Does My Kid Really Have ADHD Or Is This Just What We’re All Like Now?

Dear Good Enough Parent,

I just had a conference with my son’s teacher, and she gently suggested getting him tested for ADHD. I started researching it and got nowhere but now, I’m seeing all this ADHD content on TikTok and it sounds a lot like him. Or is that just how all kids are? Can this many children really have ADHD?!

Dear reader,

I've been researching and writing about ADHD for almost two decades now, and I have been diagnosed with it and live deeply in the world of “ADHDers.” And I both have many, many answers to your question, and none at all. But if I could choose one thing a parent could remember about ADHD, it would be that it is a biological condition that is extremely impacted by environmental influences.

I can also tell you that from a science and research perspective, ADHD is absolutely real. Researchers have isolated dopamine-related genes, which are implicated in the brain's ability to feel pleasure and reward, among other things, as markers of ADHD. Differences between ADHD and non-ADHD brains have been identified on scans. For instance, the prefrontal cortex — the center for planning and impulsive control — develops more slowly in ADHD brains, and is ultimately smaller. Scientists have also observed ADHD brains may have different levels of connectivity, with more activity in systems that allow our minds to wander. All of this is very tangible and adds to the evidence that it is very real, rooted in genetics, and not something made up by teachers to pathologize kids they don’t like. Nor is it something made up by drug companies to sell drugs.

But there are also studies that show that someone with ADHD can present differently at different points in their life and in different situations. There are ADHD girls who get by just fine, and then get identified when they hit puberty and estrogen spikes increase their symptoms (it’s true!), or when the demands of middle or high school tip the scales.

The very reason that many parents doubt their child's ADHD is their child’s inconsistencies, but inconsistency is in fact what defines ADHD.

Practically speaking, this means that while your child may truly have biological differences that manifest in something that we have decided as a culture should be called “ADHD,” he may feel and behave wildly different in, say, one teacher's classroom versus another's, or at one parent's house versus the other’s, or in the afternoon versus the morning, or when doing math homework versus writing homework, or at a birthday party versus a play date, or at the small Target with street parking and minimal displays of candy at the register, versus the big one with the endless parking lot and the unnecessarily bright lights and the seasonal Lego display. You know what’s kind of crazy? The very reason that many parents doubt their child's ADHD is their child’s inconsistencies, but inconsistency is in fact what defines ADHD.

Of course, one of those environmental factors, and it’s a big one, is that we, as adults, expect too much of children (and I suspect many professionals would agree with me here). There are so many ways to put demands and expectations on a child, and it's not always about the number of demands, or the intensity of them, but about the fit between those demands and what a certain child's brain finds doable.

We ask children to spend too much of the day sitting, which is not easy and not enjoyable for many ADHD brains. We have too many curricular standards for them to get through, which leaves little time for the self-directed work that many ADHDers love and can even hyper-focus on (like those computer games). We overschedule them, which can lead to sensory overwhelm, anxiety, or simply not enough time to recharge. (It's almost as if giving ourselves completely over to our children and then having their love and success tied up in our own sense of worth as parents isn't good for either party?) All of this takes a toll on our children.

So, are there children who we slap a label on — pathologize, as we clinicians call it — simply because we can't tolerate a typical level of squirreliness or disorganization? You bet! As you note, the uptick in child ADHD diagnoses has been sharp over the last few decades, and many researchers have tried to figure out why. In their book, The ADHD Explosion, psychologist Stephen Hinshaw and economist Richard Scheffler found that states where children underwent high-stakes standardized testing at younger ages had much higher rates of ADHD than children in states where this testing came later, or not at all. It is likely that some combination of two things happened: First, kids who didn't truly have ADHD were viewed as problematic by parents and teachers because they could not handle test preparation, or perform on the actual test. And second, kids who did have ADHD had their biology placed in a much sh*ttier environment for it, namely one where they had to spend more time filling in bubbles and learning rote information.

Most of the things we do to support children with ADHD are things you can do without a diagnosis.

Which is all to say, ADHD is both underdiagnosed and overdiagnosed. It's misdiagnosed and missed altogether. It is treated in some circles like a medical disorder but, even though there are biological markers for it, it is absolutely not. There is no one test for ADHD, no objective way, at this moment in time, to say “yep you've got it” and “no, you don't.” ADHD is defined by how people think, feel, and act. You can't know for sure that someone has depression or anxiety or is an introvert or an extrovert. These things are all about subjectivity and perception— of the clinician, of the person in question, and, most significantly for children, of the adults around them and how much they view these ADHD-like behaviors as problematic or even interesting.

