrc has seen Deacon’s confidence grow as he’s come into his own and discovered his strengths.

“To see Deacon’s personality shine through is always the best part for me,” Dr Pyrc said. “He is such a bright and kind kid who is good at so many things and so creative, so I always love to hear what he's up to and what's challenging him.”

Dr. Pyrc encourages parents to remember that while ADHD can be frustrating at times, children are doing their best. She emphasizes the importance of helping them develop the skills they need to be successful—and giving them grace throughout the journey.

October is ADHD Awareness Month. If you're concerned your child might have ADHD, talk to your pediatrician. They can help determine what's standard for your child's age and connect you with appropriate resources as needed.

The first line of treatment for children with ADHD are behavioral options. I never ask (or let) a family jump first to medication if they haven't first tried some of the techniques I’m going to describe below.

What are the goals of treatment?

1. Improved interaction with parents, teacher, classmates and siblings

2. Improved grades

In my opinion, the goals are simple and should be taken in that order. It is important to consider these goals and re-evaluate them frequently during the treatment course. Perfection should not be the goal.

I recommend these behavioral techniques before medication for all children, especially those who are young or who have milder ADHD:

1. Make a schedule daily. All kids have difficulty and waste time with transitions. Children with ADHD do this to the 1000th degree. If these transitions are scheduled and the child knows what comes next it might speed up the transition. Things that should be included on the schedule are homework time, daily chores and self-care items (shower, brushing teeth, etc).

2. Make separate areas in the house for necessary tasks. Keep toys and video games out of the space where homework needs to be completed. This helps limit the child’s distractions so that they can finish the task at hand.

3. Set small goals that are attainable. Don’t ask the child who is failing to make the A honor roll in the next six weeks. Start with turning all assignments in and that they are complete, then slight increases in grades, etc.

4. Use charts and checklists. Children with ADHD are often very visual and concrete. If you can put a list in front of them that can be checked off, they are much more likely to complete what needs to be done. I find this to be helpful for me as well ...

5. Keep choices to a minimum. Don’t tell them to go to the closet in the morning and pick out something to wear. This is a sure way to start a huge fight as they stand in front of the closet for hours while you are trying to wrestle them out the door. Pick out two options ahead of time for them to choose from.

6. Don’t discipline them impulsively. Remember that one of their biggest problems is that they don’t stop to think about consequences before they act. If your discipline follows the same pattern, how can we expect them to learn to act differently? Plan out your discipline plan in advance and be consistent. As tempting as it may be, corporal punishment is rarely effective. I’m not going to get into a spank your child or not debate here, but timeouts and restriction of privileges seem to be more effective for children with ADHD.

7. Help your child with organizational skills. Developing a system that helps them keep track of all the papers is a way to keep them from getting thrown away, having them sit in the floorboard of the car or (more infamously) avoiding having the dog eat them. If you need some help establishing this system, check out this amazing book called That Crumpled Paper Was Due Last Week.

8. Get help. Raising a child with ADHD can be very frustrating and quite exhausting. There will be lots of times when you will feel like there is nothing left to do to help. If your child continues to struggle, talk with your pediatrician about options for treatment, including medication options. Find a family counselor that can work with your child but, maybe even more importantly, that can help you develop a plan for your child and help you cope with the struggles you will face.

I hope that you find these tips helpful as you begin to think about how you can help your child with ADHD.

As you walk through the process keep in mind that your goal should be function, not perfection.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.