ADHD may be more than typical childhood energy when your child consistently struggles to focus, follow instructions, sit still, or control impulsive behaviour across multiple settings (home, school, and social situations) for six months or longer. The key distinction is that active children can regulate their behaviour when motivated or when the situation requires it, while children with ADHD genuinely cannot. If teachers and family members are all reporting the same difficulties, and your child is falling behind academically or socially despite clear effort, an ADHD assessment is a sensible next step.
Every week I see parents in our clinic who say some version of the same thing: “I don’t know if this is just normal boy energy, or if there is something going on.” That uncertainty is completely understandable. Children are supposed to be active, curious, and impulsive to some degree. The challenge is knowing where the line is between typical childhood behaviour and something that warrants a closer look.
After three decades of assessing children for ADHD, I can tell you that the distinction is not about energy levels alone. It is about whether the child can regulate that energy when the situation demands it.
What ADHD Actually Looks Like in Children
ADHD stands for Attention Deficit Hyperactivity Disorder, but the name can be misleading. It is not simply a deficit of attention. It is a neurodevelopmental condition that affects the brain’s executive functioning: the ability to plan, organise, focus, control impulses, and regulate emotions.
ADHD presents in three main ways:
Predominantly Inattentive Type
This child is not bouncing off the walls. They are the quiet daydreamer at the back of the classroom. They lose things constantly, forget instructions within seconds of hearing them, struggle to start and finish tasks, and seem to “zone out” during conversations. This type is more common in girls and is frequently missed because the child is not causing disruption.
Predominantly Hyperactive-Impulsive Type
This is the child most people picture when they think of ADHD. They cannot sit still, they talk excessively, they interrupt, they act before thinking, and they seem to have an engine running at full speed at all times. This type is more commonly identified in boys because the behaviour is highly visible and disruptive.
Combined Type
The most common presentation, combining features of both inattention and hyperactivity-impulsivity. The child has difficulty focusing and is also restless, impulsive, and constantly on the go.
ADHD vs. Typical Childhood Energy: 6 Key Differences
1. Consistency Across Settings
An active child might be wild at home but perfectly well-behaved at school, or energetic at sport but able to focus in the classroom. ADHD shows up everywhere. If your child’s teacher, grandparents, sports coach, and you are all seeing the same difficulties, that consistency is significant.
2. Ability to Focus When Motivated
Active children can concentrate when something interests them. They might struggle to sit through a maths lesson but can focus for an hour on a Lego set. Children with ADHD can also hyperfocus on things they find stimulating (this is common and confuses many parents), but they genuinely cannot sustain attention on tasks that require mental effort, even when they want to.
3. Following Multi-Step Instructions
Give an active child three instructions and they will generally follow all three, perhaps with a reminder. Give a child with ADHD three instructions and they will typically remember only the first one, or sometimes none. This is not defiance. Their working memory is genuinely struggling to hold and sequence information.
4. Impulsivity Beyond Their Age
All young children are impulsive. But by age 6 or 7, most children have developed some capacity to pause before acting. A child with ADHD at 8 or 9 may still blurt out answers, grab things from other children, run into situations without thinking, or act on emotions instantly. The impulsivity does not improve at the rate you would expect for their age.
5. Duration
A phase lasts weeks. ADHD has been present since early childhood, typically before age 7. If you look back and realise these difficulties have always been there to some degree, that is a strong indicator.
6. Impact on Functioning
The most important question is not “does my child have these symptoms?” but “are these symptoms causing real problems in their life?” Is your child falling behind at school despite being intelligent? Are friendships suffering because of impulsive or disruptive behaviour? Is family life dominated by conflict, forgotten homework, and morning battles? If the difficulties are causing genuine functional impairment, an assessment is warranted.
The ADHD Assessment Process at Anna Cohen & Co
An ADHD assessment is not a single test. It is a thorough, multi-step process designed to build a complete picture of your child’s functioning. At our practice, we use gold-standard assessment tools and take the time to do this properly.
Step 1: Detailed Parent Interview (60 to 90 Minutes)
We begin with an in-depth conversation with you about your child’s developmental history, current difficulties, family background, and school experience. We ask about pregnancy and birth history, early milestones, temperament as a baby and toddler, and when you first noticed the concerns. This context is critical for an accurate diagnosis.
Step 2: Teacher and Parent Rating Scales
We use the Conners-4, which is the current gold-standard ADHD rating scale. Both parents and teachers complete standardised questionnaires that measure attention, hyperactivity, impulsivity, learning problems, executive functioning, and emotional regulation. Having input from multiple informants (people who see your child in different settings) is essential.