So where does that leave us — and your sweet maybe-ADHD child? The good news is that there are trained professionals out there who have seen a lot of ADHD and a lot of not-ADHD and, if given the chance to spend a good amount of time with your child, they could probably give you, if nothing else, their informed opinion. These people are sometimes available to you through your insurance or a local agency or your school district, though not always. But even the trained, informed opinion of a professional is not a final certainty.

I have, in my own work as an educational psychologist, told a family that I believed their child did not have ADHD, and then given them the diagnosis years later when I reevaluated. I have been certain about ADHD diagnoses that other psychologists would dispute. Because mostly what I am doing with an evaluation is humbly offering my expert opinion. This opinion is never black and white; it’s more like, “Based on my experience and the little slice of information I have tried to gather about your child, I think they look like they have an ADHD brain!”

And, whether I give a diagnosis of ADHD or not, I always tell parents this: Most of the things we do to support children with ADHD are things you can do without a diagnosis. (This applies to adults, too.) If you pick up a book about children with ADHD and you recognize your child in it, amazing! Go about your family life for a bit, imagining your child as someone who experiences the world that way. Try some of the interventions for ADHD kids suggested in the book or elsewhere.

Almost all of these “behavioral interventions” are low-cost, though high on energy and creativity. They can involve changing the environment, namely home and school, but also lots of other little places like summer camp and the dining table and a friend's house, to better suit an ADHD brain. See if these things work, even a tiny bit. For example, using a visual timer may only make transitions at home like 15% easier, but that 15% will compound.

Join an ADHD-parent-support group or Facebook group and see if those people, at least a few of them, seem to be describing someone like your child. Tell your child’s teacher, “We’re still working out whether or not she has ADHD, but we did notice that at home, if she’s allowed to draw while she listens to stories, it’s easier for her to pay attention.” Learn about the kinds of school supports an ADHD or ADHD-like student can benefit from (here’s a good roundup).

Your kid remains your kid whatever we call their brain. So proceed like you always have, with curiosity and compassion and a willingness to listen to their experience.

You may feel it's worth getting an assessment, because you want to know more about your child’s unique mind, or because the school pressures you. But diagnosis or not, you’ll be happy that you got a head start when you realize that the world of “official” ADHD parenting is just one of endless trial, error, and acceptance.

And start talking to your child. Not necessarily about ADHD, if that feels overwhelming or premature. Talk to them about brains, how all of them are different and none is better or worse than any other, which is a simple way of describing the fancy term neurodiversity, which an older child would be excited to know if they don't already. In 20 years as an educator, I've never heard children have a problem with this concept the way adults do. Despite the fact that they get messages all the time about how much better it is to be quiet and controlled, they are quite open to the idea that these priorities are not absolute but the biased, narrow preferences of a neurotypical society.

Talk about your brain, the things that are easy for it, and the things that are tricky. Talk about the “workarounds” you use to make the tricky things in your life easier, and also the ways you just accept yourself, even if other people want you to be different. These are the foundations for a good understanding of our own brains and a positive identity for any child who is perceived as different, whether they are diagnosed or not.

Now, for the price of absolutely nothing, you’ve gotten a good chunk of what any psychologist worth their weight in behavioral questionnaires would tell a parent. But one thing the “experts” don’t know as well as you do is your kid. And your kid remains your kid whatever we call their brain. So proceed like you always have, with curiosity and compassion and a willingness to listen to their experience. Ask them what it feels like to play a computer game, to get ready for school in the morning, to do whatever their teacher thinks they are not doing so well. Look for their distress, which doesn’t necessarily mean ADHD, but does mean the environment might need some tweaking. There’s no right answer except to move toward what makes your child feel good in his own skin, and your own peace with whatever you want to call it.

The Good Enough Parent is an advice column for parents who are sick of parenting advice. Romper writer and educational psychologist Sarah Wheeler answers your questions about parenting with humor and humility — and without the guilt trips.

Let Sarah answer your questions about the messy realities of parenting! Send her your questions via this anonymous form or by emailing her at goodenoughparentcolumn@gmail.com.