Typically, ADHD is diagnosed during the school years, particularly around age 7. However, it is possible to diagnose it as early as four years old, but it is a difficult diagnosis to make at this young age.
That’s because all preschoolers, by nature, are active, impulsive, oppositional and defiant, which are also descriptors of kids with ADHD (attention-deficit/hyperactivity disorder). Kids around this age are impatient, learning how to handle themselves, forgetful, and what we adults would call “careless.”
So how can parents tell if their child’s behavior is “typical,” or if there is an underlying neurodevelopmental issue like ADHD?
The answer is not clear-cut. It’s much easier to identify hyperactivity in preschoolers than it is inattention, since it is not developmentally appropriate to expect children this age to perform effort-filled tasks for extended periods of time. Asking yourself the below nine questions may help to differentiate between “typical” preschool behavior, ADHD, and some other conditions which can masquerade as ADHD.
9 Questions to Ask When You Suspect Your Preschooler May Have ADHD
1. How often are you getting calls from preschool?
Are you getting calls about your child’s behavior a couple of times a month? Or is it multiple times a week? Typical preschoolers push boundaries and may get in trouble occasionally. However, preschoolers with ADHD are more disruptive and get into things they shouldn’t much more often than their peers. Preschool teachers are concerned because they frequently can’t sit in one place and have problems with impulse control.
2. How is your child doing with circle time?
Preschoolers with ADHD often have difficulty with circle time, because the teacher isn’t reading directly to your child. Rather, the teacher is interacting with the whole class. When they’re not being spoken to directly, kids with ADHD lose interest and their attention wanders. They do much better with one-on-one learning situations in which they get immediate feedback. Young children with ADHD also often find it very challenging to sit still during circle time.
3. Can your child follow one- or two-step directions without getting distracted?
Preschoolers should be able to follow one- and two-step directions, such as, “Hang up your coat and put your shoes away.” Sure, there are some “typical” preschoolers who won’t follow instructions because they’re feeling defiant. But kids with ADHD often have more problems with working memory than other children. They may want to follow your directions and begin to attempt it, but forget what they were asked to do and get distracted by something else.
4. Does your child “dart” at the store or at preschool?
Kids with ADHD will frequently “dart.” They’re flight risks. They’re supposed to be in line at school, moving from class to recess, but go in another direction. This could be an indicator of your child’s distractibility, impulsivity, and/or hyperactivity.
5. Do you avoid taking your child out in public, even to casual, family-friendly places?
Children with ADHD can’t sit still and will frequently run off and get into things. This can become so problematic that parents avoid taking them to family-friendly restaurants. Some refrain from short trips to the store because of the disastrous results.
6. Has your child had her hearing checked?
One ADHD symptom is “not seeming to listen when spoken to directly.” However, there can be many reasons why your child doesn’t seem to listen or has trouble following directions. One main reason may be that your child has a hearing problem. This is why the AAP recommends that kids have their hearing checked as a part of a diagnostic evaluation.
7. Do you think your child understands your words when you speak to him?
Sometimes parents chalk up their child’s inability to follow through on directions as inattention or impulsivity, and therefore assume that the cause is ADHD. However, children with language or learning issues can show the same behaviors. They don’t follow through on instructions because they have difficulty comprehending them. Along these lines, kids may not sit still to listen to a story because they can’t understand it. As part of an evaluation, your doctor should consider whether a language or learning issue might be mimicking ADHD, or co-existing with ADHD. Children with this condition have higher rates of language and learning difficulties compared to the general population.
8. Could your child have another health condition, like sleep apnea?
We also need to rule out other potential health conditions that can affect a child’s behavior before considering ADHD. For example, sleep problems can mimic the condition because children who are not well-rested will not behave well, and are often hyper or inattentive. Therefore, if your preschooler snores, which is not typical, it could be a sign of sleep apnea and you should report this to your doctor.
9. Has your child undergone an acute stressor?
If you’re seeing an acute behavioral problem on the heels of a big family stressor, I would wait it out – and get your child help for dealing with this stressor – before considering ADHD. For example, a recent death in the family, an illness, a parental separation, or a new baby can all impact a child’s behavior negatively. But this is still considered “normal.” Behavioral issues should be going on for six months or longer before we would consider ADHD as a possibility. Furthermore, if ADHD is the cause, the behavior problems will persist even after the child has recovered from the acute stressor.
Putting it all together
Adding to the complexity when trying to differentiate ADHD from typical preschool behavior is one hallmark of the condition: variability. The same child may behave well at certain times but not at others, so parents may wonder why the child can’t “get it together” more consistently. This likely has something to do with the fact that children with ADHD often are: 1) more sensitive to environmental factors than other children; 2) tend to do better in one-on-one situations; and 3) act differently in the presence of an authority figure and when rewards or high-interest motivators are present. Despite this day-to-day or moment-to-moment variability in performance, children with the condition show ADHD-related behaviors in more than one setting. Not just at home or just at school, but in both.
As you’re answering the above questions and considering whether your child’s behavior is consistent with ADHD or not, think about how often the behavior is happening and how intense it is. When a child has ADHD, there is a long-standing, high frequency, chronic nature to the concerning behaviors. If this is the case for your child, it may be time to contact your doctor. He or she can point you in the right direction from there, and may recommend a consultation with an ADHD Center or developmental-behavioral specialist.
For more information about our Center for ADHD, call 513-636-8107. Our division of Developmental and Behavioral Pediatrics can also be reached at 513-636-4611.
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