AIBU to think this might not be ADHD?

[schnauzerlover]

My lovely DS is 6 and going to a small village school. He is overall happy there, has some nice friends, but shows - at school- some typical ADHD symptoms like being very restless, always on the go, tapping hands and can't sit still etc. On waiting list for assessment as teachers been pushing for it.

However, when at home, we barely have any problems. He is even tempered (most of the time), he plays wonderfully, no sleep issues etc. It seems to be very connected to the learning environment and I think he behaves very differently at school. Though it is hard getting him to do his homework, I will say that.

For anyone who knows more- do you think it can be ADHD when it's mostly present at school? I am starting to think if it's maybe the wrong school for him...

Just to say, it's not about the labelling- it wouldn't matter of course if it was ADHD, but I am wondering if it could be that he'd be happier in a different school

He’s not stressed at home that’s why he’s calmer.

My ds was a great sleeper, and so easy going.Still adhd.

Oh I see! Well that does make sense. I wish it was easier for him!

Does he display any adhd symptoms at home? It's not something that can just be switched on and off and would show, to some extent, in all environments.

You're unlikely to even make it to the diagnosis assessment stage if there are not signs of adhd at home and at school.

Adhd traits aren't just inattentivness and hyperactivity. Do you see any of these;

• problems with executive function ie loosing belongings, forgetting things, not remembering needing something until the last moment.

• The need to keep moving and switch from task to task which is then sometimes completely switched to hyperfocus where they will remain intently focused on one activity or subject for a very prolonged length of time.

• friendship issues. Adhd kids often have difficulty maintaining friendships.

• Being extremely sensitive to rejection, criticism or things not going exactly as expected.

• Is he dry at night? Not being dry at night at a very young age is also an adhd trait.

• Time blindness. Can he tell the time at all? Can he tell the difference between 5 minutes and 1 hour?

Sleep is often an issue but not always.

Obviously it's a bit tricky at age 6 because a lot of this is reasonably typical for a lot of 6 year olds. 6 is a very you age to seek or get an adhd diagnosis as it's hard to distinguish between immaturity and adhd at such a young age. He could simply be an active 6 year old who is bored at school.

I am really grateful for you taking the time to write me such a long and thoughtful reply!

He's a very bright boy, has amazing general knowledge and is very interested in lots of different things, says he wants to be a scientist when he's older. His teacher says it's all there for him to be that, but he really struggles to maintain focus. I can also tell when I'm at school for assembly etc he is quite nervous and will always want to be near the TA for reassurance.

He says to me school is boring. He has lots of good friends, there are no issues there at all, and we travel lots (plane etc.) because of family in Europe (I'm not British). He is amazingly behaved on those trips- no problems at all. He is also bilingual and speaks the other language extremely well despite me not even trying very hard (we read books in my mother tongue though!)

The teacher seems quite adamant though that we should push for a diagnosis but I just dont know- I also think, like you, 6 years old is very young really!

Oh and, yes, he's been dry at night for a long time

Interesting to read (as an ADHDer myself currently considering possible traits in my 5 year old boy) whilst it definitely can show up differently in different environments it doesn’t sound like there’s anything showing up at home. I think the school environment isn’t great for many children, who aren’t made to stay still for long periods and that isn’t an indication of neurodivergence. I had no issues at primary school at all! Bright, capable, able to focus, though was privately very hyperactive mentally. Can you say more about what school are seeing? It’s more common for ND kids to mask at school then struggle more at home than the other way round, though yes he may be less stressed at home/you’re restricting his movements less

It's doesn't really sound like adhd to me. Unless things change you're unlikely to get past the first steps for diagnosis because the symptoms aren't just there.

I think potentially he's very bright and not being engaged enough at school.

IME teachers at school don’t tend to suggest ND without a good indications they are there. These issues are typically very under-diagnosed.

I do understand your reluctance to over-pathologise and/or over-medicate. You may even come from a family where there are other adults/children who exhibit more obvious symptoms so that your sons’ issues seem minor. (Or maybe not, but that is sometimes the case).

But remember if your ds is ND there will be lots of treatment options and he will be better off understanding himself and his own needs in the long term.

6 is very young; most doctors will not even consider for diagnosis before that. Depending on waiting lists, you could wait and see.

You may not be seeing it at home because your home life doesn't ask him to do things he struggles with. Does he ever have to sit still for periods without an activity he hyperfocuses on? Does he have to wait turns, or does it matter if he interrupts, do you step in if he's getting frustrated with an activity? Is he ever asked to follow multi-step instructions, or to listen to a remember an instruction for the task after the one he's completing?

