Whilst I understand the reasoning in the standard consensus, that we should wait until a child is a bit older before pursuing an ADHD diagnosis, I have come to believe that early screening is essential. On the surface, the reasoning for waiting makes perfect sense; it allows for other developmental factors to be ruled out and accounts for the fact that most inattentive traits don’t become truly disruptive until the jump to “big school.” In early years education, children are more naturally excited by the novelties and are learning the basics. The environment is less pressured, and because everything is a new experience, their interest levels often remain high enough to keep them engaged. However, once they move into secondary education, this changes. The curriculum becomes more serious, lessons stretch on longer, and the teaching style is often less interactive. This change brings an increase in societal expectations and personal responsibilities, and it’s usually only then, when the work can have elements of being “boring” whilst requiring sustained focus, that the ease of distraction really begins more visible and starts having a significant impact.
We may see early diagnoses for children who display hyperactivity or significant social and emotional challenges because those behaviours are “loud” and hard to ignore. But for the kids whose ADHD is primarily inattentive, the struggle is much quieter. Much like women who are frequently diagnosed decades later than men, these children fly under the radar because they aren’t seen as disrupting the classroom. We know that inattentiveness is frequently misread as a lack of effort or simply being a “daydreamer,” which is a huge part of why it’s missed. Even if they aren’t bouncing off the walls, these kids are facing internal challenges that chip away at their confidence. It is common for ADHD adults describing their teens to include that they were “feeling stupid” compared to their peers, keeping these worries to themselves, and sometimes overcompensating by becoming the class clown to hide their insecurities. By the time they hit the age where a diagnosis is “recommended,” they’ve already spent years internalised a narrative of failure.
It no longer makes sense to me to wait until a child has their learning and confidence impacted before doing something about it. In particular if there are other signs. When you consider the high rates of heritability (Grimm, et al., 2020), if a parent has ADHD and their child is consistently showing signs of being easily distracted, beyond what is ‘normal’, why are we waiting until the problem becomes more impactful when the probability is significantly high? The current diagnostic model for adults requires evidence of how ADHD negatively impacts a person’s life… school reports showing they struggled, perhaps being expelled, a history of failing at work. Small children simply haven’t lived long enough to build up that “portfolio of failure,” so we wait until the problems are big enough to count? But waiting for the “evidence” means waiting until their mental health and self-esteem have already taken a massive hit. Plus, once the problem is finally recognised, families often face years-long waiting lists for diagnosis. That is a huge amount of lost time where support could have changed the entire trajectory of their education, and their lives.
Screening for inattentive ADHD is a must. The crux of the issue is that if the expectation is to pay attention to “X” (the teacher, the book, the task), but the child’s brain is naturally pulled toward “Y,” everything else starts to cascade from that mismatch. That is where so much else about ADHD stems from, missing information and trying to find coping mechanisms to deal with it leads to much else later on, including anxiety, worry, and sleep issues. This is why it’s important to provide early screening rather than just waiting for a full diagnosis. If we can identify these traits early, as the Accessible Learning Foundation (ALF) is doing with their work in neurodivergence screening, we can get support from teachers and parents in place before a child’s problems start to affect their futures.
If we screen early, we can address these “cons” before they take centre stage and begin to impact a child’s future. More importantly, early recognition allows us to see the “pros” that come with this type of brain, facilitating the creativity, innovative problem-solving, and wide breadth of associations that often show up with ADHD minds. We should be helping these kids harness their strengths from the start, rather than waiting for them to fall behind just so we can prove they need help. It’s time we stop treating diagnosis like a reward for struggling long enough and start treating screening like the tool it could be, helping kids to navigate their worlds with an understanding that some will do it differently.
References
Grimm, O., Kranz, T. M., & Reif, A. (2020). Genetics of ADHD: What Should the Clinician Know?. Current psychiatry reports, 22(4), 18. https://doi.org/10.1007/s11920-020-1141-x