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Adhd young children


Preschoolers and ADHD - CHADD

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At times preschoolers may have difficulty paying attention, following directions, and waiting or taking their turn. These behaviors can be common and age appropriate or they may indicate the need for an Attention-Deficit/Hyperactivity Disorder (ADHD) evaluation. As a parent, you might wonder whether your preschooler has ADHD or is just being rambunctious and acting typical for his or her age. This fact sheet will tell you more about ADHD in preschoolers and what to do if you are concerned about your child.

Can preschoolers have or be diagnosed with ADHD

Yes. Children as young as age 4 can be diagnosed with ADHD. According to the 2010-2011 National Survey of Children’s Health, approximately 194,000 preschoolers (2-5 years of age) had a current ADHD diagnosis. Some children outgrow the symptoms, but others may not. Research shows that 3-year-olds who show symptoms of ADHD are much more likely to meet the diagnostic criteria for ADHD by age 13.

How can I tell if my preschooler has ADHD

Preschoolers with ADHD are more likely to be suspended from school or daycare because of their disruptive behavior. These kids have more trouble learning concepts at school, and many get special education placements at a very young age when compared to children without ADHD.

As a parent, you will want to know where your child’s behaviors fit along a range of behaviors that are typical of kids the same age. Ask yourself, “When compared with other preschoolers of the same age, where does my child’s behavior fall” Talking with your preschooler’s teachers and/or childcare providers can let you know what are common behaviors in young children and not related to a disorder and what is of more serious concern.

What is involved in having my preschooler evaluated for ADHD

To be diagnosed with ADHD, a child must have a specified number of symptoms for at least 6 months that show up in more than one area of life. For example, if your child has behaviors at home that may look like ADHD but does not have these behaviors in situations outside the home, there may be another explanation. If you suspect that your preschooler has ADHD, you will want to talk to a professional who is trained to diagnose and treat ADHD such as your child’s pediatrician, a child psychiatrist, psychologist, clinical social worker or other qualified mental health clinician. It is also important to have your child checked for other conditions such as vision, hearing, or sleep problems because sometimes the symptoms look like ADHD.

Evaluations for preschoolers should be thorough and follow the guidelines outlined by the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP). These guidelines recommend a detailed interview with you to determine how long the symptoms have been going on, how severe they are, how often they occur and in what settings. You and your child’s teachers or child care providers will be asked to complete questionnaires with rating scales to evaluate your child’s behavior. The ADHD professional will conduct a detailed review of your preschooler’s school and medical records, talk with and observe your child directly, and check for other conditions your child may have along with ADHD. The professional may also suggest other psychological tests to help understand your preschooler’s strengths and weaknesses in learning and thinking skills and screen for learning disabilities.

What are the symptoms of ADHD in children

A diagnosis of ADHD is based on The Diagnostic and Statistical Manual of Mental Disorders (DSM 5). The manual lists three presentations of ADHD–Inattentive, Hyperactive-Impulsive and Combined and the symptoms for each.

Inattentive

  • Fails to give close attention to details or makes careless mistakes
  • Has difficulty sustaining attention
  • Does not appear to listen
  • Struggles to follow through on instructions
  • Has difficulty with organization
  • Avoids or dislikes tasks requiring a lot of thinking
  • Loses things
  • Is easily distracted
  • Is forgetful in daily activities

Hyperactive Impulsive

  • Fidgets with hands or feet or squirms in chair
  • Has difficulty remaining seated
  • Runs about or climbs excessively in children; extreme restlessness in adults
  • Difficulty engaging in activities quietly
  • Acts as if driven by a motor; adults will often feel inside like they were driven by a motor
  • Talks excessively
  • Blurts out answers before questions have been completed
  • Difficulty waiting or taking turns
  • Interrupts or intrudes upon others

Combined, Inattentive & Hyperactive-impulsive

  • Has symptoms from both of the above lists

These symptoms can change over time, so children may fit different presentations as they age.

What are the causes of ADHD

Research has yet to determine the exact causes of ADHD. However, scientists have discovered a strong genetic link since ADHD can run in families. Other factors in the environment may increase the likelihood of having ADHD:

  • mother smoking cigarettes or drinking alcohol while pregnant
  • exposure to lead or pesticides in early childhood
  • premature birth or low birth weight
  • brain injury

Scientists continue to study the exact relationship of ADHD to environmental factors, but point out that there is no single cause that explains all cases of ADHD and that many factors may play a part.

The following factors are NOT known causes, but can make ADHD symptoms worse for some children:

  • watching too much television
  • eating sugar
  • family stress (poverty, family trauma)

Why is it important to address ADHD in my preschooler at an early age

Preschoolers with ADHD are more likely to have difficulties in daycare or school, including problems with peer relationships, learning, and a higher risk of injuries. An early diagnosis is important so that your child can get the needed help to minimize these problems.