Step 3: Direct Testing with Your Child (2 to 3 Hours)
Your child will complete a series of tasks designed to measure attention, concentration, processing speed, and impulse control. We use the TEA-Ch2 (Test of Everyday Attention for Children), which measures different types of attention through engaging, game-like tasks. This gives us objective data about how your child’s attention system works in real time.
Step 4: Behavioural Observation
Throughout the assessment sessions, the psychologist observes your child’s behaviour, communication style, emotional regulation, and how they respond to structured demands. This qualitative data is just as important as the test scores.
Step 5: Integration and Feedback (60 to 90 Minutes)
We compile all the data into a comprehensive written report and meet with you to explain the findings. If the assessment confirms ADHD, we discuss what type, how it is affecting your child specifically, and detailed recommendations for home, school, and any further referrals (such as to a paediatrician if medication is being considered).
What Happens If My Child Does Have ADHD?
An ADHD diagnosis is not a life sentence. It is a roadmap. Once you understand how your child’s brain works, you can make targeted changes that help them succeed.
Recommendations typically include:
- School accommodations: We can write to your child’s school with specific strategies (preferential seating, broken-down instructions, movement breaks, extra time for tests, reduced homework load)
- Behavioural strategies for home: Clear routines, visual schedules, one instruction at a time, reward systems that work with the ADHD brain, and how to manage homework without conflict
- Skills training for the child: Organisational skills, emotional regulation techniques, and social skills coaching
- Parent coaching: Understanding ADHD reframes many behaviours from “won’t” to “can’t,” which changes how parents respond and dramatically reduces household conflict
- Paediatrician referral: If medication is appropriate, we will refer to a paediatrician who specialises in ADHD. Medication is never the only intervention, but for some children it makes a significant difference alongside behavioural support
What If It Is Not ADHD?
Sometimes the assessment reveals that a child’s difficulties are better explained by anxiety, a learning difficulty, sleep problems, giftedness (yes, gifted children are frequently misidentified as having ADHD), sensory processing issues, or environmental stressors. This is exactly why a thorough assessment matters. The right diagnosis leads to the right support.
How to Get Started
If you think your child may have ADHD, start by seeing your GP for a Mental Health Treatment Plan. This provides Medicare rebates of $98.95 to $145.25 per session for the clinical components of the assessment. Then call Anna Cohen & Co on 02 9555 1168 to book.
We conduct ADHD assessments at our Balmain, Waverley, and Katoomba clinics. Some components can also be completed via telehealth for families in regional areas.
About the Author
Dr Anna Cohen is a Senior Clinical Psychologist (AHPRA PSY1176554) with over 30 years of experience working exclusively with children, adolescents and families. She is the founder of Anna Cohen & Co and co-founder of Kids & Co Clinical Psychology, which operates across six locations in Sydney and the Blue Mountains. Anna is the author of four parenting books including Skilful Parent Happy Child and Taming Teens, and the creator of the Regulated Parenting Model™.
Frequently Asked Questions
At what age can ADHD be diagnosed?
ADHD can be reliably assessed from around age 5 to 6, when the demands of formal schooling highlight attention and self-regulation difficulties. Some clinicians assess children as young as 4 in clear cases, but many ADHD-like behaviours are developmentally normal in toddlers and preschoolers.
What is the difference between ADHD and just being an active child?
The key difference is consistency and impairment. Active children can focus when they need to and regulate their behaviour when motivated. Children with ADHD struggle with these things even when they want to. ADHD shows up across multiple settings and has been present since early childhood.
How long does an ADHD assessment take?
A comprehensive assessment at Anna Cohen & Co takes 6 to 8 hours spread across 2 to 3 appointments. This includes parent interview, Conners-4 rating scales, direct testing with the child (TEA-Ch2), behavioural observation, and a feedback session with a detailed written report.
Does Medicare cover ADHD assessments?
Medicare rebates of $98.95 to $145.25 per session apply to sessions under a Mental Health Treatment Plan from your GP. This covers the clinical interview and some assessment components. The standardised cognitive testing may have a different fee structure. We explain all costs upfront before you commit.
Can girls have ADHD?
Yes. Girls are significantly underdiagnosed because they more commonly present with the inattentive type: daydreaming, difficulty organising, forgetfulness, and quiet underperformance rather than disruptive behaviour. Our assessments are designed to capture these subtler signs.
What happens after an ADHD diagnosis?
We provide a detailed written report and feedback session with specific recommendations for home and school. These include classroom accommodations, behavioural strategies, social skills development, and a paediatrician referral if medication is being considered. Many children thrive with the right combination of understanding and environmental adjustments.
