May I Ask: ADHD hard to diagnose in very young children

Q: My three-year-old can’t sit still or wait for his turn in his preschool class. One of the other parents has suggested he may have ADHD. Isn’t it a little early to tell?

A: “ADHD (Attention-Deficit/Hyperactivity Disorder) is usually diagnosed when a child is between six and 12 years old,” said Marcie Handler, Ph.D., a May Institute psychologist who specializes in child behavior disorders. “It is more difficult to diagnose in children younger than six because the symptoms exhibited may be part of normal development or reflect lack of exposure to highly structured situations such as those in classroom environments.”

ADHD is the most common behavior disorder diagnosed in children and teens. It can begin very early in childhood and continue throughout adulthood. If it is not diagnosed and treated, ADHD can cause problems at home, school, and work.

The primary symptoms of ADHD are inattention, impulsiveness, and hyperactivity. “Inattention is the most common symptom,” Handler said. “Children with ADHD not only have difficulty paying attention in school, they are often unable to stay focused on the task at hand. They also have difficulty remembering, organizing materials, and following through with directions.

 “Impulsiveness and hyperactivity can cause problems too,” Handler continued. “Children with impulsive behaviors act before thinking and may have trouble making and keeping friends. Children demonstrating hyperactive behaviors may exhibit inappropriate behaviors such as fidgeting, squirming, climbing, or running at inappropriate times. Although older children may not be quite so active, they may be unable to sit quietly while reading or talking to others.”

Symptoms of ADHD can be similar to those of other conditions such as learning disabilities, oppositional defiant disorder (ODD), depression, or anxiety. These conditions are sometimes mistaken for ADHD, or they may be present in addition to the ADHD. For example, nearly 50 percent of children and teens with ADHD also have ODD. According to the National Center for Learning Disabilities, ADHD may co-occur with learning disabilities such as dyslexia or auditory and visual problems. Many children with ADHD experience academic and social problems.

The causes of ADHD are unknown, but experts believe a chemical imbalance in the brain may play a role. It is also possible that a genetic factor may be involved, as children with ADHD tend to have family members with ADHD or other diagnoses. In fact, many undiagnosed adults discover they have ADHD when their child is diagnosed.

Before a diagnosis of ADHD can be made, a child should have a medical examination to rule out medical conditions that may be affecting his or her behavior (e.g. thyroid conditions, diabetes, or seizure disorders). Then, the child should be referred to a psychologist, child psychiatrist, or developmental pediatrician for a comprehensive evaluation that will be based on specific criteria established by the American Psychiatric Association. Teachers’ observations and rating scales completed by parents and teachers should also be included in this process. “The use of multiple evaluation tools helps ensure an accurate diagnosis,” Handler said.

There are several treatments that can help control symptoms. Stimulant medications such as methylphenidate (Ritalin) are the most effective treatment for controlling symptoms in children. Antidepressant medications may also help children who do not respond to stimulant medications.

 “In addition to medication, behavior management strategies and social skills training teach children how to change their behaviors,” Handler said. “Schools can work with parents to develop educational or behavioral support plans to address school-related problems. In all cases, parents who receive education and training about how to support their children will be able to help those with ADHD learn how to behave appropriately inside and outside the home.”

May Institute is a national nonprofit organization that provides educational, rehabilitative, and behavioral healthcare services to individuals with special needs. The Institute provides consultation to schools and families, and emotional and psychological services to individuals at counseling centers in Walpole and West Roxbury. For more information, contact May Institute at 800-778-7601, or www.mayinstitute.org.