ADHD In Preschool Age Children

Question of the Week

A preschooler having a tantrum.
When is a tantrum in preschool more than normal behavior?. Photo by Getty Images

Q. I have a son who is turning four this December who is very active and playful. He is very intelligent, he spoke early, before he turned two, and he can easily memorize songs, the alphabet, and he knows the colors. But when he went to school (8 wks now) his teacher complained that he is always disruptive in the class, doesn't want to follow instructions, is always playful and cannot sit still for at more than 30 mins. His teacher told me that he is very intelligent, but his immaturity and behavior issues are causes problems. I'm worried that he has ADHD. Joel, Canada

A. While those might all be symptoms of ADHD in an older child, they could also be a sign of an immature three or four year old boy. ADHD is difficult to diagnose in preschool age children.

Is It ADHD?

Instead of jumping on an early diagnosis of ADHD for your son, you might consider that his teacher has unrealistic expectations for what he should be doing at this age. Many three and four year olds still have short attention spans, are hyperactive and like to play, and wouldn't be expected to sit still for 2 hours at a time. Such a structured environment with a lot of other children also may not be the best fit for him right now.

If ADHD runs in the family, if he is also overly aggressive and it is leading to problems with his relationships with other children, or if his behavior is extreme and very different from all of the other preschoolers at his age, then you might seek further evaluation by a child psychologist or your pediatrician.

Still, remember that the American Academy of Pediatrics, in their latest guidelines state that "The primary care clinician should initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity."

Early ADHD Diagnosis Dilemma

Considering a diagnosis of ADHD in a preschool age child poses some big dilemmas. While you don't usually want to start these young children on ADHD medications, you also don't want them to go several years with untreated symptoms that may lead to problems learning, making friends, and cause low self-esteem.

It is important to keep in mind that preschoolers can have ADHD, but as Dr. James A. Blackman said in his article on ADHD In Preschoolers - Does It Exist And Should We Treat It?, 'high activity level, impulsivity, and short attention span - to a degree - are age-appropriate characteristics of normal preschool-aged children.'

Once a child is four or five years old and meets the criteria for ADHD, also keep in mind that the AAP states that "In areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment."

The AAP guidelines also state that:

  • in some situations, it might be helpful for parents to complete a parent-training program before confirming an ADHD diagnosis for preschool-aged children
  • placement in a qualified preschool program, such as Head Start, might be helpful for some preschoolers who might have ADHD
  • referral for Early Childhood Special Education services might be a good idea for preschoolers who could have ADHD if they have emotional or behavioral problems

Most importantly, talk to your pediatrician if you think that your preschooler might have ADHD. And don't wait until he has been kicked out of multiple daycares or preschools.

Sources:

AAP. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/ Hyperactivity Disorder in Children and Adolescents. PEDIATRICS Volume 128, Number 5, November 2011

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