Even for the preschooler who might have some symptoms but does not have ADHD, these early years are the time when significant brain development occurs. This is an optimal time for children to learn positive behaviors, and for you to know how to effectively help your child learn. It’s best to address problematic behaviors sooner rather than later.

How should ADHD be treated in preschoolers

When it comes to treatment for preschool and kindergarten-aged children, the AAP calls for behavioral treatments first and medication only when needed. Behavioral therapy from child and adolescent therapists who specialize in ADHD will provide both the parents and the children techniques to teach and reinforce positive behaviors and skills. This will help a preschooler with ADHD to successfully function at home and school.

When medication is prescribed, the AAP recommends starting children ages 4-5 on a methylphenidate medication trial beginning with a low dose. Because children respond differently to medication, what may work for one child may not work for another. The health care professional can adjust the dose to determine if it is helping, if a different medication is needed or if any side effects are present. Treating ADHD is complex, and it is important to continually monitor children to see if the treatment is working. This includes periodically repeating the rating scale assessments to make sure the medication and behavioral therapy are having the desired effect. Additionally, the AACAP Preschool Pharmacology Working Group recommends that preschoolers who are taking ADHD medication have their medication stopped (under the prescribing doctor’s direction) after 6 months to reassess the symptoms and to consider whether the medication should be continued.

What is parent behavioral training and how can it benefit me and my child

Children who have ADHD may not have the skills and behaviors that result in their receiving positive attention. Often they tend to misbehave and are in situations where they are punished more frequently than other children. This can have a negative effect on their self-image and cause them to increase their problem behaviors. Parents and caregivers (daycare providers, preschool teachers, and other caretakers) can learn to manage the behavior of preschoolers who have ADHD by becoming educated about the disorder and by receiving parent training in how to use behavioral techniques.

Parent training programs taught by trained therapists can give caretakers the tools and strategies to help children who have ADHD. A 2010 review by the Agency for Healthcare Research and Quality (AHRQ) found that effective programs:

  • help parents develop a positive relationship with their child
  • teach them about how children develop
  • help them manage negative behavior and increase positive behavior with positive discipline

Parent behavioral training programs for parents of preschool-aged children that currently have enough research evidence to be described as effective:

  • Triple P (Positive Parenting Program)
  • Incredible Years Parenting Program
  • Parent-Child Interaction Therapy

Other programs that focus on the same elements may also be helpful.

Parents and caregivers who wish to learn more about ADHD and ways to help their child may wish to enroll in Parent to Parent: Family Training on ADHD offered through CHADD.

Are preschoolers receiving the recommended treatments

The Centers for Disease Control and Prevention (CDC) reports that 1 in 2 preschoolers do not receive recommended behavioral treatment. The rates of preschool-aged children taking medication for ADHD has doubled in the last four years, and 1 in 4 receive only medication treatment, which should be the last resort.

There is a movement within the field of ADHD to increase access to behavior therapy for young children, particularly to behavioral parenting therapy that is considered evidence-based and effective. The hope is to decrease the rates of preschool and kindergarten-aged children taking medication for ADHD as a first line of treatment.

For More Information

http://www.cdc.gov/ncbddd/adhd/treatment. html

http://pediatrics.aappublications.org/content/128/5/1007.full

ADHD in Children - HelpGuide.org

adhd

Do you think your child might have ADHD? Here’s how to recognize the signs and symptoms of attention deficit hyperactivity disorder—and get the help you need.

What is ADHD or ADD?

It’s normal for children to occasionally forget their homework, daydream during class, act without thinking, or get fidgety at the dinner table. But inattention, impulsivity, and hyperactivity are also signs of attention deficit hyperactivity disorder (ADHD), sometimes known as attention deficit disorder or ADD.

ADHD is a common neurodevelopmental disorder that typically appears in early childhood, usually before the age of seven. ADHD makes it difficult for children to inhibit their spontaneous responses—responses that can involve everything from movement to speech to attentiveness. We all know kids who can’t sit still, who never seem to listen, who don’t follow instructions no matter how clearly you present them, or who blurt out inappropriate comments at inappropriate times. Sometimes these children are labeled as troublemakers, or criticized for being lazy and undisciplined. However, they may have ADHD.

Is it normal kid behavior or is it ADHD?

It can be difficult to distinguish between ADHD and normal “kid behavior.” If you spot just a few signs, or the symptoms appear only in some situations, it’s probably not ADHD. On the other hand, if your child shows a number of ADHD signs and symptoms that are present across all situations—at home, at school, and at play—it’s time to take a closer look.

Life with a child with ADHD can be frustrating and overwhelming, but as a parent there is a lot you can do to help control symptoms, overcome daily challenges, and bring greater calm to your family.

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Myths and Facts about ADHD
Myth: All kids with ADHD are hyperactive.

