ADHD in Preschool Children

Diagnosing Attention Deficit and Hyperactivity Disorder

ADHD is a descriptive diagnosis that must involve a detailed developmental history and physical examination of the child and their behavior

Preschool teachers and daycare providers tend to become concerned if the children they teach are overly hyperactive or have short attention spans. It is important that adults who work with young children understand the difference between common, age-appropriate behaviors and attention deficit and hyperactivity disorder.

What is ADHD?

ADHD stands for Attention Deficit and Hyperactivity Disorder. ADHD is a syndrome characterized by the presence of clinically significant levels of hyperactivity, impulsivity, disorganization, difficulty staying on task, short attention span, difficulty waiting in line, interrupting, and low frustration tolerance.

Psychiatric diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). For a child to be diagnosed with ADHD, it must be based on the DSM-IV criterion which outlines what is necessary to make the diagnosis. The disorder affects about 5 percent of children and occurs more commonly in boys.

ADD and ADHD in Preschool-Aged Children

Some children are considered to have ADD, Attention Deficit Disorder, which is marked by inattentiveness, confusion, distractibility, and avoidance of tasks that require focus and effort, according to Laurie LeComer, author of A Parent’s Guide to Developmental Delays. Others have hyperactivity disorder, which is marked by excessive physical activity along with impulsivity. Children that are hyperactive have difficulties with waiting, tend to interrupt, and often act before thinking. Some children have the “combined type” of difficulties, meaning they struggle with both compromised attention and hyperactive behaviors, says LeComer.

How is ADHD Diagnosed?

ADHD is a clinical diagnosis and is made by taking an appropriate history and physical examination of the child and their behavior. “The diagnosis is often made with the assistance of psychoeducational testing, or with a clinical interview, generally with a child psychiatrist or child neurologist. The clinical features must be present in at least two settings and over a period of time,” says child neurologist Dr. Sara J. Dorison.

The Importance of History, Physical and Assessment

It is important to note that ADHD is a descriptive diagnosis. Dr. Keith Kanner, child and adolescent clinical psychoanalyst, Professor of Psychiatry at University of California San Diego, and host of Fox TV’s “Your Family Matters”, explains that the diagnosis of ADHD does not take into account etiology (or cause). In other words, descriptive diagnoses do not try to find out “why” a child developed the condition. Rather, it describes a list of symptoms. If enough of such symptoms are met, then the diagnosis is made.

“What is most difficult about such descriptive diagnoses is that other conditions, such as anxiety, mimic the same criteria as ADHD and sometimes ADHD is misdiagnosed from either an anxiety condition or some other manifestation, such as childhood depression, or some sort of developmental disorder,” says Dr. Kanner. Therefore, it is very important that a detailed developmental history and assessment is made before assigning a diagnosis to a child.

Usually, doctors or psychologists use the Connor Rating Scales which allows parents and teachers to fill out forms regarding a child’s behaviors. Dorison stresses that it is important to rule out other disorders that can present similarly in a young child such as Asperger Syndrome, developmental delay, pervasive developmental disorder, autism, deafness, lead poisoning and severe anxiety.

“Though brain scans have shown slight differences in the brains of children with ADHD, the disorder is diagnosed through observable behaviors that have occurred over time in multiple environments. No scans or blood tests are currently used to diagnose a child with ADHD,” says LeComer.

If you are a daycare provider, preschool teacher, or parent and suspect ADHD in a child, contact your pediatrician so that the child can be assessed by a professional.