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.

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.

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.