ADHD Symptoms in Children

Could Your Preschooler or Toddler Have ADHD? How to Investigate

Is your toddler or preschooler’s hyperactivity normal — or something more? Use this checklist to decode your child’s behavior and to address ADD symptoms before they escalate. Early detection and intervention can make a world of difference in children with ADHD.

Mother holding hand of preshool child with ADHD while walking outside
Mother holding hand of preshool child with ADHD while walking outside

Sometimes, being a parent involves detective work. During the early years, in particular, when language is not sophisticated, a parent must look for other clues to determine whether a child is on track. Careful observation and keen attention to detail can help to identify problems and find treatment before symptoms begin to cause problems at school and on the playground. This is especially true for young children who show signs of attention deficit disorder (ADHD or ADD), which is highly treatable.

When a toddler or preschooler is wildly hyperactive or impulsive, parents are often advised to “wait and see,” even though the latest Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, suggests that children may be diagnosed with ADHD as young as 4 years old. Parents of boys who ultimately receive an ADHD diagnosis are routinely told, when their sons are in preschool, that they are “just boys being boys.” But parents who are good detectives learn which environments are “hot spots,” and begin to alter their expectations and daily lives accordingly.

Signs and Symptoms of ADHD in Toddlers and Preschoolers

The signs and symptoms of ADHD are the same for toddlers and preschoolers as they are for other children — struggles to pay attention, gets bored quickly, gets distracted easily, fidgets often or acts as if propelled by a motor, has trouble waiting their turn, interrupts conversations, takes risks, etc. Sounds like the description of a “normal” preschooler, right? Yes and no. The distinction for ADHD is the degree of these symptoms. The key is to discover if your child’s behavior is developmentally age-appropriate.

At the end of each afternoon, three-year-old Alex’s preschool offers a free-play period. Parents arrive during this time to watch their kids play before going home. Cathy noticed that her son ran wildly around the playground, and that he was repeatedly told by the teacher to “stay away from the swings.” Cathy focused her attention on four important questions:

  • Is the behavior I observe in my child similar to that of other children he encounters?
  • Is the behavior I expect of my child developmentally appropriate for his or her age?
  • Do I see a pattern of behavior when my child engages in various activities?
  • Do I see a pattern of behavior in various settings?

[Self-Test: Could Your Child Have ADHD?]

Then, she noted the results:

  • The other children settle down after a flurry of activity. Alex continues to run, and seems to get further out of control over time.
  • All the children are about the same age. When I asked the teacher about his behavior, she implied that Alex behaves like a younger child on the playground.
  • During free play, Alex appears excited but highly agitated. He doesn’t play with anyone. One-on-one, he can sit and be still.
  • Alex can be calm at home, and the teacher says that he is calmer indoors.

Cathy concluded that her son was not ready for free play in a playground setting with lots of other kids. She began picking up Alex before free play and arranging one-on-one play dates at their house. By the end of the school year, Alex had made several good friends. Great detective work, Cathy!

Does My Toddler or Preschooler Have ADHD?

Sam helped his five-year-old daughter, Grace, with schoolwork every night. She often brought home worksheets because she could not finish them in class. When he commented to another parent about how much “homework” the kindergarteners had, the other parent seemed puzzled. Sam had noticed that Grace had a hard time getting through a worksheet — she would fidget, go to the bathroom, ask for a snack, or talk about something unrelated. Grace said that she loved school, yet she couldn’t focus on school tasks. Sam thought:

  • Most of Grace’s classmates seem to be able to stick with a game or conversation for a longer time on play dates.
  • Parents of other children in Grace’s class say that their children almost always finish their work in class and that the few worksheets that come home take a short time to complete.
  • Tasks that require extended focus are difficult for Grace, unless she loves an activity.
  • At museums, or learning in an active manner, Grace does well. When she must sit still, she cannot stay on task.

[“My Child Has ADHD and Here’s What We’ve Learned”]

Sam decided to talk with Grace’s teacher, who made similar observations. She said Grace might be a little immature, but it wouldn’t hurt to investigate further. When Grace was evaluated by a learning and behavior specialist, she presented all the markers for a mild ADHD diagnosis. Behavior modification is the first ADD treatment suggested by the American Academy of Pediatrics (AAP), and Grace’s parents did just that. They read about the condition, and made changes in their home environment and the way they parented — using a behavior chart, following a routine and tighter schedule, taking a positive parenting approach — and arranged for extra help at school. Thanks to Sam’s sleuthing, Grace still loves school — and doesn’t bring it home with her every night.

Updated on January 17, 2020

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