Could your child’s ‘laziness’ be a sign of ADHD?

The diagnosis of ADHD for both adults and children has risen sharply over recent years, and many people know someone with the condition these days.

But although studies show diagnoses among school-aged children have more than doubled since 2000, and about five per cent of children and young people live with ADHD, there’s still a lack of knowledge about some symptoms.

And while the more obvious ones are in the full name of the condition – attention deficit hyperactivity disorder – some parents may be unaware that perceived laziness can be a telltale sign of the neurodiversity.

Dr Max Davie, a paediatrician who specialises in ADHD, and a trustee of ADHD UK, says: “Difficulty getting started on tasks that require sustained attention, or high cognitive load, is a common and under-appreciated presentation of ADHD, and can be dismissed as laziness.”

And Sarah Warley, a neurophysiological psychologist who featured on the recent Channel 4 documentary The Great ADHD Myth?, says that while laziness can, of course, be pure idleness, in some cases it’s also worth looking into it more deeply to see if there’s something else causing it.

While the definition of laziness is ‘not willing to work or use any effort’, ADHD UK says most people with ADHD report being willing to do a task but find themselves not doing it, so therefore because they’re not unwilling, it isn’t laziness.

Davie says that parents seeking an ADHD diagnosis for their ‘lazy’ child should carefully consider the full picture. After all, we’re all capable of being lazy sometimes, and some people will be more slothful than others without having ADHD.

“Of course, there might be other reasons why the child is unwilling to engage in a given activity,” Davie points out, “such as feeling coerced, having an unappreciated difficulty in completing it, or their refusal being part of a power dynamic.”

He says if parents are seriously considering their ‘lazy’ child might have ADHD, the first thing to think about is what the child can motivate themselves to do.

“If they’re able to do things that are very rewarding, like video gaming, or not cognitively demanding, like exercise, but struggle with organisation or complex tasks, then it’s worth thinking about ADHD,” he explains.

Warley, founder of the neurodiversity clinic The Key Clinic, says she doesn’t put a label on children and adults who present with ADHD symptoms.

“Rather than simply doing that, we take the time to dig a little deeper and find out are there any underlying biological factors that are making it really hard for this kid to sit still, focus, concentrate, control impulsivity?” she explains.

“We just want to know why someone finds X, Y, and Z difficult.”

Instead, people attending the clinic are tested for specific biochemical imbalances, which Warley says can be rebalanced with nutrient supplements, and ‘retained primitive reflexes’. She explains these are reflexes that help newborns but would normally have disappeared by the toddler years.

“If they’re retained, they can make everything so much more difficult,” she says. “They interfere with everything – balance, coordination, eye tracking. They can make you fidgety, squirmy, and inattentive, they can make it hard for you to focus, and impulsive.

“Each one has a pretty profound effect on functioning.”

Warley says that slow, controlled, neurodevelopmental exercises can be used to get rid of the retained reflexes.

She says, however, that if someone with ADHD-type behaviour isn’t held back by more obvious factors such as poor sleep, nutrition or lack of exercise, their symptoms, including laziness, could be explained by executive dysfunction.

She explains that this is the brain’s self-management system – the processes that allow us to get started on a task, hold information in mind, resist distraction, plan ahead, manage time and regulate our emotions and effort.

She says: “Psychologists who specialise in ADHD argue that it’s best understood not as a simple deficit of attention but as a difficulty with these self-regulation processes.”

She says psychologists have described ADHD as ‘not a disorder of knowing what to do, but of doing what you know’, and continues: “That distinction is exactly why ADHD is so often mistaken for laziness.

“A child or adult may genuinely want to do the task, understand why it matters and fully intend to start, yet be unable to reliably make themselves begin or keep going.

“From the outside, someone who clearly could do something but isn’t looks unmotivated. What’s actually happening is the brain’s system for initiating and sustaining effort is firing unreliably.”

She says the ADHD brain also tends to mobilise around interest and urgency rather than importance, and explains: “This is why the same person can focus for hours on something absorbing, but stall completely on something dull – a pattern that reads as selective laziness, but is really a difference in how attention and motivation are wired.

“The key point is this is a performance problem, not a matter of willpower or character. The ability is there, but consistent access to it is what’s impaired.”

Of course, perceived laziness is by no means the only symptom of ADHD, and Davie says other signs, especially in someone who isn’t ‘classic’ ADHD, can be rapid speech, emotional dysregulation, fidgeting, and attention and memory problems.

Emotional dysregulation

Davie says this is marked by rapidly changeable emotions, often with little hangover from a heightened state of an emotion or feeling such as anger or panic. “It depends on sleep, perception of safety and background mood, both in its severity and presentation,” he says.

Rapid speech

The conversational signs of ADHD very much depend on language ability and age, stresses Davie, but he explains: “Often these children will talk fast and interrupt frequently, often because they fear they might forget what they have to say. Conversely, they may leave long pauses as they lose track of what they’re talking about.”

He says they may appear to have poor eye contact because they get distracted and look elsewhere.

Fidgeting

Davie says fidgeting can only be interpreted by age and context.

“So a six-year-old with ADHD might struggle to watch TV without also pacing the floor, while a 16-year-old might manage to stay on a sofa, but need a phone to top up how stimulating the experience is.

“Similarly, while the six-year-old might be up and down throughout dinner, the 16-year-old might need to fidget if made to stay longer at the table because granny’s over.”

Attention problems

This can depend on the task, Davie stresses.

“People with ADHD struggle both with cognitively demanding tasks and also those that are undemanding but understimulating,” he says.

“Again, it’s the lack of stimulation which makes a task difficult, as well as, at times, the need to gather a lot of initial cognitive resources to plan and initiate the task.”

Disorganisation

Davie says this is variable for people with ADHD,  but leaving things lying around, losing things at school and being unable to recall messages are all useful indicators.