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The developmental-behavioral pediatrician, Dr. William B. Carey, described the dimensions of temperament as including the traits of activity level, regularity, initial reaction, adaptability, intensity, mood, distractibility, persistence and attention span, and sensitivity. These factors have been further reduced to four dimension by the psychologists Buss and Plomin to emotionality, activity, shyness, and sociability. As individuals, our children can fall at any point on these varying scales and each have their own uniqueness.

When parents complete behavioral rating scales to assess their children for symptoms of an Attention Deficit/Hyperactivity Disorder, or ADHD, there are two dimensions that are measured, including distractibility-inattention and hyperactivity-impulsivity. In the DSM-5, there are 9 items for attention problems, 6 items for hyperactivity and 3 items for impulsivity. These factors are also assessed on measures of temperament. When does a temperament trait, such as activity level become a problem? For example, boys tend to be more physically active, on average, than girls. Many parents wonder if their boys are “just being boys” when they’re told that they are disruptive in the classroom. There are no easy answers to that question, but one rule of thumb that professional will use, and which is also part of the diagnostic requirements of the DSM-5 for ADHD, is that these traits must be present to such a degree that they result in repeated failure experiences for a child and begin to have an effect on the their ability to function, in school, at home, and with peers. When children repeatedly encounter failure and require a high level of monitoring and redirection in order to carry out the tasks typically accomplished by their peers, then we begin to consider what interventions and supports will result in an increase of opportunities for success. Success is the essential vitamin that every child needs to thrive and be happy.

To assess ADHD, many pediatricians and school professionals have parents and teacher complete behavioral rating scales, such as the Vanderbilt ADHD Diagnostic Rating Scales. This can provide some preliminary data and assist in determining a diagnosis, but rating scales should never be relied upon alone to make a diagnosis of ADHD. Attentional problems and restlessness can be caused by many factors, including possible learning disabilities, anxiety, depression, and other factors. A complete psychological evaluation is essential to definitively make a diagnosis of ADHD. Most pediatricians who work in this area are aware of these possible factors and will often refer a child for a psychological evaluation prior to initiating medical treatment.

If you have concerns regarding possible ADHD in your child, it is recommended that you speak with your child’s pediatrician and request a referral for a psychological evaluation. We at the Michigan Neurodevelopment Center work closely with many pediatricians in the community and can meet your needs. Call us any time at to schedule an appointment (248) 935-4085.

Copyright © 2017 Robin L. Billings, Ph.D. All Rights Reserved

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