If your child struggles to focus or sit still, you might wonder if they have a condition that is frequently mentioned and sometimes misdiagnosed: attention deficit hyperactivity disorder, or ADHD.
Many misconceptions surround ADHD, says Dr. Omare Okotie-Eboh, MD, a pediatrician and internal medicine specialist at Memorial Hermann Medical Group (MHMG) Greater Heights, a family medicine clinic.
"Children diagnosed with ADHD are not less intelligent," he says. "Sometimes they do better in school if they are taught in a way that is more engaging and fun.”
Dr. Okotie-Eboh discusses the facts and fiction attributed to ADHD that parents need to know.
Fiction: Only boys have ADHD.
“That’s absolutely not true, though it occurs more often in boys, at a two-to-one ratio,” he says.
Girls’ symptoms tend to be different, with a focus on inattentiveness more than hyperactivity. “They tend to be distracted, disorganized and have difficulty following directions,” he says.
But every child with ADHD will present differently, Dr. Okotie-Eboh says. “People have this idea that a child with ADHD is constantly talking and bouncing off the walls. That may be true for some kids, but inattentiveness can be more prominent in others.”
Fiction: My child can focus when he wants to focus—when he plays video games—so he’s fine.
A child may be able to focus on certain activities, yet still be diagnosed with ADHD.
“ADHD symptoms are most noticeable in non-stimulating environments,” Dr. Okotie-Eboh says. “With video games, the scenes are always changing, and kids can move their hands and bodies, so that’s not where ADHD signs tend to appear.
“But put them in a quiet room or facing a less stimulating task, and symptoms come forward,” he says.
Fiction: My hyperactive toddler must have ADHD.
Under age 4, children may seem hyperactive as they learn how to interact with others and play. “That’s normal,” Dr. Okotie-Eboh says.
But after that age, you may want to have your child evaluated for the disorder if this behavior persists.
Fiction: ADHD is obvious.
ADHD is a complex condition to diagnose.
Symptoms need to be consistent for at least six months and seen in multiple settings, such as at home, at school or during extracurricular activities.
“It’s important to go through proper evaluation,” Dr. Okotie-Eboh says. “Not every kid meets the criteria for ADHD.”
The hallmarks of ADHD are hyperactivity and inattentiveness. Hyperactive children may have trouble staying still, being quiet or organizing tasks. Children may fidget, be restless, blurt out answers, intrude on other people’s activities, constantly tap their feet or hands or have difficulty waiting for their turn.
Inattentiveness may cause children to make careless mistakes and make it difficult to give attention to detail. “Some kids may avoid homework or tasks that require them to pay attention for a long time,” Dr. Okotie-Eboh says. “They can get easily distracted if they see something that doesn’t necessarily concern them in their environment.”
Even so, kids who seem to have ADHD may have an underlying condition such as mood or learning disorders, or medical conditions such as hyperthyroidism, lead toxicity or anemia. If such conditions are not considered, there could be an improper diagnosis of ADHD.
Fiction: ADHD must be treated with medication.
ADHD can vary in degree, and medication isn’t always needed or required.
For preschoolers who meet the criteria, the initial recommendation may be behavioral therapies, not medicine. Teachers, licensed therapists and parents can help children learn how to manage their symptoms.
For ages 6 and up, medicine is the first line of treatment. “But it’s not always necessary,” Dr. Okotie-Eboh says. “It depends on the severity of symptoms. Behavioral therapy may be all a child needs.”
Behavioral and parenting styles can make a difference in how children cope. Children’s ADHD can be managed, “and that can start at home,” he says. “Children can be taught ways to redirect their energy in public, but they shouldn’t be punished excessively. Kids are going to be kids.”
As for medical options, stimulants such as amphetamines might be effective for treatment. “Stimulants may seem a little bit contradictory,” Dr. Okotie-Eboh says. “But kids with ADHD need constant stimuli. These drugs increase norepinephrine and serotonin in a child's brain, which give them internal stimuli to keep them focused.”
Even so, stimulant medicines “aren’t necessarily the best choice for everyone,” he says. Some children do better with non-stimulants, such as tricyclic antidepressants. But whatever medication is prescribed, it’s got to be the right one and at the right dose to avoid overmedication or side effects, such as insomnia, nausea or weight loss.
Fiction: ADHD isn’t real. It’s just lazy parenting.
When people say ADHD isn’t real, “my response is to put them in a room with a child with ADHD,” he says. “There’s plenty of research that shows changes in the brain, such as a lower development of the frontal cortex.”
Additionally, genetics can likely play a role, with children having a 50% to 80% chance of inheriting the disorder from parents who have it.
Fiction: People outgrow ADHD.
For children diagnosed with ADHD, 50% or more will continue to have symptoms throughout their lives.
The remainder may learn how to manage them as opposed to being cured altogether.
“Adults can still have ADHD,” Dr. Okotie-Eboh says. “They may procrastinate, and find it difficult to manage their time, organize their day or complete tasks. They also may be impulsive, suddenly ending relationships or quitting jobs by overreacting to things that frustrate them.”
