Here's my 2 cents, for whatever that's worth:
ADHD is real. Stimulants work well to alleviate symptoms.
A lot of children are on stimulants that should not be.
A lot of children are not on them who should be.
Your child's situation is unique and so should his treatment plan be. The first question to answer is not how "hyper" he is but rather is there academic and social dysfunction. Some kids are hyper but make grades and are able to follow age appropriate games and social interactions.
In order to reduce errors in diagnosis, I almost always require the family to get a psychological and education profile. It can be expensive but it's "less costly" then putting a child on stimulants "to see what happens ". I have picked up quite a few children with mild intellectual deficits and/or learning disabilities who would benefit greatly from early academic interventions. Additionally, some children have anxiety or other psychiatric diagnoses at the cause of the behavior. They need therapy, not medications.
Social dysfunction is another critical clue. If a child can pay attention at soccer practice but not at school, they probably just hate school. Often times, ADHD children will need constant redirecting from a coach and begin to struggle as age and game tactics become more complicated. They will often begin to irritate their peers because they keep messing up, are loud and interrupt, and won't follow rules in games they are trying to play. This can lead to them being left out and ridiculed (hence, social dysfunction).
Our middle son has always had ADHD symptoms but was smart enough to make good grades, had lots of friends, and was a great athlete. My wife and I just put up with his poor organization and would give him frequent reminders. In middle school his grade's started dropping and his play time was getting reduced because he was often out of position and wouldn't follow all the instructions at practice/games. The final straw was it started affecting his self esteem because he knew he could do better. We started him stimulants and went from a B/C student back to a straight A student. He started earning more playing time and overall frustration level went way down. More importantly though, was the pride he felt in the accomplishments and achievements he was starting to have.
The best analogy I could give you is this: At what point would you give Tylenol to your child for fever? 99.9? 100.4? 104? A temp of 99.9 is not fever so despite what the grandma says, there is no reason to do so. If 104, you probably want to give Tylenol and gets some interventions in place. Anything in between, well that's specific to your child and the current situation. Are things improving or deteriorating with the cool wash rag and noodle soup? If not, that's when maybe it's time to start the Tylenol.
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