School classrooms also have a lot of distractions: other people talking and moving; displays on the walls; having to redirect attention between the teacher, a friend answering a question, a worksheet, etc. I feel like ADHD is a bit misnamed sometimes because it's not always a deficit of attention, it's an struggle to direct and keep your attention where someone else wants you to focus it.

Keeping an open mind, does the teacher need to give him more complex work, or more opportunities for extension, if he's bored? Rushing work can be a sign of ADHD but it can also be a sign of a child who is trying to complete something quickly because its too easy.

Hi!! Yes so the main problem is that he cannot sit still at school. Unless he finds something really super interesting. He also does talk to others a lot and fidgets around.

I do think (and had other people confirm) that he is very bright, he doesn't seem to be doing well with the sitting down though. He is so active, we spend ages together in the forest, he loves building dens and learning about other cultures (that's where the Romans and Egyptians come in).

He does bounce around at home but I don't think this is unusual for a 6 year old. My worry is that school are making a big deal out of it... they seem very confident that he'd get a diagnosis for ADHD. As I said I would have no problem with this, but I do wonder if it's maybe not that and a different school would be better for him. He would be said to not see his friends though.

I do wonder if European style schooling (where you have 4 hours sitting down, but then an early finish at 12 lunchtime) would be any better or worse for him.

That's the thing isn't it! This particular school have a lot of ND children and I am sure they wouldn't just suggest it without good cause.

I really don't want to medicate and the wait list in our area is astronomical. I asked for Right to Choose but the GP basically dismissed it and said it's better to stay in the NHS for diagnosis.

Thank you so much for what you said about treatment options- that's good to know.

My step son is like this. We have all the isms in our house! 😂 dd mainly masks in school then bat shit crazy at home, my dss is an absolute angel at home but recently been playing up in school. We suspect ASD (think young Sheldon) and rushes through work then gets bored. If the subject matter isn’t what he likes then no chance of him listening.

DS2 was very similar at that age. At home no issues as he could just get on with what he wanted, in early years it really only showed up at school. It gradually became more obvious in more settings as he got older. (He has inattentive ADHD)

Hmmm interesting. It could be that- as you say, at home he can kind of relax, and I try to keep learning sessions short and give him a reward afterwards...

My ds both diagnosed in their 20’s.
They weren’t very symptomatic at home or in low demand areas of their lives.
It showed up in puberty and secondary school for ds3 and for ds1 it was mostly socially/ relationships that were difficult for him.

I now know there were signs earlier but they were very subtle. Without realising we had built a home around their needs.

It's obviously impossible to tell from posts alone, OP, but it sounds like the concern on both sides is warranted. He clearly displays more symptoms at school, which isn't unusual for people with ADHD, but at the same time if you're not seeing it then you're not seeing it! It might be worth reading into less typical or rarely-discussed symptoms of ADHD to see if that sheds any more light, but I understand your worry about pushing too hard on something you're unsure of. My other suggestion would be to look into ADHD coping skills and see if they help might him at school, which could also help you to figure things out.

That said, assuming you're in the UK because I don't know the process elsewhere, I think it'd be worth joining a waiting list for NHS assessment. The waiting lists are typically pretty long at the moment, depending of course on your area, so it gives you time to think it over while keeping your options open. The assessments on the NHS are pretty thorough, and it's hard to even get to the assessment stage if the preliminary questionnaires don't indicate ADHD, so if he truly hasn't got ADHD then he won't get diagnosed just because the school say so. If he has got ADHD, then it opens up a world of understanding both within your family and at school. If you're worried about the idea of medication, then be assured it's not an imperative. Though it's well worth a try for most people with ADHD, there are many people who choose to be unmedicated, myself included, and instead rely on coping techniques to limit symptoms and improve focus.

I didn't really start struggling with my ADHD until secondary school, as in primary school it was just considered part of being a normal, slightly scatty kid, and from the time I began to struggle it then took six years for me to obtain a diagnosis. I do wish my school had suggested an assessment earlier, because it took me completely falling apart to be referred through the mental health system and taking the slow route to diagnosis.

I think also,having worked in a school, and a parent of 3, primary school curriculum is boring for many kids. Particularly those who have lots of learning and enrichment in their own lives. It may be that he's not challenged enough or not learning enough new stuff to remain engaged. There's a LOT of waiting around and waiting your turn etc in primary. My eldest is bright and has issues with boredom/staying still and is much happier in secondary. More challenging academically and a different teacher/classroom/subject every 50 mins! With built in movement breaks to burn off energy as you have to walk to each classroom. I don't think he's ADHD but he needs to be engaged in life and has a lot of energy.

Hi op,

I assess for ADHD and lead an nhs pathway. Firstly I would start by saying that an assessment is your choice, if you don’t really feel like he needs one you shouldn’t do it. I often see referrals where teachers have been pushing for assessment and it really annoys me, generally they have very little knowledge of what difficulties are actually being looked at and can be very biased. On the flip side I also often see kids who are clear as day ADHD and the school report no difficulties at all. So I wouldn’t say a teacher suggesting diagnosis is really any indication that your child would meet criteria.

