It is 7am, and your child is about to be late for the bus. You ramble off 3 things they need to do quickly, “Put on your shoes, grab your book bag, and brush your teeth.” A few moments later you check in only to realize your child is standing there staring off into space. His inattention is frustrating, but you manage to repeat the directions with the added support of walking with him to find his shoes. Once there you head off to finish getting ready yourself. When you return you find your child is playing with the toys near where his shoes are laying. He is distracted, and now you are angry because he is still not listening. In a last-ditch effort to get him to the bus on time you tell him sternly to put on his shoes and brush his teeth as you gather his book bag. You warn him that he must make the bus, or else he will not get TV time after school. All the rushing overwhelms your child and before you know it, he is melting down before your eyes… tears, yelling, and refusing to go to the bus. His impulsivity is relentless.
The theme of this imaginary scene is all too familiar for many families initiating therapy services for their child. As a child therapist that is focused on neurobiologically-informed play therapy it is common for the parents that I partner with to request assistance with their child’s heightened distractibility, inattention, and/or impulsivity.
These traits often interfere with the child’s ability to manage age-appropriate responsibilities as well as connect with their family and peers in meaningful ways.
These symptoms are certainly cause for concern. Often times it is assumed the root cause is Attention Deficit/Hyperactivity Disorder (ADHD), but it is critical that other factors be considered as well in order to provide the best support to your child.
ADHD is a multifaceted neurobehavioral disorder that manifests in a variety of ways. Most commonly children are diagnosed with this disorder between the ages of 5-8 depending on the severity (CDC, 2018), but there are some considerations that would cause professionals to rule it out until children reach older ages.
Children with ADHD often struggle with waiting their turn, interrupting others, self-focused behavior and thought processes, fidgeting, emotional melt downs, finishing tasks, organization, and forgetfulness.
The distinguishing feature to this diagnosis is that these symptoms must be present across a variety of settings. Without this stipulation being considered symptoms can often be mislabeled as ADHD when indeed they are rooted in other conditions like anxiety, adverse experiences or simply a regressed developmental age that a child will overcome through maturity.
Anxiety is the one of the most common diagnoses in children (Elia, 2017), but it is often the one that is frequently misunderstood. In terms of a child struggling with distraction, inattentiveness, and impulsivity, anxiety may be the culprit as well because it manifests with 3 basic presentations: drive for power/control, withdrawnness, and/or obvious worrisome traits.
A child who needs control over his environment may go to great lengths to ensure he is in power as he works to remedy the overwhelming feeling of uncertainty that is associated with anxiety. This pull for power can inadvertently lead to impulsive and disruptive behaviors.
A child who experiences anxiety may also present with withdrawnness. The disconnection with present moments is caused by the child being frozen in repetitive thought patterns that can be interpreted as inattentiveness when the child is actually very attentive to their surroundings; they are simply processing internally which limits their ability to interact with the outside world.
And, finally, a child may showcase anxiety through more classic features like biting their nails, pulling hair, difficulty sleeping, separation anxiety, repeating actions to gain desired outcomes (like with OCD), etc. Their preoccupation with these symptoms can cause a child to be viewed as distracted and/or withdrawn.
Another root cause of distraction, inattention, and impulsivity can be adverse experiences. Most parents immediately interpret this to mean “Big T” traumas, like sexual abuse, physical abuse, and neglect; however, the CDC found that people experience many different adverse experiences that qualify under this domain.
Their findings identified children who experienced not only Big T trauma, but also witnessed intimate partner violence, had caregivers with substance use disorders, mental health disorders or who were incarcerated, and/or experienced parental separation or divorce are more likely to engage in risky behaviors or deal with mental health disorders like anxiety or depression that may present as impulsive, inattention or distractedness.
Developmental and Perceived Age
It is natural for children to demonstrate some features of distractibility, inattention, and impulsiveness as they work to develop the emotional regulation skills that come with age; therefore, it is essential that a child’s developmental age (in addition to chronological age) be taken into consideration when filtering whether their symptoms are age-appropriate or not.
Sometimes all a child needs is a little more time to developmentally mature to out grow these troublesome symptoms. Additionally it is imperative to note that children that are younger in their grade level are more likely to be subjectively perceived as impulsive, inattentive, and distracted in the school setting (Chin, Lan, et al, 2016).
Ultimately there are many different possibilities that could be contributing to your child’s impulsivity, inattentiveness, and distractibility. It could truly be ADHD, or it may be a result of anxiety, adverse experiences, regressed developmental age, or a unique combination of these presentations.
Understandably it is easy to feel overwhelmed as you try to discern how to best support your child.
Partnering with a mental health professional that specializes in children and parenting will help though. Together we will gather information, assess your child’s strengths and struggles, provide accurate diagnosing, adjust parenting strategies, and provide an individualized, therapeutic environment that is fun and interactive for your child to become more focused, self-controlled, and responsive.