Diagnosing ADHD in Preschool

Why Early ADHD Diagnosis in Children Under Age 6 is Difficult

Toddlers and very young children normally exhibit many of the features of ADHD, but the diagnosis is usually made after the age of 7.Attention Deficit and Hyperactivity Disorder (ADHD) is a syndrome characterized by the presence of clinically significant levels of hyperactivity, impulsivity, short attention span, difficulty waiting in line, interrupting, disorganization, and low frustration tolerance.

Preschool teachers and daycare providers tend to be concerned when children exhibit these symptoms. However, early diagnosis of ADHD is difficult. It is important to understand that the diagnosis of ADHD usually comes after the age of 6.

ADHD Testing in Young Children

There are two reasons why ADHD is typically not diagnosed until the child is of school-age, according to 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”.

One reason is that the norming of the tests used to make the diagnosis begins with 7-year-olds and not earlier and hence, the diagnosis cannot be made.

“The second reason, which is one that has been debated by clinicians, has to do with the idea that the attentional aspects of the disorder only show up when academic conditions truly begin. This however has been debated and the current diagnosis now demands that the symptoms be in more than one environment,” says Dr. Kanner.

Individual Development and Diagnosing ADHD

Toddlers and very young children normally exhibit many of the features of ADHD. Child neurologist Dr. Sara J. Dorison explains that it is difficult to determine whether a young child has a “normal” amount of hyperactivity, impulsivity, or disorganization or a clinically significant amount of these features. Two-year-olds, for example, are impulsive and disorganized. They can’t sit for an hour listening to a lesson.

Typical children from ages 2 to 6 develop self-regulation skills and “in seat/focus” behaviors at different rates, says Laurie LeComer, author of A Parent’s Guide to Developmental Delays. There are even some differences exhibited between male and female children.

“It is important to make sure that the behaviors in question are not environmentally caused or situation-based. Different styles of family life, structured/unstructured home or daycare settings, and even personal traumas can affect children’s behavior,” explains LeComer.

While many young children develop out of ADHD-like behaviors as they naturally grow and develop new skills, children with true ADHD continue to struggle. The symptoms of ADHD cause children to begin to fall behind both socially and academically, explains LeComer.

“Over time, however, children without ADHD mature and gain more control in these areas and the ADHD children are left behind in terms of their difficulty with their symptoms. As their peers mature, children with ADHD generally become more obvious to both the teachers and the parents,” says Dorison.

Also, as the academic demands of school increase, children with ADHD often begin to lag behind their peers and not perform to their potential.

LeComer notes that though some children may exhibit inattention, learning and social difficulties, these symptoms may be indicative of other delays or disabilities. On the other hand, they may only be a difficult -yet typical- stage of the child’s development. Also, some children who have ADHD may not show clear symptoms before the age of 4 or 5.

Early childhood educators should be aware of each child’s behavior and development and approach a health care professional if they have questions or concerns if they suspect ADHD.