Fact: Some children with ADHD are hyperactive, but many others with attention problems are not. Children with ADHD who are inattentive, but not overly active, may appear to be spacey and unmotivated.

Myth: Kids with ADHD can never pay attention.

Fact: Children with ADHD are often able to concentrate on activities they enjoy. But no matter how hard they try, they have trouble maintaining focus when the task at hand is boring or repetitive.

Myth: Kids with ADHD could behave better if they wanted to.

Fact: Children with ADHD may do their best to be good, but still be unable to sit still, stay quiet, or pay attention. They may appear disobedient, but that doesn't mean they're acting out on purpose.

Myth: Kids will eventually grow out of ADHD.

Fact: ADHD often continues into adulthood, so don't wait for your child to outgrow the problem. Treatment can help your child learn to manage and minimize the symptoms.

Myth: Medication is the best treatment option for ADHD.

Fact: Medication is often prescribed for attention deficit disorder, but it might not be the best option for your child. Effective treatment for ADHD also includes education, behavior therapy, support at home and school, exercise, and proper nutrition.

ADHD symptoms

When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But the reality is much more complex. Some children with ADHD are hyperactive, while others sit quietly—with their attention miles away. Some put too much focus on a task and have trouble shifting it to something else. Others are only mildly inattentive, but overly impulsive.

The signs and symptoms a child with attention deficit disorder has depend on which characteristics predominate.

Children with ADHD may be:

  • Inattentive, but not hyperactive or impulsive.
  • Hyperactive and impulsive, but able to pay attention.
  • Inattentive, hyperactive, and impulsive (the most common form of ADHD).

Children who only have inattentive symptoms of ADHD are often overlooked, since they're not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.

ADHD symptoms at different ages

Because we expect very young children to be easily distractible and hyperactive, it's the impulsive behaviors—the dangerous climb, the blurted insult—that often stand out in preschoolers with ADHD. By age four or five, though, most children have learned how to pay attention to others, to sit quietly when instructed to, and not to say everything that pops into their heads. So by the time children reach school age, those with ADHD stand out in all three behaviors: inattentiveness, hyperactivity, and impulsivity.

Inattentiveness signs and symptoms of ADHD

It isn't that children with ADHD can't pay attention: when they're doing things they enjoy or hearing about topics in which they're interested, they have no trouble focusing and staying on task. But when the task is repetitive or boring, they quickly tune out.

Staying on track is another common problem. Children with ADHD often bounce from task to task without completing any of them, or skip necessary steps in procedures. Organizing their schoolwork and their time is harder for them than it is for most children. Kids with ADHD also have trouble concentrating if there are things going on around them; they usually need a calm, quiet environment in order to stay focused.

Symptoms of inattention in children

Your child may:

  • Have trouble staying focused; be easily distracted or get bored with a task before it's completed.
  • Appear not to listen when spoken to.
  • Have difficulty remembering things and following instructions; not pay attention to details or makes careless mistakes.
  • Have trouble staying organized, planning ahead, and finishing projects.
  • Frequently lose or misplace homework, books, toys, or other items.

Hyperactivity signs and symptoms of ADHD

The most obvious sign of ADHD is hyperactivity. While many children are naturally quite active, kids with hyperactive symptoms of attention deficit disorder are always moving. They may try to do several things at once, bouncing around from one activity to the next. Even when forced to sit still, which can be very difficult for them, their foot is tapping, their leg is shaking, or their fingers are drumming.

Symptoms of hyperactivity in children

Your child may:

  • Constantly fidget and squirm.
  • Have difficulty sitting still, playing quietly, or relaxing.
  • Move around constantly, often running or climbing inappropriately.
  • Talk excessively.
  • Have a quick temper or “short fuse.”

Impulsive signs and symptoms of ADHD

The impulsivity of children with ADHD can cause problems with self-control. Because they censor themselves less than other kids do, they'll interrupt conversations, invade other people's space, ask irrelevant questions in class, make tactless observations, and ask overly personal questions. Instructions like, “Be patient” and “Just wait a little while” are twice as hard for children with ADHD to follow as they are for other youngsters.

Children with impulsive signs and symptoms of ADHD also tend to be moody and to overreact emotionally. As a result, others may start to view the child as disrespectful, weird, or needy.

Symptoms of impulsivity in children

Your child may:

  • Act without thinking.
  • Guess, rather than taking time to solve a problem; blurt out answers in class without waiting to be called on or hear the whole question.
  • Intrude on other people's conversations or games.
  • Often interrupt others; say the wrong thing at the wrong time.
  • Be unable to keep powerful emotions in check, resulting in angry outbursts or temper tantrums.

Positive effects of ADHD in children

ADHD has nothing to do with intelligence or talent. What's more, kids with attention deficit disorder often demonstrate the following positive traits:

Creativity. Children who have ADHD can be marvelously creative and imaginative. The child who daydreams and has ten different thoughts at once can become a master problem-solver, a fountain of ideas, or an inventive artist. Children with ADHD may be easily distracted, but sometimes they notice what others don't see.

