Many children with ADHD show signs of the disorder before they reach school age. But it’s in school, when they are having trouble meeting expectations for kids in their grade, that most are referred for diagnosis.

ADHD is one of the first things that’s suspected when a child’s behavior in class, or performance on schoolwork, is problematic. A child who can’t seem to sit still, who blurts out answers in class without raising his hand, who doesn’t finish his homework, who seems to be daydreaming when the teacher gives instructions—these are well-known symptoms of ADHD.

But these are also behaviors that can be a result of other factors, from anxiety to trauma to just being younger than most of the kids in the class, and hence a little less mature.

That’s why it’s important for teachers and parents both to be aware of what ADHD looks like in the classroom, and how it might be confused with other things that could be influencing a child’s behavior. Observing kids carefully is especially important when kids are too young to be able to articulate what they are feeling. And referring struggling kids for diagnosis and appropriate support can help them succeed in school and other parts of their lives, too.

ADHD symptoms

There are three kinds of behavior involved in ADHD: inattention, hyperactivity and impulsivity. Of course all young children occasionally have trouble paying attention to teachers and parents, staying in their seats, and waiting their turn. Kids should only be diagnosed with ADHD if their behavior is much more extreme in these areas than other kids their age.

These symptoms of ADHD are divided into two groups—inattentive and hyperactive-impulsive. Some children exhibit mostly inattentive behaviors and others predominantly hyperactive-impulsive. But the majority of those with ADHD have a combination of both, which may make it very difficult for them to function in school.

Here are behaviors you might observe in school in those two categories.

Inattentive symptoms of ADHD:

  • Makes careless mistakes in school work, overlooks details 
  • Is easily distracted or sidetracked
  • Has difficulty following instructions
  • Doesn’t seem to be listening when spoken to directly
  • Has trouble organizing tasks and possessions
  • Often fails to finish work in school or chores in the classroom
  • Often avoids or resists tasks that require sustained mental effort, including doing homework
  • Often loses homework assignments, books, jackets, backpacks, sports equipment

Hyperactive or impulsive symptoms of ADHD:

  • Often fidgets or squirms
  • Has trouble staying in his seat
  • Runs and climbs where it’s inappropriate
  • Has trouble playing quietly
  • Is extremely impatient, can’t wait for his turn
  • Always seems to be “on the go” or “driven by a motor”
  • Talks excessively
  • Blurts out answers before a question is completed
  • Interrupts or intrudes on others conversations, activities, possessions

Serious impairment

It’s important to keep in mind that not every high-energy or impulsive child has ADHD. Children are diagnosed with ADHD only if they demonstrate these symptoms so often that they are causing real difficulty in at least two settings—i.e. at school and at home. And the pattern that’s causing them serious impairment must persist for at least 6 months.

Age matters

It’s also important, when considering a child’s behavior, to compare it to other children the same age—not to the range of kids in his class or grade. Within any given grade, kids’ ages can differ by almost a year, and a year can make a big difference in a child’s ability to self-regulate.

Two studies in the last few years concluded that kids who are youngest in their class are disproportionately diagnosed with ADHD. A Michigan study found that kindergarteners who are the youngest in their grade are 60% more likely to be diagnosed with ADHD than the oldest in their grade.  And it doesn’t affect just kindergarteners: a North Carolina study found that in fifth and eighth grade, the youngest children were almost twice as likely as the oldest to be prescribed medication for ADHD.

Related: Is it ADHD or Immaturity? How to Tell

Other causes

When children exhibit behaviors that we associate with ADHD, it’s important to keep in mind that they could be caused by other underlying factors. A child who is inattentive could be distracted by chronic anxiety, by a worrisome or painful situation at home, or because she’s being bullied in the playground. These are all things a child might be embarrassed by and go to some lengths to keep secret.

Another thing children often hide is undiagnosed learning disorders. If a child is fidgeting when she’s supposed to be reading, it may be that dyslexia is causing her great frustration. And if she bolts from her chair, it could be because she is ashamed that she doesn’t seem to be able to do what the other kids can do, and intent on covering that fact up.

Related: Not All Attention Problems Are ADHD

Girls are different

The stereotype of ADHD is boys disrupting the classroom by jumping up from their seats, getting in other kids’ business, or blurting out answers without raising their hands. But girls get ADHD too, and they tend to be diagnosed much later because their symptoms are more subtle. More of them have the only inattentive symptoms of ADHD, and they get written off as dreamy or ditzy. If they have the hyperactive-impulsive symptoms they are more likely to be seen as pushy, hyper-talkative, or overemotional. Impulsive girls may have trouble being socially appropriate and struggle to make and keep friends.

But a big reason that many girls aren’t diagnosed is that they knock themselves out to compensate for their weaknesses and hide their embarrassment about falling behind, losing things, feeling clueless. The growing awareness, as they get older, that they have to work much harder than their peers without ADHD to accomplish the same thing is very damaging to their self-esteem. Girls who are chronically hard on themselves about their lapses may be struggling with thoughts that they’re stupid or broken.

Reltated: How Girls With ADHD Are Different

Red flags

Keeping a keen eye on kids’ behavior in the classroom is important not just because it affects their learning—and potentially the ability of other kids in the class to learn—but also because it’s a window into their social and emotional development. When kids are failing or struggling in school for an extended period of time, or acting out in frustration, without getting help, it can lead to a pattern of dysfunctional behavior that gets harder and harder to break.

That’s why it’s important for parents to get a good diagnosis from a mental health professional who takes the time to carefully consider the pattern of a child’s behavior and what it might (and might not) indicate. Being not only caring but precise about defining and treating a child’s problems when he is young pays off many times over in the long run.

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