A child can be completely involved in a game outside, using their body, following what is happening, wanting to keep going. Bring them indoors and ask them to sit with something they haven't chosen, and the picture changes. They move between activities. Nothing seems to hold them for long.
For a parent wondering about ADHD, that difference can be confusing. Is the child struggling to concentrate, or can they concentrate perfectly well when they want to?
I would want to look closely at the difference before drawing either conclusion. What is happening in the activity that works? What changes in the one that doesn't? The answer may tell us something useful about how to support this child, whatever an assessment eventually finds.
By age
What parents notice depends on the child's age
With a preschooler, I would start with play. Can they become involved in something, return to it, share it with another person? Is moving from one activity to another happening everywhere, or mainly when the play involves sitting still? I would also ask about ordinary routines, including meals, rather than judge attention through one adult-led task.
Once children start school, the differences may become more visible through lessons and schoolwork. A parent or teacher might notice unfinished tasks, forgotten instructions, frequent interruptions or a child who needs much more help to get started than expected for their age. Some children are visibly restless. Others are quieter and easily overlooked.
These observations can be reasons to seek an assessment, but they are not a diagnosis. ADHD involves a persistent pattern of attention and/or hyperactivity-impulsivity difficulties that is beyond what would be expected developmentally and affects everyday functioning. Assessment considers the pattern over time and in more than one setting, not simply whether a child dislikes a particular lesson.
A spectrum
You don't have to wait for a diagnosis to act
ADHD is better thought of as a spectrum than a switch. A diagnosis is a point on that spectrum, and the point moves and shifts: with age, with the demands of a particular year, with sleep, with what else is going on. Two clinicians can look at the same child and place that point differently.
So if you have noticed something, it doesn't matter yet whether a diagnosis gets confirmed. There is still something there that can be addressed. If there is inattention, that can be worked on. If there is restlessness, or trouble applying yourself to one thing for long, we can think about what would support that. We don't need to rely on the diagnosis to start.
The trap I see is being diagnosis-centred in either direction. Once there is a diagnosis, the family thinks: well, that's the diagnosis, there is nothing else to do. Or there is no diagnosis, so there is nothing to do. Either way, action ends up in second place. Break it down instead. What is the actual difficulty for this child? Focus? Concentration? Restlessness? Not being able to stay with something? Then ask what conditions in the child's life you could change to support that one thing. Don't treat it as one big lump called ADHD that can't be touched. Each part can be.
The foundations
Sleep, movement, food, and where the dopamine comes from
Supporting attention takes a deepening, ongoing understanding of the nervous system, in adults as much as in children. The foundations are not glamorous. Sleep, and in particular enough of the deep, dreaming sleep that comes from going to bed early rather than late. Movement, exercise and being in the body. Food, which for teenagers and adults also means caffeine and other substances. When one of these is missing, attention is the first thing to go, ADHD or not.
Then there is the one I would ask every parent who is noticing ADHD tendencies to think about, which is where the child's dopamine is coming from. I am wary of the phrase dopamine addiction, because it has become so normalised that it no longer sounds like a warning. But a reliance on it is very real, and it is most obvious with screens: reels, short-form video, the apps children play, even the YouTube content made for them. Everything is getting shorter and faster, and all of it pushes the brain towards dopamine that arrives without effort.
I think of this as cheap or free dopamine: dopamine that has been uncoupled from the part of the brain that does the wanting and the working. Normally you have to work for it, and that work is what motivation is. A brain geared towards dopamine is, in one sense, the ADHD trait itself. These are often very creative people who think outside the box, like new things and chase novelty, because that is where the reward is. The trouble is that when free dopamine is available from a screen, the drive to seek it through effort fades. The creativity and the motivation go with it. That is when a trait becomes a problem.
Harnessed the right way, the same trait is a powerful tool for learning. Which is why I would start with reducing screen time and the other easy sources of dopamine, sleeping more and earlier, and getting the body moving, before anything more elaborate.
A trait, not a defect
The problem is in the relationship with the world
ADHD in and of itself is not a defect. It is a difficulty in relation to the world we currently live in and the way our days are structured. There is a view that it is simply part of normal human variation, and there is something in that. But I don't want to normalise it either, because people flip between the two and both extremes let the child down.
Here is how I would put it. You can carry the trait and have it cause you no problems at all, because you take care of it: you sleep, you move, you guard the dopamine, you build a life that fits the way your attention works. If you don't take care of it, it is very, very problematic, and I want to stress that. It is a problem when it is causing a problem. So the question is never whether the child is defective. It is what care the trait needs, now, from the adults around it.
Where the attention is
Find it, then move it sideways
People with ADHD do have attention. What they have is selective attention, and it is sometimes remarkable. So find out where your child's attention already is. What can they focus on? What holds them?
Then look for a way to move that attention sideways into something more wholesome, a step at a time. Say a child is very good at gaming. First the gaming has to come down, so the brain gets something of a dopamine reset. Then look for something adjacent to it: coding, building something on the computer, making things, work that is creative and educational but still has the shape their attention likes. It is a segue, not a swap. You are using what already works to get to what you want.
School can be part of the same conversation. Clearer instructions, movement opportunities or a more manageable task may be worth discussing with the teacher. Any substantial change to the school day needs an individual plan with the school and relevant clinicians.
After a diagnosis
A diagnosis should leave room for understanding
A diagnosis can help explain longstanding difficulties and guide appropriate support. A GP is a useful place to begin; they can assess health concerns and discuss referral to a clinician with the relevant ADHD expertise. An OT can contribute a picture of everyday participation, while teachers and other professionals bring information from their settings. Treatment may include educational and psychological support and, where appropriate, medication. Everyday adjustments and clinical care work alongside each other, and the foundations above are worth keeping whatever the assessment finds.
My concern is only when the diagnosis becomes a full stop, in either direction: this is the explanation, so there is nothing more to understand, or there is no diagnosis, so there is nothing to do. The longer view matters more to me. We are helping a child get through today, but also helping them gradually discover what their attention needs and where it goes willingly. That understanding will matter when adults are no longer organising every part of their day.
Being able to focus on a favourite game will not answer whether a child has ADHD. It may show you something smaller and more useful: where this child's attention already lives, and how you might build a road out from there.