Does my preschool child have ADHD?
The Doc Smitty looks at the symptoms and diagnosis of ADHD
I am not kidding when I say that I had a mother of a 6 month old ask me if her child was going to be ADHD, “Because he just moves all the time!”
While that was an easy question to answer, I do get more difficult questions about young children with hyperactivity.
In order to start this conversation, it is important to remember the core ADHD symptoms: inattention, impulsivity and hyperactivity.
Based on appropriate diagnostic criteria, you cannot diagnose ADHD until age 4. It is also difficult to diagnose children until they are in school because the diagnosis requires that symptoms be present in more than one environment.
As with any type of behavioral problem, the degrees of severity present a wide spectrum of the various symptoms of ADHD.
Inattention-Some children can focus for hours at a time but some jump from one activity to the next very quickly, seeming to never really focus on one thing for a significant amount of time.
Impulsivity-Some children are very cautious and don’t do anything dangerous, while others jump from my exam table across the room to the chairs on the other side.
Hyperactivity-Some children can sit still for long periods of time, while others are constantly fidgeting and restless.
So, how does this look in a 3-4 year old child?
All 3 and 4 year olds show signs of inattention. There are a select few children in this age group who can maintain focus for extended periods of time. Because of this, it’s hard to get too excited about concerns about a 3 year old’s attention span.
I have definitely seen varying levels of impulsivity in this age group. Those that are highly impulsive, in my experience, often go on to meet criteria for ADHD as they get older. Remember, however, that talking back and aggression are not necessarily impulsivity.
The most common symptom that parents interpret as ADHD is hyperactivity. There is definitely a difference between the general restlessness of a typical 3 year old and a child that truly becomes ADHD in the future.
Children at this age are often described by parents who report, “Their motor is just always running” or “They just go non-stop from the moment they wake up.” Because I see so many children of this age group every day, I also have some subjective sense of what is normal or abnormal for the age group and this can help my assessment over time. However, I never make snap judgments because any child can act like they have ADHD on a particular day.
So, what if you are concerned that your young child may be showing some signs of hyperactivity? A great place to start is here: ADHD Behavioral Treatment-8 Tips.
Here are some basic things to remember:
1. Try to stay patient.
Because so many of these young children will outgrow these symptoms, it is important to stay patient with them.
2. Try to stay calm.
Anxiety only makes hyperactivity worse. Yelling at a kid to sit down and shut up will most likely just make your problems worse.
3. Try to stay consistent.
Children with hyperactivity do their best with structure and clearly defined boundaries. If these children don’t know what to expect from minute to minute, they cannot adjust as easily as most kids. If they are not disciplined consistently, they do not know where the boundaries lie. With any behavior problem, I ask my families to pick out what 1 or maybe 2 behaviors that they want to extinguish and be consistent in the their punishment for those. It is not feasible to fix all of your child’s problems at once.
Also remember to praise them when they do the proper behavior. If a child is only getting negative reinforcement, they will often choose that over positive reinforcement.
Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page.He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.