Flexibility. Because children with ADHD consider a lot of options at once, they don't become set on one alternative early on and are more open to different ideas.

Enthusiasm and spontaneity. Children with ADHD are rarely boring! They're interested in a lot of different things and have lively personalities. In short, if they're not exasperating you (and sometimes even when they are), they're a lot of fun to be with.

Energy and drive. When kids with ADHD are motivated, they work or play hard and strive to succeed. It actually may be difficult to distract them from a task that interests them, especially if the activity is interactive or hands-on.

Is it really ADHD?

Just because a child has symptoms of inattention, impulsivity, or hyperactivity does not mean that they have ADHD. Certain medical conditions, psychological disorders, and stressful life events can cause symptoms that look like ADHD.

Before an accurate diagnosis of ADHD can be made, it is important that you see a mental health professional to explore and rule out the following possibilities:

Learning disabilities or problems with reading, writing, motor skills, or language.

Major life events or traumatic experiences, such as a recent move, death of a loved one, bullying, or divorce.

Psychological disorders including anxiety, depression, or bipolar disorder.

Behavioral disorders such as conduct disorder, reactive attachment disorder, and oppositional defiant disorder.

Medical conditions, including thyroid problems, neurological conditions, epilepsy, and sleep disorders.

Helping a child with ADHD

Whether or not your child's symptoms of inattention, hyperactivity, and impulsivity are due to ADHD, they can cause many problems if left untreated. Children who can't focus and control themselves may struggle in school, get into frequent trouble, and find it hard to get along with others or make friends. These frustrations and difficulties can lead to low self-esteem as well as friction and stress for the whole family.

But treatment can make a dramatic difference in your child's symptoms. With the right support, your child can get on track for success in all areas of life.

If your child struggles with symptoms that look like ADHD, don't wait to seek professional help. You can treat your child's symptoms of hyperactivity, inattention, and impulsivity without having a diagnosis of attention deficit disorder.  Options to start with include getting your child into therapy, implementing a better diet and exercise plan, and modifying the home environment to minimize distractions.

If you do receive a diagnosis of ADHD, you can then work with your child's doctor, therapist, and school to make a personalized treatment plan that meets their specific needs. Effective treatment for childhood ADHD involves behavioral therapy, parent education and training, social support, and assistance at school. Medication may also be used; however, it should never be the sole attention deficit disorder treatment.

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Parenting tips for children with ADHD

If your child is hyperactive, inattentive, or impulsive, it may take a lot of energy to get them to listen, finish a task, or sit still. The constant monitoring can be frustrating and exhausting. Sometimes you may feel like your child is running the show. But there are steps you can take to regain control of the situation, while simultaneously helping your child make the most of their abilities.

While attention deficit disorder is not caused by bad parenting, there are effective parenting strategies that can go a long way to correct problem behaviors. Children with ADHD need structure, consistency, clear communication, and rewards and consequences for their behavior. They also need lots of love, support, and encouragement.

There are many things parents can do to reduce the signs and symptoms of ADHD without sacrificing the natural energy, playfulness, and sense of wonder unique in every child.

Take care of yourself so you're better able to care for your child. Eat right, exercise, get enough sleep, find ways to reduce stress, and seek face-to-face support from family and friends as well as your child's doctor and teachers.

Establish structure and stick to it. Help your child stay focused and organized by following daily routines, simplifying your child's schedule, and keeping your child busy with healthy activities.

Set clear expectations. Make the rules of behavior simple and explain what will happen when they are obeyed or broken—and follow through each time with a reward or a consequence.

Encourage exercise and sleep. Physical activity improves concentration and promotes brain growth. Importantly for children with ADHD, it also leads to better sleep, which in turn can reduce the symptoms of ADHD.

Help your child eat right. To manage symptoms of ADHD, schedule regular healthy meals or snacks every three hours and cut back on junk and sugary food.

Teach your child how to make friends. Help them become a better listener, learn to read people's faces and body language, and interact more smoothly with others.

School tips for children with ADHD

ADHD, obviously, gets in the way of learning. You can't absorb information or get your work done if you're running around the classroom or zoning out on what you're supposed to be reading or listening to. Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with ADHD have a hard time doing—not because they aren't willing, but because their brains won't let them.

But that doesn't mean kids with ADHD can't succeed at school. There are many things both parents and teachers can do to help children with ADHD thrive in the classroom. It starts with evaluating each child's individual weaknesses and strengths, then coming up with creative strategies for helping them focus, stay on task, and learn to their full capability.

Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D.

