ADHD Symptoms in Children

Signs of ADHD in Preschoolers: Misinterpreted Symptoms and Effective Interventions

Is it typical preschool-age behavior, or ADHD? Learn about the early signs of ADHD in preschoolers and the importance of early identification and intervention, especially in the form of behavior training.

By Alexis Bancroft, Ph.D., Cynthia Martin, Psy.D. Verified Updated on March 6, 2025
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Preschool-aged children are rambunctious, curious, and sometimes mischievous. Rarely are they consistently attentive, regulated, and cooperative. So how do we differentiate typical developmental behaviors from possible symptoms of hyperactivity, impulsivity, and inattention that characterize ADHD?

ADHD symptoms can manifest and be diagnosed in young children. In fact, research indicates that the earliest signs of ADHD can emerge in infancy. In preschoolers, certain behaviors and challenges — especially if they interfere with functioning as the child progresses through expected developmental milestones — offer early clues that ADHD is present.

Is it ADHD or Typical Preschool Behavior?

The preschool years are an exciting time of cognitive, physical, social, and emotional growth that bridges the gap between toddlerhood and the school-aged years. Common behaviors that mark the preschool years include the following:

  • eagerness to participate in group activities
  • curiosity and affection
  • a budding sense of humor
  • easily encouraged and discouraged
  • intense feelings
  • high energy
  • showing off or demanding attention
  • difficulty following adult-led activities for long periods of time
  • emerging executive function skills

A wide range of behaviors is considered developmentally appropriate in preschool-age children. The following milestones, which focus on inhibition, a developing sense of danger, and awareness of social expectations, are particularly important:

  • By age 3: avoids touching hot objects, like a stove, when warned
  • By age 4: avoids danger (e.g., not jumping from tall heights at the playground); changes behavior based on the situation
  • By age 5: follows rules and takes turns when playing games with other children; pays attention for 5 to 10 minutes during a screen-free activity

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The milestones above reflect the expected achievements of at least 75% of children in each age range. Similarly, common behavioral red flags that may indicate ADHD include the following:

  • difficulty attending to a non-screen task for 5 to 10 minutes by age 5
  • excessive climbing and jumping (like over furniture) when the behavior might not be expected or appropriate
  • moving quickly from toy to toy or having difficulty playing with toys at all
  • difficulty waiting; impatience
  • frequently interrupting adults (during phone calls, in-person conversations)
  • acting or moving in unsafe ways (e.g., bolting across the street despite being told to hold an adult’s hand, unbuckling their seat belt when the car is in motion, reaching for a piping hot dish)
  • difficulty following instructions and adhering to routines
  • excessive talking and noise making while doing activities (like homework)
  • constantly on the go and “bouncing off the walls”; difficulty calming the body
  • high reactivity
  • social difficulties

It’s true that many preschool-age children will experience ADHD-like symptoms. Of these children, a small percentage will go on to develop ADHD that may impair day-to-day functioning if left untreated.

[Read: Is Preschool Too Early to Diagnose ADHD?]

How to Help Your Preschooler

By age 5, upwards of 90% of the brain is developed. Because of this, early childhood is a critical period of intervention, where new neural pathways can be built before patterns of behavior become entrenched. Here are some of the things you can do to help a child with ADHD develop positive patterns of behavior:

Offer Vigorous Praise

  • Catch your preschooler being good. Celebrate your child when they engage in a behavior you want to see more of. Say, “Wow, thanks for coming to the table the first time I called you over!” or, “I love how you picked out your shirt without me even asking you to do it. Awesome work.” Do not immediately react when your child engages in behaviors you wish to see less of, like interrupting, so your child does not equate with non-preferred behaviors with instant attention.
  • Praise by the numbers. You’ll be coaching and correcting your child in many ways, which makes frequent positive reinforcement essential. For every one time that you correct your child’s behavior, make sure to offer roughly four positive comments.

Model Structure & Consistency

  • Use routines and visual schedules. These layer predictability into a unpredictable world, reducing stress and fostering stability. Illustrate the steps of your child’s morning, after-school, and evening routines on fun visuals to help with information processing. Have your child check off each step as they complete it.
  • Offer advanced warnings. Because all good things must come to an end, let kids know when transitions are on the horizon. Give 3- and 1-minute alerts when playtime is about to end, for example. When time’s up, say, “Three, two, one, this is all done. Let me help you clean it up and move on to the next thing.” Visual timers are immensely helpful here, as they help your child know how much time is left, allowing them to better regulate their expectations and behavior.

Give Clear, Specific Instructions

  • Clearly explain rules, expectations, and consequences. Your child must understand, in no uncertain terms, what is required of them and the consequences of not following the rules. You don’t want to surprise your child with an unexpected consequence for an expectation they didn’t fully understand.
    • Instead of: “Be a good boy!”
    • Try: “Please listen to your babysitter on your way home from school today.”
    • Instead of: “Play nicely with your toys!”
    • Try: “Toys are to play with. They’re not to throw. If you throw the toy, I will take it.”
    • Instead of: “Behave when you play with your brother!”
    • Try: “You cannot hit your brother. If you hit your brother, I will remove you.”
  • Chunk it up — one step at a time. Directions like “get ready to go to school” or “get ready for bed” are complex and often difficult to process. Spell out all the involved micro-tasks to help your child follow through.
    • Instead of: “It’s time to go. Finish your breakfast, put your shoes on, and grab your backpack.”
    • Try: “Please finish your breakfast.” (Pause and wait to give the next step once this step is completed.)
  • Avoid framing directions as questions or options that your child can say “no” to.
    • Instead of: “Can you put on your shoes?”
    • Try: “Please put on your shoes.”
    • Instead of: “Can you get ready for dinner?”
    • Try: “Please wash your hands for dinner.”

Never Penalize Your Child for Their Feelings

  • Empathize but maintain expectations. Your child is allowed to feel sad or upset when, say, playtime is up. Show that you understand how they feel as you guide them to the next activity. Say:
    • “I know this is hard for you.”
    • “I hear you.”
    • “It’s OK to have big feelings.”
  • Bond without correction. For 5 to 15 minutes a day, give your child your undivided attention as you engage in an activity together. Do not correct or discipline your child’s behavior during this special, positive time. If 15 minutes is too long to go without a correction, start with a shorter period of time. No matter the length, never make this bonding period with your child contingent on their behavior.

Involve the School

  • Loop in your child’s school or nursery to their diagnosis and treatment program. Children with attention and regulation difficulties do better when they’re supported across environments. Without school-wide awareness, your child’s behaviors may be misunderstood and/or misattributed. Helpful school interventions include the following:
    • daily behavior report cards
    • visual schedules
    • movement breaks
    • clear directions
    • preferential seating
    • peer modeling

The Question of ADHD Medication

While the American Academy of Pediatrics (AAP) recommends behavioral interventions as the frontline treatment for ADHD in children ages 4 to 6, ADHD medication may be indicated for preschool-age children if behavioral interventions do not provide significant improvement and if moderate to severe disturbance in a child’s functioning persist. Talk to your pediatrician about whether medication may be an appropriate part of your preschooler’s treatment plan.

Signs of ADHD in Preschoolers: Next Steps

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “ADHD in Preschool: Early Diagnosis & Intervention for Young Children” [Video Replay & Podcast #516] with Alexis Bancroft, Ph.D., and Cynthia Martin, Psy.D., which was broadcast on August 8, 2024.

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