If you care for patients in the primary care setting, it has become common for parents of preschoolers to ask if their child might be hyperactive and ask about their need to start medication for attention-deficit hyperactivity disorder (ADHD). In fact during the last decade there has been an increasing trend of children age 4-5 years diagnosed and often treated with a stimulant medication for what was considered ADHD. For this reason the AAP in 2011 put out evidence-based guidelines to help all of us better decide whether a preschool child really meets diagnostic criteria for ADHD or not, and when pharmacologic treatment is warranted.