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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ADHD stands for attention deficit hyperactivity disorder.

There are three core symptoms of ADHD:

1. Inattention

2. Impulsivity

3. Hyperactivity

Inattention

Inattention can present itself in many ways. Some of the most common complaints that I hear about are daydreaming, forgetting assignments and inability to complete a short list of chores at home.

Often children who mostly have inattention do not become recognized until they are older because they are not the ones causing all kinds of problems in the kindergarten classroom. They will skirt by making OK grades and not getting in trouble until they get a little older and the requirements to sit still and complete assignments on their own increase.

Impulsivity

Do you know that split second where you think about telling someone off but you stop yourself? Or you think about driving 100 mph because you’re running late but don’t because you realize it will be dangerous? That split second is another thing that children with ADHD are lacking. They push right through that pause and act before thinking about the consequences of their action.

The best summary for this problem is that they lack the ability to determine if the upcoming action is: safe or appropriate for time and place.

Hyperactivity

The hyperactive symptoms are the ones that most people (even strangers) will notice about children with ADHD. They are not even necessarily bad kids, it’s simply that they have a significant struggle with staying seated, staying still when seated and not talking out of turn. These symptoms are usually noticed by 4 years of age and progressively worsen until about 7 years.

Learn more about hyperactivity and ADHD here.

ADHD subtypes

There are three major types of ADHD and they are characterized by which of the core symptoms your child demonstrates: mostly inattentive, mostly hyperactive-impulsive and combined.

Diagnosis

The diagnosis of ADHD can be made by multiple practitioners: pediatricians, psychologist, psychiatrists and some counselors are trained to diagnose ADHD. I prefer to make my own diagnosis in my clinic unless the case is particularly challenging or there is something complex about the presentation.

There are many different modalities that can be used to diagnose ADHD but it is mostly made by parental history, teacher’s reports and screening scales. I prefer to use the Vanderbilt scale but there are many other scales out there that can be used.

Diagnostic criteria

Diagnostic criteria for ADHD start at age 4 so younger children are generally not diagnosed with ADHD. This is due in part to the complexity of trying to decide what is normal and what is hyperactive or inattentive for a child younger than 3.

The following criteria are used:

1. Be present in more than one environment (home and school) - this is important because children who have issues only at home or only at school are usually having more of a problem with the structure at one place than actually having a tendency towards ADHD

2.  Be present for more than 6 months

3. Be present before age 7 - this is becoming more of a problem as adolescents and adults are becoming more aware of the problem but demonstrating that there were symptoms prior to age 7 can be difficult

4. The symptoms must impair function-see below

5.  Be excessive for the developmental level of the child - An active 2 year old is not hyperactive but normal.

Does it impair function?

My main point when I am discussing a child’s ADHD with the family is focused upon this aspect of the diagnosis and treatment. For most children, impairment of function means that they are not progressing through school appropriately, are in trouble at school regularly for hyperactive or impulsive behaviors or have difficulty performing regular function at the house because of their ADHD.