Think Your Preschooler or Toddler Has ADHD? Ask These Four Questions
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.
When a preschooler is wildly hyperactive or impulsive, parents often feel like they have to “wait and see” if it really is attention deficit hyperactivity disorder (ADHD). The truth is that the signs and symptoms of ADHD can already present at a very young age. Medical guidelines today, furthermore, note that children as young as 4 may be diagnosed with ADHD.
Still, it can be tempting to confuse normal preschooler behavior — struggling to pay attention, getting bored or distracted quickly, fidgeting, and more — with ADHD. The distinction for ADHD is the degree of these symptoms, and asking the right questions.
Does My Preschooler Have ADHD?
Parents should be guided by these four questions when determining if their child’s behavior goes beyond the norm:
- 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?
What ADHD Can Look Like: Scenarios
At the end of each afternoon, 3-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 the four important questions above. This is what she noticed:
- 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.
Alex’s behavior could be pointing to an ADHD diagnosis down the line. For the time being, however, 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.
Here’s another scenario: 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.
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 ADHD 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.
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Updated on January 3, 2021