Preschool-Age Childhood ADHD

A preschool-age child with attention deficit hyperactivity disorder (ADHD) has a more difficult time acquiring social cues and exhibits more hyperactive behaviors than their peers. Thought processes in such cases are goal-directed, but they may reveal difficulties staying focused on a subject or task.

Important signs and symptoms of ADHD in a preschooler include:

• Disliking or avoiding tasks that require paying attention for more than one or two minutes
  • Being read to or eating while sitting at a table is difficult.
  • The child may have difficulty sitting still during story time or napping while the other children sleep.
• Difficulty concentrating on tasks that they do not enjoy
  • A child with ADHD may have no trouble focusing on activities they enjoy, but they struggle to stay focused when the task at hand is boring or repetitive.
• Excessive questioning and talking
  • In preschool, a child with ADHD cannot remain quiet while the teacher gives instructions. They may ask several questions in a sequence, but then leave before they are answered.
• Constantly on the move
  • Children with ADHD may run in circles until they are exhausted. They cannot sit motionless in one place and may kick or move their feet when seated.
• May have trouble getting along with other children
  • Children with ADHD may be violent toward other children, even punching, kicking, or biting them. 
  • They may butt into someone else's game without permission or take a toy from another child's hands.
• Getting into potentially bad situations because of fearlessness
  • Because of their risk-taking behavior, children with ADHD are more likely to be hurt than other children. 
  • They climb, run, and leap without thinking, even in risky situations such as being near traffic or having reached a great height.

Other warning signs and symptoms of ADHD in preschoolers

• Loses interest after only a few moments of participation in an activity and begins doing something else
• Can't hop on one foot by the age of four
• Easily distracted and forgetful
• Difficulty following instructions
• May daydream a lot more than others
• Frequently misplaces items such as toys, shoes, and clothing
• Squirms and fidgets a lot
• Talks almost nonstop and frequently interrupt others
• Urge to comment or touch everything they see or like
• Difficulty controlling their emotions and making inappropriate remarks

ADHD symptoms may have a considerable effect on a child's academic and learning development. Early-onset symptoms put children at risk of academic failure and grade repetition later in life. If you see indications of ADHD in your child, you should see a pediatrician. Early detection and treatment of ADHD in your child may assist in reducing learning difficulties that may emerge later as a result of the disorder.

A preschool-aged child must exhibit specific symptoms in more than one area of life for at least six months to be diagnosed with attention deficit hyperactivity disorder (ADHD). If you feel your preschooler has ADHD, you should consult a specialist qualified in diagnosing and treating ADHD, such as a pediatrician or child psychiatrist. 

Preschoolers should undergo comprehensive evaluations that adhere to the standards established by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.

• A thorough assessment of a child's medical and behavioral history at home and school
• Looking or hearing for concerning signs and symptoms
• Directly observing or conversing with a child
• Questionnaires to assess child's behavior
• Psychological tests to assess thinking and learning abilities
• Total health checkup to rule out any underlying health conditions (other than ADHD)

According to these guidelines, a full interview with parents is recommended to ascertain how long the symptoms have been present, how severe they are, how frequently they occur, and in what contexts. 

• To evaluate a child’s conduct, their parent and teachers or childcare providers will be required to complete questionnaires using rating scales. 
• The ADHD specialist will thoroughly evaluate your preschooler's school and medical records, speak with and watch your child firsthand, and look for other disorders the child may have in addition to ADHD. 
• The expert may suggest psychological tests to assist in understanding the preschoolers’ strengths and limitations in learning and thinking skills, as well as to screen for learning difficulties.

Additionally, it is critical to have your child evaluated for other disorders, such as vision, hearing, or sleep issues, as these symptoms can mimic ADHD.

The best way to treat attention deficit hyperactivity disorder (ADHD) is with a multimodal strategy. The American Academy of Pediatrics (AAP) recommends behavioral therapies first and medication only when necessary for preschool- and kindergarten-aged children.

Treatment and management options for ADHD at preschool age

• Psychoeducation
  • The first and most crucial component of an ADHD treatment strategy is to educate parents, teachers, caregivers, and other adults who regularly interact with the child about ADHD.
  • According to studies, offering ADHD education considerably enhances the likelihood that treatment will be continued in the long run. 
  • The more a family learns about ADHD and how it affects their kid, the more equipped they will be to make educated decisions and apply techniques and adjustments at home and in school.
• Request for classroom/school accommodations
  • Students with ADHD may find school challenging, so it's crucial to ask for classroom modifications for your child.
• Behavior therapy
  • The AAP guidelines on ADHD for preschoolers suggest that behavior therapy should be the foremost treatment option for children aged four and five years. 
  • Behavior treatment for children with ADHD comprises teaching specialized ADHD behavioral management skills to parents and other adults who interact with the kid.
• Exercise
  • According to research, regular exercise can enhance cognitive performance and may alleviate ADHD symptoms. Exercise releases many hormones that can boost brain function and attention.
• Mindfulness
  • Can help with better attention awareness, stress management, being less reactive to impulsive ideas, and being less judgmental of ADHD symptoms.
• Sleep
  • Crucial to a child’s health and growth and essential for learning, attention, and memory, as well as academic accomplishment and physical growth. As a result, children must get age-appropriate quality and amount of sleep. 
  • The National Sleep Foundation recommends that children get between 9 and 11 hours of sleep every night. 
  • Children who sleep less or get poor-quality sleep will struggle to function well during the day, particularly in school.
• Medication management (only if required)
  • It is not generally suggested that children younger than six years take ADHD medication, but in some cases, it may be necessary. According to the AAP guidelines, medication can and should be explored if behavioral treatment is unavailable and has not worked or if symptoms are severe enough that the child or family is at risk of harm.
  • When medication is provided, the AAP suggests starting with a low dose of methylphenidate. Because children react differently to drugs, what works for one may not work for others.
  • Physicians can change the dose to see whether it is helpful, if a different medicine is required or if there are any unwanted effects.
  • Furthermore, preschoolers who take ADHD medication have their prescription discontinued (at the instruction of the providing doctor) after six months to review the symptoms and determine if the drug should be continued.

ADHD therapy is complicated, and it is important to continuously assess children to see if the treatment is effective. This includes performing rating scale tests regularly to ensure that the medicine and behavioral treatment have the desired effect.

Don’t draw immediate conclusions if a parent or teacher suspects that ADHD is causing issues in preschool or kindergarten. ADHD is a complex condition with various symptoms that might be confused with other issues. 

• The inability to pay attention may indicate anything as basic as the child's emotional immaturity, or it may be an indication of stress, such as when a new baby joins the family or the parents divorce.
• Concentration issues may also result from a medical problem such as low blood sugar, allergies, or a thyroid imbalance. 
• If your child does not appear to listen and follow directions, they may have a hearing or processing impairment.

Children aged as young as four years can be diagnosed with ADHD. Some children outgrow the symptoms, but others may not. Research shows that three-year-old children who show symptoms of ADHD are much more likely to meet the diagnostic criteria for ADHD by 13 years. However, they should meet the criteria as proposed by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.