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Middle Childhood (6-12 years)


ADHD is often first diagnosed in this age group because school based expectations highlight struggles with attention, impulsivity, and hyperactivity.

Anxiety Disorder

There has been a sharp increase in children of this age group being diagnosed with anxiety disorders over the past decade. At this developmental stage, children often begin to be able to express their anxieties, but often cannot recognize their irrational nature. Children this age may begin to attempt to hide their anxiety, resulting in what often looks like oppositional behavior. Schools may also see an increase in somatic complaints and a decrease in school performance for children in this age group.

Autism Spectrum Disorder

Children with ASD may have difficulties performing motor skills such as pedaling a bike, catching a ball, or climbing on outdoor play equipment. Once in school, academic skills are often an area of relative strength though the child’s “obsessive” interests often intrude in the classroom setting and interfere with classroom functioning. In addition, children with ASD are likely to show delays in important social developmental tasks such as making and keeping friends. They may show particular interest in one or a few children around them, but the depth of their interactions is often relatively superficial.

Attachment Disorder

  • Frequent complaints about aches and pains
  • Age inappropriate demands for attention
  • Disinvestment in school and/or homework
  • Inability to reflect on feelings or motives regarding behaviors
  • Inability to understand the impact of behavior on others, lack of response to consequences
  • Inability to concentrate or sit still
  • Difficulty with reciprocity (give and take) in relationships
  • May appear amoral (lacking moral development)
  • Lying and stealing

Bipolar Disorder

During this developmental stage, Bipolar Disorder continues to resemble other disruptive behavior and mood disorders making accurate diagnosis challenging even for well seasoned clinicians. Along with the mood dysregulation and behavioral problems seen in early childhood, interpersonal relationships with peers may begin to be negatively affected. It is not uncommon for children of this age group to begin finding vocabulary for the symptoms they experience and may complain of such things as “racing thoughts.”


As with the early childhood group, children in this age group may show some signs of developmental regression such as bed wetting. They may also begin to show decreases in school performance and attendance and may begin self-harming behaviors (e.g. substance use, cutting, eraser burning).

Eating Disorders

Although eating disorders have historically been a problem that first occurs in adolescence and/or young adulthood, more recent studies indicate that the average age of onset for eating disorders in the United States is now between 9 and 12 years of age. 90% of Americans with eating disorders are children and adolescents.

Oppositional Defiant Disorder

Boys are diagnosed with O.D.D. more often than girls in this age bracket. Defiant and oppositional behaviors frequently intensify during this developmental period with an increase in direct confrontation and overt disruption in both the home and school environments. In addition, schools may see some or all of the following in students with O.D.D.:

  • An unusually high or low self-esteem
  • A pattern of apparently unprovoked mood swings
  • Easily triggered frustration
  • Swearing
  • Alcohol and/or drug use
  • Frequent conflict with parents, teachers, and/or peers

Substance Abuse

This age group is most likely to access substances from liquor or medicine cabinets at their or their friends’ homes. Additionally, this age group is at high risk for use of inhalants because of easy accessibility.


Due to new requirements of academic achievement and socialization that come with school attendance, signs and symptoms of trauma may surface or become more pronounced at this age. It is common in this age group to see post traumatic stress expressed through “worst case scenario” thinking, re-enactment of the trauma by incessant re-telling of their trauma story, and sometimes a desire to seek revenge for the trauma or related events. Children and adolescents experiencing post trauma stress may also begin showing signs of depression and may have reduced competencies in all developmental areas, including significant academic impairments.