Not naughty, just misunderstood: Spotting the early signs of ADHD in kids

When children struggle to sit still, follow instructions or keep up in class, their behaviour is often mistaken for laziness or disobedience. In many cases, these could be signs of Attention Deficit or Hyperactivity Disorder (ADHD), says Clinical Psychologist and Senior Lecturer at IMU, Dr Serena In.

To explain, Dr Serena takes the example of Joe, an eight-year-old who fidgets constantly, blurts out answers, loses things and struggles to follow routines despite his best efforts. Like many with ADHD, he faces daily misunderstandings, often being labelled naughty or lazy.

According to Dr Serena, boys are diagnosed three to four times more often than girls, partly because girls may mask their symptoms more effectively.

"ADHD is a neuro-developmental disorder that starts in early childhood. It affects how our brain develops and how it processes things. It is not a behavioural problem. What happens in the brain affects the way a child functions," she said in a statement.

She explains that there are three types of ADHD, the predominantly hyperactive-impulsive type, the predominantly inattentive type or a combination of both.

"The hyperactive-impulsive types have difficulty staying on a task, are always on the go and are fidgety. They can’t sit still through a class lesson, or even a movie.

"They may also display a lack of self-control. For example, a typical child would be able to learn behaviours such as lining up and taking turns, but a hyperactive-impulsive type will find it very difficult to do so," she added.

Dr Serena said the cause of ADHD are linked to multiple factors, including genetics, environmental exposures and maternal prenatal influences.

She also advises limiting screen time for young children, as overstimulation from fast-paced media can worsen attention problems and hinder healthy brain development.

"Excessive screen time also means less exercise, less quality sleep, less time for homework which ultimately affects a child’s ability to be at their best,” she explained adding that more longitudinal studies need to be done to really understand the impact of over-using devices.

How to get a diagnosis

For children, Dr Serena said diagnosis typically begins with observations from parents, teachers and caregivers across various settings.

She said teachers often play a crucial role in identifying potential cases.

"Observations need to come from more than one person and from different settings. When you see that the behaviours across these settings form a pattern, then there could be cause for concern," she said.

She further noted that parents who bring their children for assessment have often been asked to do so by teachers.

"Teachers play an important role in recognising when a child needs help," she said.

She also added that in Malaysia, a clinical psychologist conducts a thorough assessment over several sessions to evaluate symptoms, rule out other conditions, and highlight a child’s strengths. These assessments lead to tailored treatment plans which may involve therapy, medication or both.

"A comprehensive assessment will take a minimum of three sessions. During the sessions, a clinical psychologist will use a combination of assessment tools, behaviour observations, cognitive assessments, as well as other adaptive functioning screening to rule out other disorders," she said.

Dr Serena stresses that trying to self-diagnose with online tests is a sure way to misdiagnose or overdiagnose.

"Always see a registered professional as they are adequately trained to diagnose accurately. Parents can go to both private or public health clinics depending on levels of affordability and urgency of the case.

"The private sector will be able to see a child quite immediately, while those seeking help at government hospitals will have to wait to get an appointment. You also need to get a referral letter from a clinic or a GP if you want to get an appointment at a government facility," she added.

During the sessions, Dr Serena said a clinical psychologist will also identify the child's strengths.

“We don’t confirm a diagnosis and leave you with just a label. Through a thorough assessment, psychologists will highlight the child’s strengths for example, memory abilities, creativity or the ability to hyperfocus on areas of interest.

"Essentially, a diagnosis leads to specific and practical recommendations, as well as a treatment plan that is tailored for the child. That is why a psychological assessment by a mental health professional is so beneficial," she explained.