ADHD Diagnosis in Kids

Isn’t My 4-Year-Old Too Young to Be Diagnosed With ADHD? Common Parental Concerns and Answers

Preschool teachers, relatives, and even friends have commented on your child’s abnormal hyperactivity, lack of focus, and daredevil behavior. You experience the extreme behavior every day, but you hesitate to pursue an evaluation for ADHD in no small part because it is scary to think your child has a neurological condition that will impact his health and happiness. Here are reasons parents often give for delaying a diagnosis, and responses from ADHD specialists who strongly persuade them to reconsider.

A preschooler with ADHD playing on the slide at the playground
A preschooler with ADHD playing on the slide at the playground

Does My 4-Year-Old Have ADHD? At What Age Can You Tell?

Medical guidelines for diagnosing and treating ADHD in children long stipulated that only children 6 or older could be evaluated for ADHD. That all changed in 2011, when the American Academy of Pediatrics (AAP) noted that children as young as 4 could be diagnosed and treated for the condition, too.

ADHD in children between 4 and 6 years of age typically looks like persistent and debilitating inattention, hyperactivity, and/or impulsivity. Behavioral therapy is the first treatment option the AAP recommends for children in this age group, followed by medication.

It’s not unheard of for children younger than 4, though, to also be diagnosed. The AAP, however, does not provide guidelines for diagnosis below the 4-year mark.

Still, some parents hesitate to have their children evaluated before they are school-age. Here are four common reasons why they wait and why they shouldn’t.

[Click to Read: When Toddler Tantrums Are Actually ADHD — Early Signs of ADD and Emotional Dysregulation]

Signs of ADHD in Toddlers: Common Concerns

1. “It’s normal for preschoolers to be hyperactive and have short attention spans.”

It’s true that preschoolers are naturally active and usually can’t focus as long as older children can, but there are stark differences between kids with ADHD and those without it.

“Preschoolers with ADHD run out into the street without thinking,” says Patricia Quinn, M.D., a developmental pediatrician in Washington, D.C.. “Very young children with ADHD have more broken bones, more stitches, and more emergency room visits than children who don’t have the condition.”

She adds: “Having your child diagnosed and treated in preschool will help her manage symptoms and will likely keep him or her safe and sound.”

[Essential Reading: Is Preschool Too Early to Diagnose ADHD?]

2. “I’m afraid to medicate my 4-year-old.”

Behavior therapy, as mentioned, is actually the first type of treatment the AAP recommends for 4-year-olds. If behavior therapy has been tried (usually in an 8- to 12-week program) and found not to work, then the doctor can consider putting a 4-year-old on ADHD medication, which the guidelines say is also effective and safe for children in this age group. Many children ultimately end up with both therapy and medicine.

“Medication at any age is never a magic bullet,” says Michael Reiff, M.D., professor of pediatrics at the University of Minnesota, who served on the committee that developed the 2011 AAP guidelines. “However, if your child exhibits dangerous behaviors that significantly impair his daily living, it seems reasonable to consider the possibility of medication management.”

“Parents should ask, ‘Would it be helpful to my child to explore what medications have to offer?’” says William Dodson, M.D., a retired psychiatrist who practiced in Colorado. “As one pediatrician said, ‘We’re not talking about a tattoo on your child’s face. We are going to see what medication has to offer and then decide, based on knowledge rather than fear.’”

3. “Behavior therapy doesn’t work.”

Behavioral therapy actually aims to help parents effectively manage and improve their child’s behavior by changing how they approach and interact with their child. This form of therapy, taught by a therapist or another trained medical professional, has been proven time and time again to be an effective intervention for children, especially those between ages 4 and 6.

“Behavior therapy won’t change the wiring of a child’s brain,” says Ari Tuckman, PsyD, a psychologist based in Pennsylvania. “It can, however, minimize distractions and change the tone of the interactions between a child and parents or teachers.”

He adds: “Behavior therapy enables a child with ADHD to function better, just as changing the way a diabetic’s diet can help him feel and function better without changing his ability to process sugar.”

4. “I don’t want my child to be labeled.”

Your child may actually be less likely to be labeled a “troublemaker,” a “bad kid,” or a “daydreamer” if you address his ADHD early.

“One study showed that a child with untreated ADHD received 20,000 negative messages in the first 10 years of life,” Dodson says. “If a child mostly hears, ‘You’re a little monster, you’re impossible to deal with,’ it affects how the child thinks about himself. Treating ADHD can help your child function and behave better, and will most likely build his self-esteem.”

[Read This Next: Think Your Preschooler or Toddler Has ADHD? Ask These Four Questions]

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