  • References

    Neurodevelopmental Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787.x01_Neurodevelopmental_Disorders

    Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860

    Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., Zurhellen, W., & Disorder, S. on C. and A. with A.-D. (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4). https://doi.org/10.1542/peds.2019-2528

    Felt, B. T., Biermann, B., Christner, J. G., Kochhar, P., & Harrison, R. V. (2014). Diagnosis and Management of ADHD in Children. American Family Physician, 90(7), 456–464. https://www.aafp.org/afp/2014/1001/p456.html

    Rytter, M. J. H., Andersen, L. B. B., Houmann, T., Bilenberg, N., Hvolby, A., Mølgaard, C., Michaelsen, K. F., & Lauritzen, L. (2015). Diet in the treatment of ADHD in children—A systematic review of the literature. Nordic Journal of Psychiatry, 69(1), 1–18. https://doi.org/10.3109/08039488.2014.921933

For kids: ADHD – Diagnosing and treating ADHD in children. (KidsHealth)

For teens: ADHD – Diagnosing and treating ADHD in teenagers. (TeensHealth)

Attention-Deficit/Hyperactivity Disorder (AD/HD) – Guide to ADHD for parents. (Center for Parent Information & Resources)

Attention-Deficit/Hyperactivity Disorder in Children and Teens: What You Need to Know – Signs, symptoms, causes, and treatment. (National Institute of Mental Health)

Symptoms and Diagnosis of ADHD – Including the signs of hyperactivity, impulsivity, and inattention. (Centers for Disease Control and Prevention)

Around the web

Last updated: October 21, 2022

Children with attention deficit hyperactivity disorder: epidemiology, comorbidity and diagnosis

Elis Charach, MSc, MD
Hospital for Sick Children, Canada
(English). Translation: November 2015

PDF document

Epidemiology of ADHD

Children with Attention Deficit Hyperactivity Disorder (ADHD), which is characterized by levels of inattention, hyperactivity and impulsivity beyond the normal age range, are most often identified and treated in primary school. Studies around the world have identified an ADHD prevalence rate equivalent to 5.29% (95% CI: 5.01-5.56) among children and adolescents. 1 Rates are higher for boys than for girls and for children under 12 years of age compared to adolescents. 1.2 Estimates of prevalence depend on the method of determination, the diagnostic criteria used, and whether criteria for assessing functional disorders are included. 1 Overall, country rates are almost the same, except in Africa and the Middle East, where prevalence rates are lower than in North America and Europe. 1

Symptoms typically cause functional difficulties with behavior and schoolwork, and often disrupt family and peer relationships. 3.4 Children with ADHD are more likely to seek health care services and have an increased percentage of injuries compared to children without the condition. 5.6 While symptoms of hyperactivity decrease during adolescence, most children with ADHD continue to show some cognitive impairment (eg, executive function deficits, working memory impairment) compared to their peers in adolescence and adulthood. 7.8 Research has found lower high school completion rates, earlier initiation of alcohol and illegal substance use, higher rates of cigarette smoking and car accidents among adolescents with ADHD. 9-14 Hyperactivity in childhood is also associated with the subsequent onset of other psychiatric disorders, including anxiety, behavioral disorders, affective disorders, suicidal behavior, and antisocial personality disorder. 13.15-18 Adults with a childhood history of ADHD have higher than expected rates of injuries and accidents, marital and work difficulties, teenage pregnancies, and children born out of wedlock. 15,17,19-21 ADHD is an important public health issue, not only because of the long-term hardship experienced by individuals and families, but also because of the heavy burden placed on the educational, health care, and criminal justice systems. 22-24

Population studies have found that child inattention and hyperactivity are more common in single-parent families, as well as in families with low parental education, parental unemployment and low income. 17,25,26 Data from family studies suggest that ADHD symptoms are highly heritable, 27 however, early environmental factors also play a role. Smoking and maternal alcohol consumption in the prenatal (antenatal) period, low birth weight, and developmental problems are associated with high levels of inattention and hyperactivity. 26.28 More recently, a review of longitudinal data from The Canadian National Longitudinal Survey of Children and Youth found that approximately 7% of children show persistently high levels of parental hyperactivity from two years of age to the first grades of primary schools. 29 Maternal smoking during the prenatal period, maternal depression, poor parenting practices, and living in a disadvantaged neighborhood in the early years of life are all associated with later childhood behavior problems, including inattention and hyperactivity 4 years later. 29-31

Clinical detection and treatment of ADHD in North America may vary geographically, presumably reflecting differences in community practices or access to services. 32-34 Treatment of symptoms of inattention and hyperactivity with stimulant drugs has increased in frequency since the early to mid-1990s and likely reflects longer periods of use with continued treatment into adolescence, as well as an increase in the number of girls diagnosed and treated disease. 35-38

