Identifying Attention Deficit Hyperactivity Disorder (ADHD) in Young Children:

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed behavioral disorders in childhood. Rates have been increasing over the past few decades and there are different reasons suggested for this increase, including better screening for ADHD. According to the DSM-5, the childhood rate of ADHD in the United States is estimated at five percent. Community population samples and parent report of children in some studies have found higher estimates (up to 11%).

ADHD can profoundly affect children’s educational performance, wellbeing, and social interactions (American Academy of Pediatrics, 2011). Common referral concerns for ADHD include exhibiting behaviors such as high activity level, impulsivity, and poor attention. Accurate diagnosis, particularly when children are young, requires informed clinical judgment and the use of multiple assessment measures and information about how a child is functioning across different settings over time. Children can be diagnosed as young as 4 years of age (although most children are not diagnosed with ADHD until age 7). While symptoms may be observed in early childhood, accurate diagnosis is incredibly difficult – because many of the “problem behaviors” associated with ADHD fall in the range of typical or age-expected behavior for young children.

Early signs of possible ADHD that have been identified include:

• Acts before thinking,
• Changes activities frequently
• Has a short attention span
• Fails to focus and follow directions
• Distracts easily
• Has difficulty staying on task (Fewell & Deutscher, 2002, p27).

According to Dr. Mark Mahone, early signs of ADHD risk for preschool children include:

• Dislikes or avoids activities that require paying attention for more than a few minutes
• Loses interest and moves on to another activity after engaging in an activity quickly
• Talks more and makes more noise compared to same age peers,
• Climbs on things even when told not to
• Not able to hop on one foot by age 4
• Almost always restless
• Fearlessness results in getting into dangerous situations
• Warms up too fast to strangers
• Aggressive to peers in and preschool expulsion and
• Injures him or herself by running or moving fast even when told not to do so

(See: http://www.kennedykrieger.org/overview/news/it-adhd-or-typical-toddler-behavior-ten-early-signs-adhd-risk-preschool-age-children)

Characteristics of ADHD – Predominantly Inattentive Presentation

• Fails to give close attention to details or makes careless mistakes.
• Has difficulty sustaining attention.
• Does not appear to listen.
• Struggles to follow through on instructions.
• Has difficulty with organization.
• Avoids or dislikes tasks requiring sustained mental effort.
• Loses things.
• Is easily distracted.
• Is forgetful in daily activities.

Characteristics of ADHD – Predominantly Hyperactive/Impulsive Presentation

• Fidgets with hands or feet or squirms in chair.
• Has difficulty remaining seated.
• Runs about or climbs excessively in children; extreme restlessness in adults. Difficulty engaging in activities quietly.
• Acts as if driven by a motor; adults will often feel internally as if they were driven by a motor.
• Talks excessively.
• Blurts out answers before questions have been completed.
• Difficulty waiting or taking turns.
• Interrupts or intrudes upon others.

(See:http://www.chadd.org/Understanding-ADHD/Parents-Caregivers-of-Children-with-ADHD/Symptoms-and-Causes/Symptoms-and-Diagnostic-
Criteria.aspx#sthash.fz8ZbS23.dpuf)

Impulsivity, inattention, high activity levels and distractibility are all commonly observed in young children. Problems with self-control or hyperactivity occur with many preschool children and are expected -to a degree. Therefore, it is important to consult with a knowledgeable and
informed professional who can help differentiate between developmentally appropriate (or age appropriate) behaviors and when behaviors fall outside of the expected range. Problematic behaviors need to be more frequent, severe, and persistent compared to same age peers. It is also the combination of these behaviors and how they affect functioning in different environments that might suggest a possible underlying disability.

If you have concerns about your child’s behavior or questions about ADHD talk with your pediatrician or a psychologist.

Resources

Preschoolers and ADHD (National Research Center on ADHD): https://chadd.org/wp-content/uploads/2018/05/preschoolers.pdf

Is it ADHD or Typical Toddler Behavior? Ten Early Signs of ADHD Risk in Preschool Children: http://www.kennedykrieger.org/overview/news/it-adhd-or-typical-toddler-behavior-ten-early-signs-adhd-risk-preschool-age-children

ADHD: https://kidshealth.org/en/parents/adhd.html