Ask an expert: Active or ADHD – what's the difference?

Q: “What’s the difference between a very active, inquisitive child and a child with ADHD? Well-meaning people have told me that I should have my 6-year-old evaluated for the disorder, but I’m not so sure.”

Answered by Bertha Kao, M.D., pediatrics, Providence Medical Group-Sherwood

Kids are naturally active and inquisitive – some more so than others. I wouldn’t consider that a cause for concern. This could just be a normal part of your child’s development or personality. But if teachers or others are gently trying to tell you that there are problems with your child’s behavior, or if other issues are present, it’s worth taking a closer look.

One of the main differences between a normally active child and one with attention deficit hyperactivity disorder, known as ADHD, is that the disorder really interferes with a child’s ability to function and get along well in school and social situations. 

To determine whether or not a child has the disorder, a doctor will examine a long list of behaviors, not just a couple. ADHD may be suspected when many of these behaviors occur often, not just occasionally, and when they are considered inappropriate for the child’s developmental level. 

Here are some of the symptoms of ADHD that doctors look for when evaluating a child:

Symptoms of inattention (aka attention deficit): 

  • Doesn’t pay attention to details 
  • Has trouble holding attention on activities
  • Doesn’t seem to listen when spoken to 
  • Doesn’t follow through on instructions and fails to finish tasks
  • Has trouble organizing tasks and activities
  • Tries to avoid tasks that require sustained mental effort 
  • Often loses things 
  • Is easily distracted
  • Is often forgetful 
Symptoms of hyperactivity and impulsive behavior:
  • Fidgets, squirms, taps hands or feet
  • Has trouble staying seated, gets up often
  • Runs around when it’s not appropriate 
  • Has trouble playing quietly
  • Is often on the go
  • Talks a lot
  • Blurts out answers before a question has been completed
  • Has trouble waiting his or her turn
  • Interrupts or intrudes on others 

Simply noticing some of these behaviors does not necessarily mean that your child has ADHD. On the other hand, if you haven’t noticed many of these behaviors, but others are commenting on them, that’s something to pay attention to. Problems with ADHD often show up in environments outside of the home, where a child is outside of his normal comfort zone. 

In short, it can be really hard for a parent to tell whether a child’s activity level or attention span is cause for concern. Because of that, I encourage parents to play it safe: If you have even a mild suspicion, make an appointment with your child’s pediatrician or family physician to look into it. 

A doctor’s evaluation will involve the following:
  • A complete family history, because ADHD tends to run in families 
  • A thorough history of your child’s health and a physical examination to rule out other conditions with similar symptoms
  • A detailed questionnaire about the child’s behavior, to be filled out by at least three adults who know the child well (parents, teachers, day care providers)
  • Observing the child’s behavior 

If your doctor finds no problem, then you’ll leave with peace of mind. But if the doctor does diagnose ADHD, there are very good treatments and interventions available. 

Finding it at an early age allows you to give your youngster the support he needs to be more successful in school, social relationships and life.