Comorbid (or comorbid) disorders

Half to two-thirds of children diagnosed with ADHD also have comorbid psychiatric and developmental disorders, including rebelliousness and aggressive behavior, anxiety, low self-esteem, tic disorders, disorders motility, learning disabilities and speech disorders. 39-46 Sleep problems, including enuresis (bedwetting), are common, along with disturbed sleep breathing, which is a potentially modifiable cause for increased inattention. 47.48 The global decline in well-being in children with ADHD increases with the number of comorbidities. 13.49 Concomitant diagnoses also increase the likelihood of additional difficulties for children as they progress into adolescence and adulthood. 10,15,16,50-55

Neurocognitive difficulties are an important source of deterioration in well-being in children with ADHD. Areas of executive functioning and working memory, as well as specific speech and learning disorders, are common in the clinical group. 56.57-64 Approximately one third of children referred for psychiatric, often behavioral, problems may have previously undiagnosed speech problems. 65 Potential cognitive problems should be diagnosed whenever possible to ensure appropriate correction in educational settings.

ADHD in preschool children

Attention deficit hyperactivity disorder (ADHD) usually begins before the child enters school. However, in preschool children, ADHD is characterized not only by attention deficits, excessive impulsivity, and hyperactivity, but is often accompanied by violent outbursts of anger, demanding, confrontational behavior, and aggressiveness, which can interfere with attendance at daycare centers or lead to avoidance of family gatherings, and also represent a heavy burden of care for the family and contribute to distress. 66,67,68 These disruptive behaviors are often a concern for parents, many of which are 66 diagnosed as oppositional defiant disorder. Early identification of the disorder can be helpful in addressing a number of developmental issues that children with ADHD may have.

Assessment of ADHD in school-age children

In elementary school, teachers often bring to the attention of parents their concerns about the learning style and behavioral difficulties of their children. Educators generally expect kindergarten and first grade children to be able to follow classroom routines, follow simple directions, play cooperatively with peers, and stay focused for 15 to 20 minutes during classwork. The issues raised by educators, especially experienced educators, are a source of important information about the child's academic and social functioning.

The formal diagnosis of ADHD reflects pervasive and damaging levels of inattention, distractibility, hyperactivity, and impulsivity. The child's symptoms should be beyond the normal age range and cause impairment of functioning, most commonly in academic or social skills, relationships with peers, and family. Difficulties are usually present in the preschool years, although they are not always diagnosed. The harassing behavior recurs in more than one context - in the family, at school, or in public places, such as on a trip to the park or at the grocery store.

There are two sets of formal diagnostic rules used in Canada, DSM IV TR (Diagnostic and Stratistical Manual, Fourth Edition, Text Revised; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised) and ICD-10 (International Classification of Disorders , Tenth Edition; International Classification of Diseases, Tenth Edition). The DSM IV diagnosis of attention deficit/hyperactivity disorder (ADHD) largely reflects the consensus understanding of the diagnosis in the United States. There are three types of ADHD (see Table 1 for diagnostic symptoms).

Type I - predominantly inattentive type, the child exhibits 6 of the 9 symptoms of inattention described;

Type II - predominantly hyperactive-impulsive type, the child has 6 out of 9 hyperactive-impulsive symptoms;

type III - combined type, where the child shows high levels of development of symptoms of both types (see diagnostic symptoms in Table 1).

The ICD-10 diagnosis of hyperkinetic disorder is most commonly used by physicians who practice outside of North America. The theoretical underpinnings of ADHD and hyperkinetic disorder overlap to a large extent: the MCD-10 diagnosis of hyperkinetic disorder covers a narrower group of children who must meet both criteria - both hyperactivity and inattention and distractibility. However, when considering aspects of the overall clinical picture, children with ADHD, especially of the combined type, show similar impairments in functioning and need intervention in the same way as children with hyperkinetic disorder. 69

Clinical diagnosis of a child with ADHD is best done by professionals trained in child mental health and psychosocial development tests. Because young children often respond to stressful situations with increased levels of activity and distractibility, and have learning and social difficulties, identification of alternative explanations for these complicating symptoms requires diagnostic evaluation of the child's age, family, and social contexts. Physical symptoms such as poor sleep or chronic illness should also be considered as potential causes or contributing factors to a child's difficulty. Ideally, the doctor should obtain information about the child's social and school life from more than one informant who has the opportunity to observe him in various situations, for example, this may be the child's parent and his teacher. Self-report surveys of parents and educators are widely used to obtain information about the behavior of a particular child at home or in the school environment, respectively. 4 In addition, it is essential to conduct detailed clinical interviews with parents of young children and, for older children, with the child or adolescent himself. Reviewing school records over several years is also useful for getting a longitudinal view of a child from multiple educators. The identification of comorbid disorders is one of the important aspects of the diagnostic evaluation, including the learning and speech disorders discussed in the last section. In addition, psychosocial problems and age-related difficulties should be identified, as they can complicate the treatment of ADHD and affect the long-term prognosis.

