Attention deficit hyperactivity disorder, or ADHD, is a commonly diagnosed condition during childhood and adolescence. ADHD is characterized by consistent demonstration of the following traits: decreased attention span, impulsive behavior, and excessive fidgeting or other nondirected motor activity. All children, including children with Down syndrome, display these traits from time to time, but children with ADHD demonstrate them to a much higher degree than their peers and do so across environments—at home, in school, and during play.

The frequency of ADHD in children with Down syndrome is not known with certainty. However, ADHD-like symptoms are more common in young children with Down syndrome than they are in typically developing children. Before an official diagnosis of ADHD is made, other possible medical conditions, changes to educational programming, and communication needs should be ruled out first.

The following could present ADHD-like symptoms and should be considered:

• Hearing and Vision Issues: children with Down syndrome are prone to hearing loss and vision issues. Both vision and hearing should be assessed regularly to rule out things like ear infections, the need for glasses, and other vision and auditory diagnoses that may contribute to attention difficulties.

• Gastrointestinal Issues: people with Down syndrome are at increased risk for celiac disease and constipation. Both diagnoses can cause changes in energy, behavior, and restlessness.

• Thyroid Issues: about 30% of people with Down syndrome have thyroid disease at some point in life. Most have hypothyroidism or an underactive thyroid gland; a few have a disease that results in an overactive thyroid gland (Graves’ disease). An underactive thyroid gland can, among other things, make a child very tired and apathetic. Too much thyroid activity can cause agitation and restlessness. Therefore, both conditions can look like poor attention and behavior.

• Sleep Disorders: people with Down syndrome are frequently diagnosed with various sleep disorders. These disorders are a group of conditions with many different causes, but all result in insufficient sleep. Lack of sleep can result in restlessness, poor attention, mood swings, inability to focus, and challenging behaviors.

• Communication: people with Down syndrome have many barriers to effective communication. The receptive language skills of children with Down syndrome are often much stronger than their expressive language skills. A child may express his or her frustration by acting out or by inattention.

• Education: children with Down syndrome have a wide range of learning styles. A child’s educational team may need to try more than one method of presenting material before finding the one that works best for the child. If material is presented in a way that is not compatible with a child’s learning style, that child may appear bored, hyperactive, fidgety, or inattentive.

If you are concerned about decreased attention span, impulsive behavior, and excessive fidgeting or other non-directed motor activity in your child, it is appropriate to consult your pediatrician, a developmental or behavioral pediatrician, or child psychiatrist.