Which Is It, ADHD or Immaturity?

Children younger than most in their class may have a harder time paying attention, sitting, or controlling their behavior. These things are also symptoms of Attention Deficit Hyperactivity Disorder (ADHD).

ADHD is one of the most commonly diagnosed behavioral disorders in children in the United States. But some experts believe ADHD is overdiagnosed, especially in immature children.

Experts say the younger children in their class are more likely to be diagnosed with ADHD than their older classmates. A recent study found that boys born at the end of an education threshold (for example, born in December if the deadline to start school is January 1) were 30% more likely to be diagnosed with ADHD. . In the same study, girls at the end of a school cutoff were 70% more likely to be diagnosed with ADHD.

Since ADHD is a neurological disease that causes differences in the brain that have nothing to do with age or date of birth, some say that immaturity is often mistaken for ADHD.


“There can be up to a whole year between the oldest and youngest children in a classroom. Developmentally, there can be a big gap between these groups, ”says Anson Koshy, MD, assistant professor of pediatrics at McGovern Medical School at the University of Texas Health Science Center in Houston.

“Young children may have more difficulty paying attention or sitting still, especially compared to their older peers. And these age-appropriate behaviors can be mistaken for ADHD, ”Koshy says.

If you are unsure whether your child has ADHD or is just immature, there are things that can help you find out.

Young children? Watch and wait

ADHD can be diagnosed as early as 4 years old, but many experts, including Koshy, say early diagnosis can be wrong for most very young children.

“Toddlers and preschoolers are especially likely to have problems with impulse control and have trouble concentrating and staying on task,” Koshy says. But most children come out of it. Only 5% to 10% of preschoolers with ADHD-like symptoms are diagnosed with ADHD later in life.

Look outside the classroom

Teachers are often the first to suggest that a child may have ADHD. This makes sense because they see them for a good part of the day. But research shows that teachers are more likely to suspect ADHD in younger children in their classes.

“They may not be aware of immaturity or some other problem, like a learning disability, may be the real reason a child has trouble paying attention during class,” Koshy says.

In addition, young children have a shorter attention span and need a lot of opportunity to move. If your child is in a classroom where there are few breaks or little physical activity (such as recess and physical education classes), they are more likely to be anxious or lose focus.

This is why it is important to examine your child’s behavior outside of school.

“I ask worried parents: What is your child’s morning routine like? What about meals, recreation and extracurricular activities? Koshy said.

“If your son or daughter has trouble concentrating, sitting or controlling himself at home and on the weekends, it’s more a sign that he or she may have ADHD.”

Don’t rush for the diagnosis

Since there are no lab tests for ADHD, an expert (such as a pediatrician, psychologist, neurologist, or psychiatrist) makes a diagnosis based on your child’s symptoms and looking at other things, like your child’s family history and medical history.

“Your doctor or therapist will ask you questions about your child’s behavior and will also ask your child’s teacher – and possibly other family members – for feedback,” says Nicole Brown, MD, pediatrician at Montefiore Children’s Hospital in New York City.

This process can take a long time. Your child’s doctor or therapist may want to assess your child for several months to see if their behavior changes as they get older or their circumstances change (for example, during summer vacation).

If in doubt about a diagnosis, get a second opinion.

“Ask your child’s doctor, ‘Do you feel comfortable diagnosing ADHD? Do you have experience diagnosing it and what methods do you use? Brown says. “If the answer is no, seek help from someone experienced in treating children with ADHD.”

It is also important to consider other causes, such as learning disabilities. Psychoeducational testing is an objective way to compare your child’s educational strengths and weaknesses with other children their age. Ask your child’s doctor or school about this.

Focus on behavior

Over 90% of pediatricians prescribe medication to children after they are diagnosed with ADHD. Medication can be effective for children with ADHD. But they can cause serious side effects, like sleep problems and appetite problems. So it should only be used for kids who definitely have ADHD and are at least elementary school age, Koshy says.

Behavior therapy is often a better first step.

“Research has proven that therapy helps children with ADHD as well as those who are just plain immature,” Koshy says.

When looking for a therapist, “look for someone who has worked with children of different ages and stages of development and who has experience with ADHD,” says Brown. “It increases the chances that they can separate, whether your child is having problems because of his age or because [they have] ADHD. “

Parent training – that is, learning behavioral strategies for communicating with and helping your child – can also help you be clear and consistent with expectations and consequences.


“Often, parenting training makes the biggest difference for kids,” Koshy says.

Consider taking a class or meeting with a therapist who specializes in ADHD and childhood behavior problems. Ask your child’s doctor for a recommendation.

“While you wait to find out what’s going on with your child, there is a lot you can do to help them do better and have an easier time at home and at school,” says Brown.

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Jothi Venkat

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