There are two additional things here- firstly the absolute earliest I would assess a child is 6. This is because any child under 5/6 would definitely score as having ADHD. We wouldn’t expect a child under 6 to be able to focus for long periods, organise themselves, sit at the table for long periods etc. So it’s all very likely your son is just taking a little bit longer to settle into his school expectations than the rest of the class, which is not an issue at all.

If you were seeing lots of difficulties at home this might impact whether we would assess now. In order to meet diagnostic criteria we would need to see difficulties consistent with ADHd. In order to meet criteria we need to see those difficulties in 2 or more settings AND the difficulties need to have a significant and pervasive impact on the child. So long as nobody else is really reporting anything and you think he’s generally a happy child who is doing well at school, it doesn’t sound like he would meet criteria even if the referral was accepted. It might be that you start to see more difficulties/ meltdowns at home as he gets a bit older (usually around age 9 when school demands increase we see that), and it might be worth seeking an assessment at that point.

Your child does not need a diagnosis for school to put strategies in place to support him, so if they think he struggles to focus they can just help him a bit more, I’d be suggesting that as a first step. Having lists of what will happen in the lesson, check ins during quiet working time, purposeful seating plan, a movement break are what strategies they should start with if they are really that concerned.

Good luck OP!

Is he an only child? It sounds like you do lots of fun, interesting and educational things at home and out and about with him and that keeps him busy, focused and challenged. In a class of potentially 30, with a range of different needs, he isn't going to get that 1 to 1 attention he gets with you/ in the company of adults. It may be that he just struggles with that at school, or that he may have a diagnosis and traits show more at school where he doesn't get as much adult attention/focus on him and things that keep him interested and busy on his agenda. For a teacher to notice and want to refer, his behaviours must be standing out as different from 'the norm'. They wouldn't give themselves extra work for an assessment otherwise.
It probably wouldnt be any different in a different school in this country. He'd still have to share the adults attention with lots of others.

My DS at the same age sounds very similar, not too many issues at home but school
was different. He’s now 10 and diagnosed AuDHD. Not saying your son will be but 6 is still very early for some kids. Lovely energetic boy not manic, not bouncing off of the walls. Homework was a write off, he was 6 during Covid, it was such a battle getting him to do any home learning. His NT friends were nowhere near as bad, we just thought we were bad parents. No amount of consequences, sticker charts etc helped. He’s now 10, medicated and doing so well at school

Yes. I was going to say much the same.

OP, if the teacher thinks your DS has ADHD, I would keep an open mind and allow the diagnostic process to go ahead. It’s much better you know one way or the other because then you will know what you are dealing with.

Regarding home life, there probably are signs (possibly quite subtle ones) in his behaviour, but if you are not very knowledgeable about ADHD, you may simply not have realised.

MY DC2 got diagnosed at 20. They sailed through primary school with no problems at all. Secondary school was problematic though and would have been much less problematic if we’d had the understanding that we now have as a result of the diagnosis.

It’s not so much “relax” it is at home he can focus on whatever his current interest is. So without external guidance on task he can just look like a child that is really focused on what he is doing. DS2 loved puzzles at that age; so at home he’d have just looked like a child happily occupied with a puzzle.

Similar to @ChaosMonkeyHandler - ADHD wasn’t even on my radar for my DS, in fact I never thought of him being anything other than very bright and quirky. Lockdown learning quickly showed me otherwise! School had been flagging concerns since reception, but it was only about year 4-5 where it became clear there was something going on. School clearly saw many more issues than we did at home, but in hindsight, the entire family is ND and therefore home life is naturally more ND friendly.
He was diagnosed AuDHD in Y5, got great support at school in Y5 and 6, and now at grammar school. We have not medicated him.

So I think at age 6, it is quite possible issues are visible at school that aren’t at home. But it is young to pushing for a diagnosis, unless he is being seriously impaired at school. I would ask to meet them to discuss what strategies could be put in place to help him, and maybe consider seeking diagnosis in a few more years (in which case, get on the waiting list now, it takes ages).
You don’t have to medicate if you feel it isn’t the right choice - but equally I know many children for whom it has been a complete game-changer!

lots of ND kids are totally different at school and home. My daughter is autistic and it’s the opposite - massive masking all day, huge meltdowns later. For your son, I’d guess the traditional classroom structure and the waiting around would make some of his tendencies more obvious. Easy enough to respond to him 1:1 and it sounds like you have a busy and active life - but far more difficult when there are kids who need a slower learning pace, waiting in queues for things, etc etc.