Table 1: DSM IV TR Criteria for Attention Deficit Hyperactivity Disorder

A. Choice of option (1) or (2):

(1) Six or more of the following symptoms persist during inattention6 months, are expressed to the degree of inadequacy and do not correspond to the age level:

Inattention

    1. often does not pay close attention to details or makes careless mistakes
    2. often has difficulty maintaining attention during tasks or play activities
    3. often the child does not seem to listen when spoken to directly
    4. often unable to follow directions and complete lessons, homework, or chores (not due to disobedience or failure to understand directions)
    5. often has difficulty organizing assignments and other activities
    6. often avoids, dislikes, or does not want to participate in tasks that require prolonged mental effort
    7. often loses things needed at school and at home (eg toys, school supplies, pencils, books, work tools)
    8. easily distracted by extraneous stimuli
    9. forgetful in everyday situations

(2) Six or more of the following symptoms of hyperactivity and impulsivity persist for 6 months, are expressed to the degree of inadequacy and do not correspond to the age norm:

Hyperactivity

    1. frequent restless movements in the hands and feet, fidgeting in a chair
    2. often gets up from his seat in the classroom during lessons or in other situations in which you need to stay in place.
    3. often runs or climbs things beyond measure in situations where this is unacceptable
    4. cannot play quietly and engage in leisure activities
    5. is often in constant motion or behaves as if "it has a motor attached to it"
    6. often talkative

Impulsivity

    1. often answers questions without thinking or listening to the end
    2. usually has difficulty waiting in line
    3. often interferes with or pesters others (for example, interferes in conversations or games)

B. Some symptoms of hyperactivity-impulsivity or inattention that worsen well-being were present in a child under 7 years of age.

C. Problems associated with these symptoms occur in two or more areas of life (e.g., school and home)

D. There must be clear evidence of clinically significant impairment in social life, academic activities, or studies associated with acquiring a profession.

E. Symptoms do not completely overlap with pervasive developmental disorder, schizophrenia, or other psychotic disorder, and cannot be explained by other mental disorders (eg, mood disorder, anxiety disorder, dissociative disorder, or personality disorder).

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For citation:

Charach E. Children with attention deficit hyperactivity disorder: epidemiology, comorbidity and diagnosis. In: Tremblay RE, Buavan M, Peters RDeV, eds. Shakhar R, eds. Topics. Encyclopedia of Early Childhood Development [online]. https://www.encyclopedia-deti.com/giperaktivnost-i-nevnimatelnost-sdvg/ot-ekspertov/deti-s-sindromom-deficita-vnimaniya-i. Published: March 2010 (English). Viewed on October 25, 2022

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90,000 ADHD in preschool children. Attention deficit hyperactivity disorder. ADHD in preschool children. Attention deficit hyperactivity disorder.

Gimranov Rinat Fazylzhanovich
Neurologist, neurophysiologist, experience - 33 years;
Professor of Neurology, MD;
Clinic for Rehabilitation Neurology. About the author

Publication date: October 6, 2019

Updated: March 25, 2021

Attention deficit hyperactivity disorder is a common behavioral disorder in children that interferes with their socialization and academic success.

Due to the peculiarities of psycho-emotional development, such children without the necessary complex therapy during adolescence are especially prone to behavioral problems.

Content of the article:

  • 1 Causes of
  • 2 Symptoms
    • 2. 1 in early childhood
    • 2.2 In preschool children and primary schoolchildren
  • 3 Types
  • 4 Diagnostics and treatment with CDs in children literature

Causes of occurrence

Attention deficit disorder can manifest itself in children at any age: at 3-4 years old, at 5-8 years old at the first encounter with systemic education, at 9on the threshold of puberty. It depends on the factors that contributed to the formation of a child's diagnosis of ADHD, the psychological characteristics of the child, and the identification of signs of the syndrome by doctors.

Causes of attention deficit in children are conditionally divided into several groups.

Factors affecting the formation of the fetus at the stage of gestation:

  • cord entanglement;
  • difficult, too long or rapid labor resulting in damage to the head or spine;
  • difficult environmental situation, high content of toxic substances in the air and water;
  • infectious diseases transmitted by the mother during pregnancy;
  • threatened miscarriage;
  • medication during pregnancy;
  • abuse of alcohol, cigarettes, drugs;
  • asphyxia.

Factors affecting the development of the child after birth:

  • heart disease;
  • bronchial asthma;
  • heart failure;
  • neurotoxic drugs;
  • diseases occurring with a temperature above 39 degrees.

Genetically determined cases occur due to a malfunction in the gene responsible for the production of dopamine, the function of dopamine receptors.

In this case, the syndrome develops in case of additional exposure to provoking factors. That is, only the predisposition to ADHD is inherited.

