What are the symptoms of ADHD, and how can it be told apart from normal energy? Read the signs by age, possible causes and practical tips for parents.
"He can't sit still for two minutes." "It takes her an hour to start her homework." "It's as if he never hears what I say." If these sentences sound familiar, you may be wondering whether your child is simply energetic or may be living with attention deficit hyperactivity disorder (ADHD). The symptoms of attention deficit are one of the most talked-about subjects in school-age children, but also one of the most misunderstood. Not every energetic child has ADHD, and it cannot be said that every quiet child has no attention problem. In this article we look at what ADHD is, the signs through which it shows itself, how it differs from normal childhood energy, its possible causes and what parents can do.
What Is ADHD?
Attention deficit hyperactivity disorder is a neurodevelopmental condition related to developmental differences in the functions of the brain that regulate attention, impulse control and activity level. It is usually noticed in childhood, but symptoms can continue in adolescence and adulthood in different forms.
It is important to stress from the start that ADHD is not the result of "lack of discipline", "laziness" or "bad parenting". A child with ADHD has to put in far more effort than their peers to concentrate, stay in their seat or control their impulses. These children are often criticised with "they can do it, they just don't"; yet the real matter is that, even if they want to, they cannot use these skills as easily as their peers.
The subtypes of ADHD
ADHD is usually seen in three forms:
- Predominantly inattentive type: The child may not be very active, but struggles to sustain attention, follow instructions and organise their work. These children are often described as "absent-minded" or "daydreamers", and in girls this type can be missed more often.
- Predominantly hyperactive-impulsive type: The child is constantly on the move, finds waiting difficult and acts without thinking.
- Combined type: Both groups of symptoms are clearly present together.
What causes ADHD?
ADHD has no single cause. Research in the field shows that genetic predisposition plays an important role; ADHD is known to be more common in families. Differences in the development of the brain regions related to attention and impulse control are also associated with ADHD.
Factors such as smoking and alcohol use during pregnancy, premature birth and low birth weight are also thought to pose a risk. However, sugar consumption, "spoiling" or parenting style do not on their own cause ADHD. The family environment can, though, significantly affect how the symptoms play out in daily life and how the child copes with them.
What Are the Symptoms of Attention Deficit?
The symptoms of ADHD can be grouped under three main headings: inattention, hyperactivity and impulsivity.
Signs related to inattention
- Difficulty paying attention to details, making careless mistakes
- Difficulty sustaining attention during lessons, homework or play
- Seeming not to listen when spoken to directly
- Being unable to follow instructions through to the end, leaving tasks unfinished
- Difficulty organising homework and belongings
- Avoiding tasks that require sustained mental effort
- Frequently losing items such as pencils, erasers and coats
- Being easily distracted by outside stimuli
- Forgetfulness in daily tasks
Signs related to hyperactivity
- Constantly fidgeting in their seat, playing with hands and feet
- Getting up from their seat in situations where they are expected to remain seated
- Running or climbing in inappropriate settings
- Difficulty playing quietly
- Being constantly on the go, as if "driven by a motor"
- Talking too much
Signs related to impulsivity
- Blurting out the answer before the question is finished
- Difficulty waiting for their turn
- Frequently interrupting others' conversations or games
- Engaging in risky behaviour without thinking about the consequences
These symptoms of attention deficit do not on their own amount to a diagnosis. For an ADHD diagnosis, the symptoms must be seen in more than one setting (for example both at home and at school), must have continued for a certain period, must be marked for the child's age and must clearly affect their daily life. A diagnosis can only be made by a child and adolescent psychiatrist after a comprehensive assessment.
Is My Child Just Energetic, or Is It ADHD?
It should be remembered that children, especially in the preschool period, are naturally active and curious and have short attention spans. A four-year-old being unable to sit still for half an hour is developmentally expected. For this reason, assessment is always carried out taking the child's age and developmental level into account.
The following questions can serve as a guide in telling the difference:
- Persistence: Are the symptoms limited to a period of a few weeks, or have they continued for a long time?
- Setting: Are the symptoms seen only at home, or also at school, among friends and on visits to relatives?
- Comparison with peers: Is the child's activity and attention span markedly different from that of other children of the same age?
- Functioning: Do the symptoms make it harder for the child to learn, to have friendships and to get along within the family?
Imagine a seven-year-old who can be glued to the screen for hours while watching a favourite cartoon, but when they sit down at the homework table gets up after five minutes, plays with their pencil and looks out of the window. Parents may think, "They can focus when they want to, so there's no problem." Yet children with ADHD can focus for a long time on very interesting activities that give quick rewards, while struggling with boring or effortful tasks. For this reason, the observation that "they can focus on the screen" does not on its own rule out ADHD.
Conditions that can be confused with ADHD
Some conditions can cause symptoms similar to ADHD. Anxiety, depression, learning difficulties, sleep problems, hearing or vision problems, traumatic experiences and intense stress in the family can also cause attention and behaviour problems. It is also known that long, unsupervised screen use can have negative effects on attention span and sleep pattern; you can look at our article on screen addiction on this subject. For this reason, a comprehensive assessment is very important for telling ADHD apart from these conditions.
How do the symptoms of attention deficit change with age?
Symptoms can take on different appearances according to the child's stage of development. In the preschool period, hyperactivity may be more marked: the child constantly climbs, runs, jumps from game to game and has trouble noticing danger. However, it is quite difficult to distinguish this from normal activity at this age; specialists therefore generally act cautiously and may prefer to observe the child for a while.
