ADHD Weekly, January 12, 2023

Does your child struggle in preschool? When it’s time to sit at the rainbow rug for story time, are they the one wiggling around or popping back to their feet? Maybe they haven’t yet mastered the idea of personal space? Does your child seem more accident prone than peers or has their impulsivity resulted in injury?

A lot of these behaviors are common in preschool children. Parents can find it hard to recognize what behaviors may be outgrown and what behaviors may be signs of ADHD or another neurodevelopmental disorder.

On one popular social media website, some parents shared the symptoms that prompted them to seek a diagnosis for their child during preschool. Many described similar symptoms, including nonstop talking, constant motion, and impulsivity. Their children struggled to follow instructions even with repeated reminders. What stands out among these descriptions is that their preschoolers displayed these behaviors constantly, both at school and at home.

“The concerning point with regard to ADHD symptoms in young kids is that, similar to older children, the symptoms are associated with significant behavioral and academic impairment,” says George J. DuPaul, PhD. Dr. DuPaul is a professor and associate dean for research at Lehigh University. He says early intervention is important for preschool children when it comes to ADHD, but that a diagnosis in very young children must consider many factors, including age.

How young is too young for an evaluation?

The American Academy of Pediatrics lowered their recommendations for the treatment of ADHD in young children from age six to age four. For the youngest children, especially prior to their entering first grade, behavior management and parent training interventions are the preferred first-line treatments, with medication management held off until the child is older.

While the AAP guidelines cover children ages four and older, children younger than four have been diagnosed with ADHD. It is challenging to diagnose children from ages three to four, says Dr. DuPaul.

“I certainly am very hesitant to diagnose ADHD younger than age two,” he says. “In fact, I’ve never done that in my career.”

Many of the symptoms of ADHD can look like ordinary preschool age behavior, including restlessness, talking excessively, and not following directions. This could make ADHD symptoms and normal behavior at that age difficult to separate during an evaluation. Before you contact your child’s doctor, you should consider the severity of behaviors as well as the places behaviors occur. For instance, if your child exhibits nonstop movement only at school, there may be other factors to consider, such as the classroom environment. A good question to ask your child’s preschool teacher or caregiver is whether your child’s behaviors are out of the ordinary for their same-aged peers. Ask if your child’s behavior is persistent and whether they are the only child in the class exhibiting the behavior.

Also keep in mind how long your child’s behaviors have occurred. The diagnostic criteria for an ADHD diagnosis require that symptoms must be present for at least six months. If you are concerned about your preschooler’s behavior, it is important for your child’s doctor to rule out other developmental disorders, says Dr. DuPaul.

Recommended treatment for preschoolers

The recommended ADHD treatment for preschool children is behavioral parent training. This type of training focuses on teaching parents to approach changing behaviors by first identifying problem behaviors, and then determining why the behavior occurs. The process of behavioral parent training involves parents anticipating problem behaviors and helping their child develop new skills to replace the problem behaviors.

Medication for ADHD is not recommended for children younger than six years of age. There are exceptions based on risk factors, and each child’s condition must be carefully assessed. Your child’s doctor may recommend medication if there is no improvement after your family completes behavioral parent training or if your child’s behaviors become worse. In some cases, medication may be considered for a preschooler if the child has a co-occurring condition that requires medication for good management of the condition.

A diagnosis of ADHD in a young child must be carefully considered, so you’ll want to work closely with a provider who specializes in treating ADHD in preschoolers. Early intervention for ADHD is important to help your child get a good start, academically and socially.

“It is clear that the best way to prevent behavior problems, boost academic functioning during the early elementary grades—kindergarten and first grade—and reduce injuries, is to recognize symptoms early and provide intensive intervention,” says Dr. DuPaul.

Looking for more on ADHD in preschoolers?

• Preschoolers and ADHD
• ADHD in Preschool: What Parents Should Look For (infographic)
• A CDC Winnable Battle – ADHD in Young Children
• Webinar: When Preschoolers Have ADHD
• Early Intervention: Preventing Academic and Behavior Problems in Young Children with ADHD
• Behavioral Treatments First: Preschoolers and ADHD

Join the discussion: When did you first see signs of ADHD in your children?