Symptoms

Symptoms and signs of ADHD (attention deficit disorder) in children aged 3-4 years, 6-7 years and 9 years old vary considerably. Due to differences in the characteristics of physiology, the predominance of types of activity and ways of knowing the world around. The sooner the deviation is detected, the faster it will be corrected, to help the child develop to the norm.

In early childhood

It is possible to determine the presence of abnormalities in the first years of life, since congenital ADHD will manifest itself from the first months.

Signs of attention deficit disorder in young children:

  • when overtired, instead of changing activities to calm or falling asleep, falls into hysterics;
  • high muscle tone - the baby is constantly trying to get rid of tight-fitting clothes, diapers;
  • too early development - a newborn earlier than peers begins to hold his head, crawl, walk;
  • sleep disorders - the child sleeps in fits and starts, wakes up often, screams, the total duration of sleep is below normal;
  • abrupt changes in the environment: bright lights, loud music, new people - cause hysteria;
  • attention does not linger on a new toy for long.

If suspicious behavioral patterns are detected in very young children, a full-fledged diagnosis is required, which allows to identify the initial cause, concomitant factors and start early corrective work, which already by the 1st grade of the school allows you to bring the behavior to normal.

Similar symptoms can be an indication of more serious developmental disorders, so they should not be ignored.

In preschoolers and primary school children

More obviously, specifically, ADHD begins to unfold after 3 years. During the period of systematic cognitive activity, for which it is necessary to constantly involve attention, memory, speech, most of the symptoms become aggravated:

  • loud, fast, confused speech, talkativeness;
  • frequent change of activity despite the fact that the work started is not brought to the end;
  • violent display of emotions;
  • avoidance of routine, monotonous affairs;
  • frequent mood swings;
  • impulsiveness;
  • poorly developed self-preservation instinct;
  • problems with concentration;
  • learning problems with high IQ;
  • difficulties in communicating with peers;
  • poorly developed coordination;
  • paucity of the emotional component.

Even mild manifestations of 2-3 points are a reason to visit a pediatric neurologist.

Types of ADHD

Depending on the causes that provoked the development of the syndrome, it manifests itself in different ways. In the process of diagnosis, the individual characteristics of the child are taken into account, allowing the treatment to be adjusted in an optimal way for him.

The following types of pathology are distinguished:

  • Attention deficit disorder without hyperactivity in children has its own distinctive features and requires treatment of a completely different type. As a rule, it manifests itself in girls of primary school age. They are easily distracted, "hovering in the clouds", but at the same time they are able to quickly assimilate information, they are prone to calm, quiet behavior. Intellectual abilities are preserved, but distracted attention leads to numerous "accidental" mistakes in the process of solving problems, writing.
  • Attention deficit hyperactivity disorder is less common than other forms, in preschool children for no apparent reason characteristic signs appear, without treatment by school age the danger of symptoms becomes more pronounced, interferes with intellectual development, the emergence of academic success.
  • Hyperactivity without attention deficit characterizes overly mobile children who are not able to maintain a calm position for a long time, obey strict rules. However, their attention is completely preserved, the development of intelligence is even faster than that of their peers.

Each of the types requires, at a minimum, behavioral correction, since minor deviations from the norm at an early age, by puberty, can develop into quite serious problems.

Statistics show that at least 50% of children diagnosed with ADHD during adolescence are seen in offenses of varying severity, drinking alcohol, smoking.

Diagnosis and treatment of ADHD in children

When a child simply has reduced attention, not a deficit, it is not at all necessary that he be diagnosed with ADHD in neurology, it depends on what result special studies and psychological testing show.

It is possible to determine how to treat attention deficit disorder in children, what forecasts for the future with manifested symptoms of ADHD can only be made after a complete examination.

If such a deviation is suspected, it is obligatory to carry out:

  • Collection of information. The pediatrician looks at the patient's card to establish all possible causes of behavior change, asks parents and relatives about the baby's features, the specifics of their manifestation. To clarify all the details, special questionnaires compiled by psychologists are used.
  • Neuropsychological testing. Electroencephalographic monitoring (EEG) will show the correspondence between the beta and theta rhythms generated by neurons. If it is found that the beta rhythm is below the expected norm, then the bioelectrical activity of the brain is weakened, which is the cause of changes in behavior.
  • Consultation with a pediatrician will reveal health factors that influence the diagnosis. A mandatory clinical and detailed blood test is carried out, the level of hormones is established in order to identify and eliminate other diseases that provoke neurological disorders.

After establishing the aspects of the patient's condition, the attending physician prescribes a complex treatment:

  • BFB (biofeedback method) - a physiotherapy technique that stabilizes the bioelectrical activity of the brain, the method has been successfully practiced for almost half a century;
  • exercise therapy (physiotherapy exercises), a set of exercises is developed by the attending physician, and the classes are conducted by the trainer;
  • reflexology;
  • laser therapy;
  • massage of the collar zone in courses several times a year simultaneously with other physiotherapy;