School has started, kicking off a new semester of homework, group projects, field trips and sports. For some children and their families, though, these aspects of the school year bring outsized stress and struggle. Routine assignments beget hours of procrastination and redirection, collaboration turns into conflict with peers, permission slips lay crumpled at the bottom of the backpack and coaches wonder why so-and-so can’t keep his head in the game. Cue the concerned teacher emails. Is it ADHD?
Well, maybe. If you and your child’s teacher are concerned about your child’s school performance, it’s important to discuss it with your pediatrician. The cardinal features of attention deficit-hyperactivity disorder, or ADHD, are hyperactivity, impulsivity and inattention. Other conditions can cause some or all of these problems, though. Here are some of the more common ones:
- Sleep deprivation. When children fall short on sleep, even by 15-30 minutes a day, their behavior suffers. Rather than falling asleep in class, children tend to become wired and have trouble concentrating. A child who is “not acting tired” may be the one in most need of an earlier bedtime.
- Obstructive sleep apnea. Sometimes daytime sleepiness is from staying up too late, but sometimes it is from the fragmented sleep of airway obstruction. Make sure your pediatrician knows if your child snores, especially if his breathing is marked by pauses and gasps. 
- Learning disabilities. A child who draws pictures in his workbook might not understand the material. Most schools have the resources to test for problems such as dyslexia. There is significant overlap among children with learning disabilities and those with ADHD, but both problems need to be addressed.
- Attention seeking. All children crave parental warmth, clear limits and security. Children in a chaotic home environment may act out to try to fill these needs. Many parenting books, counselors and your pediatrician can offer advice to remedy an unhealthy home dynamic.
- Young age. Kindergarten classrooms generally don’t have desks because 5 year olds are not neurologically equipped to sit still all day. As the prefrontal cortex matures with age, so does the ability to stay put and pay attention. A lot happens in a year. Sometimes the abilities of the oldest students in the class lead to unfair expectations for the youngest. A 2012 study in Pediatrics revealed that children with birthdays in the latest third of the school year were 50 percent more likely to be prescribed ADHD medication that those with the earliest birthdays.
Of course, all children benefit from healthy habits, such as adequate sleep and plenty of exercise, as well as a supportive learning environment and consistent, affectionate parenting. For children with attention and behavior problems, addressing these needs is even more critical. Talk to your pediatrician about your concerns so that together we can help your child have a happy, successful school year.
Dr. Suzanne Condron is a board-certified pediatrician at Kelsey-Seybold Clinic – Fort Bend Medical and Diagnostic Center whose clinical interests include obesity, nutrition, allergies, asthma, childhood development, literacy, infectious diseases and preventive medicine.
 Zoega H, Valdimarsdottir UA, and Hernandez-Diaz SH. Age, academic performance, and stimulant prescribing for ADHD: a nationwide cohort study. Pediatrics; 2012;130;1012.
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 O’Brien LM, Mervis CB, and Holbrook CR, et al. Neurobehavioral implications of habitual snoring in children. Pediatrics 2004; 114; 44.
 Langberg JM, Vaughn AJ, and Brinkman WB et al. Clinical utility of the Vanderbilt ADHD Rating Scale for ruling out comorbid learning disorders. Pediatrics 2010; 126; e1033. Zoega H, Valdimarsdottir UA, and Hernandez-Diaz SH. Age, academic performance, and stimulant prescribing for ADHD: a nationwide cohort study. Pediatrics; 2012;130;1012.