How Soon is Too Soon? Diagnosing ADHD in Young Children

Getting kids the help they need as early as possible will set them up for success later in life. There are numerous early intervention programs available for kids who fail to meet their developmental milestones on time or struggle with speech problems. But when it comes to behaviors related to ADHD, like impulsivity, hyperactivity, and difficulty paying attention in young children it can be harder to identify the source of the problem, and harder to know how to help. How soon is too soon to start thinking about an ADHD diagnosis, and when can you start to intervene?

According to the American Academy of Pediatrics, ADHD can be reliably diagnosed in children as young as 4-years-old. Although it’s important to note that not all kids with ADHD can be identified this early. Kids who receive diagnoses at this young age are more likely to be boys than girls, and their symptoms will cluster more around hyperactivity and impulsivity than difficulty paying attention. Why? During the preschool years the demands placed on kids’ attention are generally fairly light. At school or day care, activities are brief, they change frequently, and they are designed to be engaging and active. They are exactly the type of activities that kids do well with when they have short attention spans! As a result, attention challenges may not be obvious at this age.

If you’re the parent or teacher of preschool age children, or have spent any time around preschoolers, then you know that in general kids at this age are very active, and most behave pretty impulsively – they act first and think later. So, how can you tell the preschoolers with ADHD from the preschoolers without ADHD? The kids with ADHD are much more hyperactive and impulsive than their peers. They rarely sit still, although some may sit for longer stretches of time if they’re watching TV or playing videogames. They run and climb on things excessively, to such an extent that their parents and teachers worry about their safety. Some of these kids may have already had trips to the ER because of falls and other accidents. Their high activity levels and impulsive behavior also cause serious challenges at school or day care. Their parents receive calls from school at least once a week, and sometimes kids with these ADHD symptoms are asked to leave their day care or preschool program altogether. At home, mealtimes are a challenge because of difficulties with staying seated at the table, even for a few minutes. Going to a restaurant, church, or participating in any activity that requires sitting feels next to impossible, even when parents provide activities to keep their kids entertained. More active family outings may feel difficult too, because it’s hard to keep the child from running off or having a meltdown if they don’t get their way.

When it comes to diagnosing ADHD in preschool children, higher levels of activity and impulsive behavior alone aren’t enough. Diagnosing ADHD at any age can be challenge, but in young children it is especially difficult. Kids who are anxious, have learning differences, a history of trauma, social challenges, or other mental health concerns can behave in ways that mimic ADHD symptoms. A thorough assessment by a medical doctor or psychologist to rule out other causes is essential. This assessment should include gathering detailed information from parents, teachers, and the child to determine whether or not ADHD is present.

When a preschool child is diagnosed with ADHD, behavioral interventions, especially those that are put into place by parents and teachers under the guidance of a trained therapist, are the first line treatment according to the American Academy of Pediatrics. Kids who don’t improve with intensive behavioral interventions can be treated with medication, in addition to ongoing behavior therapy. ADHD medications have been shown to be effective with kids as young as 4-years-old, although they may not work quite as well as they do for older children and may be accompanied by greater side effects. One treatment to avoid is one-on-one therapy, where the child talks directly to the therapist week after week without parent involvement in the sessions. At this age especially, it is essential that parents are involved in sessions and are learning new skills that they can use at home to help their child.

If you suspect that your preschooler may have ADHD, talk to your pediatrician. Let them know about your concerns and request a thorough assessment. If ADHD is the source of the problem, then start treatment as soon as possible. Getting help for your child’s ADHD now will set them up for success in elementary school and beyond.

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