Do you have a very young child of preschool age, perhaps 3 or 4 years old, who is exhibiting some of the classic signs of attention-deficit/hyperactivity disorder, or ADHD? Have you tried taking your child to your doctor for an official diagnosis? ADHD is a disorder that is normally associated with elementary school children, and as such, many doctors are reluctant to diagnose ADHD in very young children, even when the behaviors are extreme. This can create problems for both parents and preschool teachers, because if the child has indeed developed ADHD it’s impossible to get treatment without a diagnosis. However, most doctors’ reluctance in diagnosing ADHD in children who are very young does not mean that it never happens, just that those of preschool age must meet a number of specific criteria before receiving this type of diagnosis. In this article we will explore this topic a bit further, first by explaining why ADHD diagnoses in very young children are rare, followed by the criteria doctors use to ultimately make their determination.
The Problem with Diagnosing ADHD in Very Young Children
ADHD is the most commonly diagnosed behavioral disorder in elementary school-age children, with approximately 10% of all children diagnosed. The condition, which affects three boys to every one girl, is characterized by three major symptoms: hyperactivity, impulsivity and inattention. These broad symptoms can cause a number of problematic behaviors in children, including daydreaming, constantly getting out of one’s seat during school, fidgeting and restless behavior and even aggressiveness.
There is no biological test for the presence of ADHD in children, which means doctors have only observable behavior to rely on when making their diagnosis. What doctors look for are signs of hyperactivity, impulsivity and/or inattention that occur frequently and are so severe that they create problems with a child’s ability to function normally—to behave normally and to perform as they should in school. If a child shows these signs, a treatment plan, which may include a combination of medication and therapy, will usually be initiated.
So what about very young children of preschool age? Why are doctors so reluctant to render the same diagnosis in these children? The reasons for this are many. In the past few years, many research studies on ADHD in school-age children have been conducted, and a lot has been learned about the disorder in this age group, but unfortunately only a handful of those studies have included children that are very young. Thus, doctors are still a bit unclear about the manner in which ADHD affects this group.
The problem, according to researchers, in diagnosing ADHD in preschool-age children is that the behaviors that are typically associated with the condition, behaviors reflecting hyperactivity, impulsivity and inattention, are generally considered age-appropriate for preschoolers. As a result, in many cases doctors prefer waiting a couple of years to see if children will grow out of the behavior before saddling them with an ADHD diagnosis.
Diagnosing ADHD in Very Young Children
While most doctors are reluctant to diagnose ADHD in young children, in some cases, where the inappropriate behavior is so extreme—when behavior is consistently worse than children their own age—this type of diagnosis may indeed be offered. For example, many preschool-age children have trouble sitting still for any length of time, but when a child cannot focus on anything, in any environment, even those activities that should be pleasurable, there may be an underlying problem with ADHD.
There are two behavioral patterns in young children that are usually a “red flag” that something is wrong. The first is a refusal to participate cooperatively in any activities, at school and at home, and a failure to respect other people’s boundaries, even after repeated reminders. The second pattern, which may be very easy for parents to identify, is that they seem to be avoided by their classmates and playmates, shunned because of the way they act. Both of these patterns represent something much more than typical developmental behavior, and in these cases, an ADHD diagnosis may be warranted.