Is it ADD or ‘normal’ child behavior?

You find your child just isn’t paying attention. He’s forgetful, not finishing his homework, and easily distracted. Are these bad habits just “normal” kid behavior, or could he have Attention Deficit Disorder?

If a child seems to be consistently exhibiting most or all of these, often or very often, and a degree of disturbance or impairment of daily life is arising in multiple settings (school and home, for example), then this is most likely ADD:

• Failing to give attention to detail

• Making careless mistakes

• Not sustaining attention in tasks

• Not following through with multi-step instructions

• Failing to finish schoolwork

• Disorganization

• Avoiding engagement in activities that require sustained mental effort (except TV or video games!)

• Forgetfulness

• Easily distracted

• Losing things necessary for tasks or activities.

These are maladaptive behaviors, but normal children could exhibit a few of them occasionally. When the child seems to be consistently exhibiting most or all of them, then this becomes ADD more than the child “just being a kid.”

ADD is one of the most common disorders found in children, affecting approximately seven to 10 percent of those in school (and more, depending on the information source). It is a brain-based disorder, and, most likely, a child with ADD was born with it.

In ADD, the brain cannot establish good connections in the areas that regulate attention, filtering of stimuli, sequencing, organizing, planning, etc. Children with ADD have difficulties with attention, but do not present with problems pertaining to high activity level or poor impulse control. Even if a child may be born with these defective brain connections, though, he cannot be diagnosed with certainty until he is school-aged.

ADD is multifactorial, meaning that the combination of various factors could cause it, but we know that genetics play a strong role in its development. It tends to run in families and very often parents of my patients tell me that they used to suffer from ADD, or currently have it. It is also very common that ADD repeats in the siblings.

To evaluate a child for ADD there are several steps to take. First, parents should always consult with their pediatrician if they are concerned. The pediatrician will make sure that the symptoms do not arise from a medical condition, i.e. seizures. Some feel comfortable making the diagnosis themselves, but if not, then a specialist such as a developmental pediatrician, child neurologist or a child psychiatrist will help determine if it is ADD.

At that point, an extensive history is taken, behavioral questionnaires are completed and conditions which commonly coexist with the disorder — such as learning disabilities, anxiety or depression, or autism — are ruled in or out, as some may mimic ADD. Treatment will then be discussed.

If you are still not sure if your child may have ADD, an evaluation can be scheduled by calling (718) 226-6396.

Saidi Clemente, MD FAAP is an assistant professor at SUNY Downstate Medical School and division chief of development-behavioral pediatrics at Staten Island University Hospital.