ADHD in Preschool Kids

How early is too early to tell if your toddler or preschooler might have ADHD?

Most children aren’t checked for ADHD until they’re school age, but kids as young as 4 can be diagnosed, according to guidelines set by the American Academy of Pediatrics (AAP).

At that age, many kids are active and impulsive. So what’s different about kids with ADHD? And if your young child has ADHD, how is it treated?

Stand Out From Other Tots

Compared to other kids their age, children with ADHD often have a harder time sitting still, even for a few minutes. They are unable to wait their turn -- blurting out answers or cutting to the front of the line, for example -- and they may talk excessively.

"Young kids with ADHD are incredibly active all the time," says James Perrin, MD, a pediatrics professor at Harvard Medical School. "Most 4-year-olds are very active in general, but they settle down -- take naps, sit for meals. A child with ADHD is on the go all the time."

"What sets these kids apart is the degree and frequency with which they are hyper and impulsive," says George DuPaul, PhD, professor of school psychology at Lehigh University. "These kids are literally plowing through activities and people at a high pace."

The Diagnosis

ADHD is diagnosed based on symptoms of inattention, hyperactivity, and impulsivity. But inattention often isn’t as apparent in preschoolers.

Sometimes, well-meaning parents, caregivers, or teachers may suspect ADHD. That's not enough. A doctor's full evaluation is needed for diagnosis.

To diagnose a preschooler, a doctor will rely on a detailed descriptions of your child's behavior from parents, day care providers, preschool teachers, and other adults who regularly see your child, along with their own observation. It’s important to talk about all symptoms with your doctor.

Just because your child has some hyperactivity and impulsivity doesn't mean they have ADHD. For example, children who are frustrated because they have a problem with seeing, hearing, or talking may act out in the same way as children with ADHD. Your child may need testing to rule out other possibilities.

Behavioral Therapy Comes First

For preschoolers diagnosed with ADHD, behavioral therapy is the first treatment.

This type of treatment involves changes in behavior by parents and teachers. Techniques include praising and rewarding good behavior, ignoring bad behavior, and using time-outs. Structure and routine are important for young kids with ADHD.

The Medication Question

If your child is 4 or older and you’ve tried behavioral therapy for at least 6 months without much change, you can also try low-dose ADHD medication.

"But don't ever give up on behavioral therapy," Perrin says. "Behavioral therapy is important even when a child is on medication."

Not all ADHD medicines are FDA approved for children younger than 6. But many doctors prescribe these drugs for preschoolers with ADHD.

"ADHD medication doesn't work as well for this age group," Perrin says. "It definitely does work, but it works less powerfully and less predictably in younger children than in an older child."

Although there can be side effects, the AAP believes that the benefits outweigh the risks in young children who aren't getting better with behavioral therapy.

A study found that young children are more sensitive than older children to the side effects of methylphenidate, one of the more commonly used medications. Those side effects may include delayed growth, loss of appetite and weight loss, insomnia, and anxiety. The side effects, including delayed growth, reversed once the kids stopped taking the medication, DuPaul says.

There aren't any studies on the long-term effects in children who start ADHD drugs at such a young age. But studies of children in elementary school "have not indicated any long-term side effects of treatment," DuPaul says.

Deciding whether to make medication part of your child’s treatment isn’t easy. It's a decision that’s made after carefully weighing the pros and cons. What’s right for one child (and family) may not be right for yours. Talk to your child's doctor, and together you can decide what’s best for your child.

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