# When should an ASHA or PHC worker escalate a child showing signs of ADHD?

Canonical: https://pinnacleblooms.org/ask/when-should-an-asha-or-phc-worker-escalate-a-child-showing-signs-of-adhd
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Escalate a school-age child (around 6+) when inattention, hyperactivity or impulsivity persists for 6+ months across two settings (home and school) and disrupts learning or relationships — confirmed by parent and teacher. Refer promptly if red flags suggest another cause. The worker notices and routes; only a clinician diagnoses.

*An ASHA or PHC worker is often the first to notice a restless, inattentive child — and knowing exactly when to escalate is one of the most valuable judgements you make.*

## In short
ADHD is not diagnosed in the field, and never from a single restless day. Escalate to a medical officer or paediatrician when a child of **school age (around 6 or older)** shows a *persistent pattern* — present for at least six months, across more than one setting (home **and** school/anganwadi) — of inattention, hyperactivity or impulsivity that is clearly out of step with the child's age and is interfering with learning, friendships or family life. Below age 6, observe and support rather than label; high activity is developmentally normal in young children.

## When to escalate — a field decision guide
Refer onward to the medical officer / PHC physician when you observe a *sustained pattern* (not an occasional bad day):

- **Inattention** — cannot stay with a task, loses things repeatedly, doesn't seem to listen, easily distracted, struggling at school despite trying
- **Hyperactivity** — constant fidgeting, cannot stay seated when expected, always "on the go"
- **Impulsivity** — interrupts, cannot wait turns, acts before thinking, frequent accidents
- **Two or more settings** — the difficulty appears both at home and at school/anganwadi, reported by parent *and* teacher
- **Six months or longer**, and clearly affecting learning or relationships

**Escalate promptly (don't wait) if** there are red flags suggesting another cause — new-onset behaviour change, suspected seizures or staring spells, hearing or vision concerns, signs of distress, self-harm or unsafe impulsivity. These need a medical review first, as several conditions mimic ADHD.

What the worker does **not** do: diagnose, label the child to the family, or start any treatment. Your role is to notice the pattern, reassure the family, and route to the right clinician.

## The Pinnacle way
ADHD ([ICD-11 6A05](/adhd)) is confirmed only by a qualified clinician, never in the field and never from a checklist. At Pinnacle Blooms Network, a clinical [AbilityScore®](/ask/what-is-the-abilityscore-and-how-is-it-calculated) and any diagnosis are formed only at a Pinnacle Blooms Network centre under qualified clinician care, after ruling out other causes. For a child you've flagged, a structured [child-development assessment](https://www.pinnacleblooms.org/pinnacleai) gives the family clarity and a plan — not a label. With 70+ centres across 4 states and 700+ therapists, onward support is close at hand.

## Trusted sources
WHO ICD-11 (6A05, attention deficit hyperactivity disorder); CDC — Learn the Signs. Act Early.; Indian Academy of Pediatrics; American Academy of Pediatrics (HealthyChildren.org); NICE NG87 on ADHD diagnosis and management.

**Next step —** When the pattern fits, refer with confidence. [Book a developmental assessment](https://www.pinnacleblooms.org/enroll-autism-speech-aba-therapies-india) so a Pinnacle clinician can give the family answers.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- WHO ICD-11 — Attention deficit hyperactivity disorder: https://icd.who.int/browse11
- CDC — Learn the Signs. Act Early.: https://www.cdc.gov/child-development
- American Academy of Pediatrics — HealthyChildren.org: https://www.healthychildren.org
- NICE NG87 — ADHD diagnosis and management: https://www.nice.org.uk/guidance/ng87

## Connected topics and perspectives
- Conditions: https://pinnacleblooms.org/ask/conditions
- Asha Phc: https://pinnacleblooms.org/ask/lens/stakeholder/asha_phc
- Cognitive: https://pinnacleblooms.org/ask/lens/domain/cognitive
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- Screen: https://pinnacleblooms.org/ask/lens/lifecycle/screen
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