ADHD in Young Children

Health Writer

Often, diagnosis comes sometime after the age of 6. This happens for a number of reasons:

  • The "terrible twos" have many similarities to ADHD.

  • Preschoolers are known to become agitated, excited and "act out" when schedules are disrupted, they are in high stimulus situations or are overly tired. These behaviors can be similar to behaviors seen in children with ADHD.

  • Children's developmental and learning milestones can occur at different ages. When a child is not maturing at the same level, it is sometimes assumed that they will "catch up" to children their own age within a relatively short period of time.

  • Doctors are sometimes reluctant to diagnose and treat a preschooler for ADHD, preferring instead to adopt a "wait and see" attitude to determine if ADHD is really present.

  • According to the Diagnostic and Statistical Manual IV, certain conditions must be present for a diagnosis to occur: symptoms must be present in at least two different environments (home and school or home and day care), and there must be clear evidence of clinically significant impairment. These conditions are sometime difficult for a doctor to determine when a child is two or three years old.

Although some children have been diagnosed as early as two years old, it is much more common for a child to be diagnosed after age six, once they have begun attending school all day.

Parents of children with ADHD have often indicated that even before school age, they knew that there was something "different" about their child since they were infants or toddlers. There are some examples of signs that may indicate the presence of ADHD. However, many children exhibiting these signs grow up to have no problems and are never diagnosed with ADHD. The following, therefore, is a listing of characteristics that are common in children later diagnosed with ADHD:

Infancy (0-12 months)

  • More fidgety or squirmy

  • Less able or less interested in cuddling

  • Impatient, easily frustrated

  • Require more attention than average baby

  • May sleep less or take short catnaps

Toddler (1 to 3 years)

  • Inability to sustain attention for even a few minutes
  • Constantly distracted by sights and sounds around them
  • Difficulty sustaining eye contact
  • Able to pay attention to certain high interest things such as a favorite video game or playing outside when high energy levels are required

  • Excessively hyperactive

  • Always in motion

  • Lack of interest in cuddling or quiet activities

  • Difficulty calming down after becoming excited

  • Highly impulsive: will jump off of decks, slides or out of windows, will run into the street more often

  • Accident-prone

  • Difficulty sleeping, may have a hard time falling asleep and may be up at 5:00 AM each morning

Preschool

  • Inability to sit still

  • Lack of interest in quiet activities or in listening to stories

  • Changes activities every few minutes

  • Inconsistency in attention skills, may be able to hold attention when an activity is interesting, but not able to keep attention for other activities

  • Always in motion, sometimes running without looking, may run into street or fall often

  • Can be very talkative

  • Poor social skills

  • Behavioral problems, not listening, disobeying or consistent unsafe behaviors

  • Can be clumsy or have underdeveloped coordination

  • May grab toys from classmates, siblings or friends

  • Difficulty waiting for their turn

  • May be aggressive, causing fights or hitting other children

Whether or not your child has been diagnosed with ADHD, there are a number of ways you can help to manage their behaviors:

  1. Understand the symptoms of ADHD to try to avoid punishing your child for having ADHD. Predetermine how you will react in situations to avoid overreacting and then dismissing a punishment. Be as consistent as possible.
  2. When giving directions or instructions, keep them simple. Keep them to one instruction at a possible and give directions in one sentence. Children with ADHD are often forgetful. Rather than becoming frustrated, let your child complete one part of the instruction at a time, then give another.
  3. Keep eye contact with your child. If necessary, gently hold their chin so that they are looking at you when you speak. Children tend to listen more closely when they are looking at you as you speak.
  4. Structure your day as much as possible. Keep nap times, meal times and dinner times at the same time each day. Having the day predictable for the child will help them cope better. Let them know any disruptions that may happen and what to expect. Let them know what you expect of them.
  1. Give them plenty of time to release energy. Set up times during the day for them to run or release energy. Make daily trips to the playground or play outside. If stuck in the house, use a radio or CD and have them dance.

  2. Choose toys carefully. Children with ADHD can be emotionally immature. Allow toys that will benefit them developmentally and also provide toys to stretch their intelligence. (Children with ADHD do not have a lower intelligence level.)

  3. Integrate learning techniques. Use as many as the senses as possible when teaching a new skill. If you are teaching your child colors find items they can touch, eat, or smell. Have them draw with crayons. Having learning become interactive will help them learn more quickly.

  4. Create an environment to help them succeed. Accept they may be accident prone and put away items you don't want broken. Use simple organizational structures they can use to put away toys. Use pictures on drawers to help them know what is inside.

  5. Choose behavioral management techniques that are immediate. A child will have a hard time relating a consequence to an action if they do not happen simultaneously. Make rewards immediate as well. Give praise often when your child behaves correctly.

  1. Be prepared for times when you will be in an environment that will be difficult for your child. If they will need to sit for extended periods, bring along small activities, drinks and snacks to keep them occupied. If you are going to be in a high stimulus area, be prepared to remove your child for a few minutes to help them calm down and then return to the activity.

  2. For things your child must remember, use rhymes or songs. Have them help you make up the rhymes and songs to make this even more successful. (This works well for learning to spell their name or remember their phone number.)

  3. Find what your child does well. If they are creative (and many children with ADHD are) supply items that will encourage their talents.

  4. Be consistent. Consistency is the most important part of behavioral management when working with children with ADHD. The more consistent you are, the more they will know exactly what to expect and be able to follow your rules.

Sources: Chandler, MD, Jim (2002). What is ADHD?. from Attenion Deficit Disorder Resources Web site: http://www.addresources.org/article_adhd_chandler1.php (2000). Symptoms of ADHD - DSM-IV Criteria. from Centers for Disease Control and Prevention Web site: http://www.cdc.gov/ncbddd/adhd/symptom.htm