Seattle's Child

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ADHD Children Aren’t Always Hyperactive


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"My son can't have ADHD. He's not hyper! He can sit and play video games for hours!"

I have heard this many times in my pediatric practice. Saying a child has attention deficit hyperactivity disorder (ADHD) seems to conjure images of kids bouncing off walls and ceilings as if they were jumping on an invisible trampoline. However, that image doesn't accurately depict most ADHD children.

There are essentially three subcategories of ADHD:

  • Predominantly hyperactive or impulsive

  • Predominantly inattentive (sometimes called ADD)

  • A combination of both.

I generally refer to any of these subcategories as ADHD.

The primarily hyperactive version is generally diagnosed early on when the child's actions and impulsiveness have a direct impact on others.

The most inattentive version of ADHD is usually picked up later, often in third or fourth grade. Until that point, parents and teachers either make accommodations due to age or assist the child to get the work done. The shift comes when the child has to apply concepts to learn new things and gets overwhelmed.


Before making an ADHD diagnosis, there must be a thorough evaluation that includes information obtained from the parents, teachers, and the child. In my practice, I don't usually evaluate children younger than 5 because ADHD-type behavior is normal in children that age. Often a learning evaluation is needed as well.

The first question I ask is whether the child's behavior is apparent at school, home, and play. If it is situational — the child seems to do well at home but not school or vice versa — then an ADHD diagnosis is probably not accurate.

There is no simple test for ADHD. A diagnosis comes from professionals who gather information on symptoms: thorough assessments (such as the Vanderbilt questionnaire), observations, and standardized behavior ratings.

If your child is diagnosed with ADHD, you're not alone. About 3 to 7 percent of school-age children have it. Actually, your child is in good company: Winston Churchill, Mozart, Einstein, Da Vinci, and Walt Disney are all thought to have had ADHD.

Another thing to realize is that this isn't something your child will outgrow. Rather, he or she will eventually learn the coping and compensation skills to be successful.

Finding the Right Treatment

Treatment is imperative, and there is no quick fix. A multimodal approach is needed as medication is not a cure. The most common approach is two-pronged: a prescribed medication (generally a stimulant) and behavior modification.

ADHD medications are not sedatives and won't turn your child into a zombie. ADHD is a biochemical condition and most ADHD medications are stimulants that have a paradoxical effect on ADHD children. There are several types of medications with different side effects, so it may take some time to find the right medication for your child

Beware of unproven treatments. There are many unfounded cures, such as vision training, vitamins, biofeedback, spinal cranial manipulation, and anti-ADHD diets. These methods have all been debunked. Parents need to research treatments and inform the child's physician of any alternative treatments being considered.

Ways You Can Help Your Child

  • Set clear goals.

  • Use posters and check-off boxes to help your child with her morning routine.

  • Be consistent and structured. If you know the daily schedule will change, try to let him know in advance.

  • Be clear with consequences: Look right into your child's eyes and ask if she understands.

  • Stay calm and don't yell. Yelling will frustrate both of you and won't help your child understand what to do.

  • Take breaks during homework time.

  • Remind your child (and yourself) that it's not his fault that he's faced with this issue.

  • Make sure your school is linked in with your child's treatment plan. Ask for feedback on a regular basis.

Dr. Robert Nohle, chief of pediatrics at Group Health, writes a column for parents with children ages 6 to 12. He covers a wide range of topics.