Diagnosing ADHD in Preschoolers & Young Children
Attention Deficit/Hyperactivity Disorder (ADHD) can be difficult to diagnose in preschool-aged children. The criteria for ADHD are more clearly applicable to children attending primary school. However, the DSM-IV, the manual used for diagnosing ADHD and other psychiatric conditions, states that the diagnosis of ADHD cannot be made unless “…symptoms that caused impairment were present before age 7 years.” This means that all children with ADHD had symptoms when they were younger.
Which symptoms would have been most apparent? When would they be most recognizable?
Many would say that very young children who go on to be diagnosed with ADHD are “difficult,” and have symptoms of the hyperactive and impulsive type of ADHD. A parent with a child who is not yet attending preschool can certainly be concerned about behavior like this.
Many would say that very young children who go on to be diagnosed with ADHD are “difficult,” and have symptoms of the hyperactive and impulsive type of ADHD.
Normal toddler behavior cannot be easily distinguished from ADHD behavior. As the child gets older, it will be easier to tell the difference between normal and abnormal behavior. The DSM-IV criteria have been used successfully to diagnose children four to six years of age with ADHD, says Benjamin B. Lahey, PhD.
There is currently much research looking for better ways to diagnose ADHD in younger children. While the DSM-IV criteria can be applied, better tests for young children would be useful and are needed, says M. Tandon.
Research in this area has shown that the DSM-IV criteria can be applied to even younger children if they are in a setting, like preschool, where impairment can be seen by someone else besides the parents. One study comparing behavioral treatments for young children diagnosed with ADHD required preschool attendance between three to five years of age. The researchers stated, “To participate, children were required to attend an early childhood center (preschool or center-type day care) at least two days per week.” They needed information from the preschool teachers or day care providers to diagnose the children, as well as monitor progress.
Preschool teachers can compare a child that goes to preschool with other children of the same age. A teacher who notices behavior that is not appropriate for the child’s age should communicate this to the child’s parents. If you have concerns about your child who is in preschool, you should ask the teacher directly. You can discuss your concerns with your child’s doctor. You may need to ask your pediatrician if he or she feels comfortable evaluating your child for ADHD at a young age, or whether or not there are child psychology specialists in your area that might be equipped to do so.
By the time your child is five to six years of age and in kindergarten or first grade, it will be easier to make a diagnosis. There is no specific test to diagnose ADHD. Information must be gathered from all possible places, including your child’s teachers. A pediatrician, family physician, psychiatrist, or psychologist can make the diagnosis. A psychologist from the school who will gather the information from you, the school, and the child’s doctor may evaluate your child. Your doctor can also make the diagnosis, but frequently the person who has easy access to the most information, the ability to do some specific psychological evaluations, and has the most experience works is the school psychologist. (This may vary, depending on where you live.)
In the public school system, children with ADHD should be identified and treated as special needs students, if their ADHD warrants. By age five or six, a child with ADHD will have trouble paying attention in class, finishing tasks, listening to instructions, and holding still. He may be disruptive to the rest of the class. He may interrupt others, blurt out answers, or have trouble taking turns.
By age five or six, a child with ADHD will have trouble paying attention in class, finishing tasks, listening to instructions, and holding still.
No matter what age your child is diagnosed at, treatment will be suggested. Treatment of ADHD includes both behavioral therapy and medication. For some people, the use of medication is controversial and undesirable, although most healthcare professionals and teachers agree that it can have benefits. If your child is diagnosed with ADHD, you need to be prepared to agree to some kind of treatment. Often, a combination of education, behavioral therapy, and stimulant medication can make a very significant difference in your child’s behavior.
In a study of children ages three to five, researchers gathered information from both parents and teachers. The children and parents were randomly assigned to get parent education alone or along with individualized, assessment-based intervention in-home and in preschool or daycare settings. Behavior in both groups of children improved significantly just through teaching the parents how to deal with their children.
The Preschool ADHD Treatment Study (PATS) was the first large-scale, long-term study of medical treatment of many young children with ADHD. Just over 300 children ages 3 to 5 years of age with extreme ADHD symptoms that did not respond to family and behavioral therapy were treated with methylphenidate (Ritalin) or placebos. Although there were side effects, and some of the children had to stop taking the medication, the majority of the treated children experienced a marked decrease in their symptoms.
Time will tell if your child has ADHD. If you feel very strongly that your child has the disorder – and you want not just the diagnosis but also some kind of treatment – once your child has started preschool, you can seek out professionals in your area with the experience to make the diagnosis in a preschool-age child, as well as suggest treatment.