Does my child have ADHD (Attention Deficit/Hyperactivity Disorder)?
ADHD is a diagnosis based on a checklist of symptoms or behaviours. We can see these in children when a part of the brain, in the prefrontal cortex called 'executive function', isn't working well.
Our executive function helps to manage our most complex cognitive tasks in day to day life: sustained attention, working memory, organising ourselves and impulse control. For some children, it doesn't work so well most of the time, while for other children, it doesn't work well at times when they need it most: for example, during tasks that are particularly difficult for that child, such as reading or handwriting. Executive function is one of the areas of the brain most sensitive to any form of stress – physical, emotional or cognitive stressors – so can be affected by multiple different pathways. Prematurity, low birth weight, motor coordination difficulties, poor sleep, sensory issues, fetal alcohol exposure, trauma and anxiety are examples of factors that can cause downstream difficulties in executive functioning.
So when I'm asked to see a child with ADHD symptoms, I try to look both at whether the child is showing signs of poor executive function and what else may be going on upstream as a potential source of stress for that child. We can then use this information to help the child's executive function to work better by addressing the underlying issues. Whether we use the label 'ADHD' depends on whether or not it is a useful diagnosis in helping people understand the child better.