"ADHD"… Not every hyperactive child has it

Dr. Wala' Hafez

Attention Deficit Hyperactivity Disorder (ADHD) has returned to the global spotlight, amid a rising number of children and adolescents receiving a diagnosis of the disorder in recent years. According to a report published by the British newspaper *The Guardian*, the number of young people aged 16 to 24 in England receiving support related to ADHD or autism reached approximately 205,000 in April 2026, nearly three times the number recorded in 2019.

**Accurate Assessment**

The difficulty parents face in distinguishing ADHD lies in the similarity between some of its symptoms and common behaviors observed in children and adolescents. A child may become distracted while doing homework, forget school supplies, interrupt others, or struggle to sit still. However, the presence of these behaviors does not necessarily indicate a disorder, nor is it sufficient on its own for a diagnosis.

The American Academy of Pediatrics emphasizes that diagnosis requires a structured medical assessment based on information from parents and teachers, taking into account the duration, severity, and impact of symptoms on academic performance, social relationships, and daily life. The importance of this assessment increases when symptoms persist for at least six months, appear in two or more settings (such as home and school), and clearly affect the child’s performance, while also ruling out other potential causes such as sleep disorders, anxiety, or learning difficulties.

**Anxiety and Learning Difficulties: Common Misconceptions**

A common misconception is that every highly active child or one with poor concentration has ADHD. In reality, its symptoms can overlap with other conditions, most notably sleep disorders, anxiety, learning difficulties, and hearing or vision problems, as well as family and school pressures that may affect a child’s focus and daily performance.

Therefore, an accurate assessment does not merely involve identifying ADHD symptoms but also investigating other potential causes and checking for comorbid conditions that may require different therapeutic or educational interventions. A systematic review published in the journal *Pediatrics*, which included 231 studies on diagnostic tools for ADHD in children and adolescents, found that diagnostic accuracy requires combining specialized clinical assessment, standardized rating scales, and information provided by parents, teachers, and the child themselves. The review confirmed that no single tool can replace a comprehensive evaluation.

**Self-Diagnosis**

With the widespread circulation of videos and symptom checklists for ADHD on social media platforms, some adolescents have reached a conviction that they have the disorder before undergoing any medical assessment. While these platforms play a role in raising awareness about mental health and neurodevelopmental disorders and encouraging some individuals to seek help, the problem arises when general information is used for self-diagnosis, bypassing specialized medical evaluation.

A scientific review published in *Pediatric Clinics of North America* warns that reliance on content provided by non-specialist influencers may lead to inaccurate self-diagnoses due to misinterpretation of symptoms or the spread of misleading information. Consequently, a child’s or adolescent’s experience resembling symptoms described by an influencer does not confirm a diagnosis, just as the absence of all listed symptoms does not rule it out. Specialized clinical assessment remains the foundation of accurate diagnosis.

**When Does a Child Need a Medical Assessment?**

A medical assessment should be sought when parents or teachers observe persistent difficulties with attention, impulsivity, or hyperactivity, especially if these begin to affect academic achievement, social relationships, or the ability to perform daily tasks. It is not advisable to wait for academic or behavioral problems to worsen before seeking help, nor should every temporary academic setback be considered an indicator of a disorder. The goal of assessment is not merely to diagnose, but to understand the true causes of the difficulties the child faces and to determine the appropriate intervention and type of support needed at home and school.

**The Need for Medication**

A diagnosis of ADHD does not necessarily mean starting medication. Experts emphasize that the choice of treatment plan should be based on the child’s age, the severity of symptoms, their impact on daily life, as well as any comorbid conditions and the needs of the family and school. The treatment plan may include family education, training parents in behavioral management techniques, providing school support, and, when appropriate, medication, according to the assessment of a specialist physician.

The American Academy of Pediatrics recommends starting with behavioral interventions for children under six, with medication considered in specific cases. For older children and adolescents, guidelines recommend combining medication with behavioral interventions and school support, tailored to the needs of each case.

**Specialized Diagnosis Does Not Necessarily Mean an Increase in Prevalence**

An increase in diagnoses does not necessarily mean a rise in the prevalence of the disorder or over-diagnosis by physicians. This increase may reflect improved awareness of symptoms and the identification of cases that remained undiagnosed or unsupported for years. Conversely, diagnosing children based on transient behaviors or online symptom checklists should be avoided. This highlights the importance of specialized assessment, which gathers information from multiple sources and considers the child’s performance and behavior at home and school. A child who forgets homework once is not necessarily diagnosed with ADHD, just as a child experiencing persistent distraction that affects their studies and relationships should not be reduced to being labeled “lazy” or “uninterested.”

**For Parents: Monitor Behavior**

When suspecting a child may have ADHD, the correct first step is observation, not self-diagnosis. Parents are advised to record the nature of the behavior, when it occurs, its frequency at home and school, and its impact on academic achievement, sleep, and social relationships, then present these observations to a specialist physician. It is also important to be aware of other factors that may affect concentration, such as lack of sleep, excessive use of electronic devices, psychological stress, learning difficulties, and hearing or vision problems.

True awareness of the disorder does not mean diagnosing every child with inattention, but rather distinguishing between normal childhood behaviors and persistent symptoms that affect the child’s life and require specialized medical assessment. This awareness helps identify previously undiagnosed cases and ensures children receive appropriate support without exaggeration or neglect.