In the primary-school period, the symptoms of attention deficit often become more visible. This is because school requires sitting for long periods, following instructions and completing boring tasks. Feedback from teachers increases in this period. Approaching adolescence, activity often decreases; it may be replaced by inner restlessness, difficulty planning, leaving homework until the last minute and difficulties with time management. This change can lead some families to think "it's gone now", whereas the difficulties may only have changed form.
How Do the Symptoms of Attention Deficit Affect School and Family Life?
ADHD can affect not only a child's lessons but also their self-confidence, friendships and relationships within the family. Children with ADHD are often warned, criticised and punished during the day. Over time they may develop negative beliefs such as "I'm just naughty" or "I'm stupid".
In Turkey, the education system, with its exam-oriented structure in particular, requires long periods of sitting and working quietly. The LGS (Turkey's national high-school entrance exam) preparation process, study sessions and cram-school schedules can be especially demanding for children with ADHD. Crowded classrooms make it hard for teachers to devote separate time to each student. In the extended-family setting, grandparents' attitude of "we didn't have this sort of thing in our day" can increase the pressure on parents.
Common effects include:
- Fluctuations in school performance and falling short of their potential
- Conflict and exclusion in friendships
- Constant tension at home, homework time turning into a battle
- Low self-confidence and negative thoughts about themselves
- An increased risk of accidents and injuries
- Burnout and feelings of guilt in parents
What Can Parents Do at Home?
Whether or not there is an ADHD diagnosis, it is possible to support at home a child who is struggling with attention and behaviour. If you are observing symptoms of attention deficit in your child, the steps below can make daily life easier for both your child and the family, even while you wait for the assessment process. Rather than trying to apply all of these suggestions at once, it is more sustainable to start with the few that suit your family best and add new ones over time. Remember, the aim is not to "fix" the child but to see their strengths and stand beside them in the areas where they struggle:
- Establish a routine: Regular sleep, meal, homework and play times let the child know what to expect.
- Give instructions short and clear: One-step directions such as "First put the toys in the box" are more workable than "Tidy your room". Speaking with eye contact also helps get their attention.
- Break tasks into small pieces: Dividing homework into short sections and giving short movement breaks in between makes it easier to focus.
- Notice positive behaviour: Noticing and appreciating behaviour that is going well, rather than criticising, supports the child's self-confidence.
- Reduce distractions: It is helpful to limit stimuli such as television, tablets and phones in the place where homework is done.
- Give room for movement: Sport and physical activity help the child release their energy in a healthy way.
- Work with the school: Keeping regular contact with the teacher makes it possible to develop a consistent approach at home and at school.
- Support yourself too: Being the parent of a child with ADHD can be tiring. It is important to find a space where you can share your own feelings.
A child with attention deficit is not unwilling; they are a child who learns differently and needs to be supported differently.
When Should You Seek Professional Support?
It can be helpful to consult a specialist in the following situations:
- If symptoms related to attention, activity or impulsivity have lasted at least a few months
- If the symptoms are observed both at home and at school
- If the teacher has voiced concerns about your child's attention or behaviour
- If your child's school performance, friendships or self-confidence are affected
- If tension in the family has clearly increased because of the child's behaviour
The ADHD diagnosis and, where necessary, the decision on medication are made by a child and adolescent psychiatrist. Psychological assessment and therapy accompany this process and support the child and the family. If you would like to know in more detail when you should seek a specialist, our article on when to take your child to a child psychologist may be a helpful guide.
How Is ADHD Addressed in Therapy?
Working with ADHD is usually a multifaceted process. Alongside the child psychiatry assessment, psychological support, parent training and work with the school are important parts of this process. The work carried out under child and play therapy may include the following:
Parent training
In sessions with parents, information about ADHD is given and behaviour management strategies that can be applied at home are worked on. Reinforcing positive behaviour, setting consistent limits and strengthening the parent-child relationship are among the main goals.
Work with the child
According to the child's age, play-based methods or Cognitive Behavioural Therapy techniques can be used. Work is done on emotional regulation, impulse control, planning and organisation skills, problem solving and social skills. Supporting the child's self-confidence and transforming their negative beliefs about themselves are also an important part of the process.
Work with the school
With the parent's consent, contact can be made with the teacher and arrangements that can be applied in the classroom can be discussed. A consistent approach between home and school significantly supports the child's development.
Frequently Asked Questions
Does ADHD go away when children grow up?
In some children with ADHD, symptoms, especially hyperactivity, may ease with age. However, difficulties with attention and organisation can continue in adolescence and adulthood in different forms. Early recognition and appropriate support help the child develop their skills for coping with these difficulties.
Who diagnoses ADHD?
An ADHD diagnosis is made by a child and adolescent psychiatrist. In this process, information from parents and teachers, interviews with the child and, where necessary, psychological tests are used. Psychologists can contribute to the assessment process and carry out the therapy process.
Does ADHD look different in girls?
In girls, the predominantly inattentive type may be seen more often. Because these children are perceived as quiet, absent-minded and daydreamy in class, the symptoms can be overlooked. For this reason, it is important to pay attention to children who are quiet but constantly struggling.
Does sugar consumption cause hyperactivity?
Although it is a widespread belief, sugar consumption has not been shown to cause ADHD on its own. However, a balanced diet, regular sleep and physical activity support every child's overall wellbeing and attention.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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