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Tuesday, March 15, 2016

Answers to FAQ’s About Diagnosing ADHD in Preschoolers

Children are being diagnosed with ADHD at younger and younger ages, even as young as the preschool years.  This is partly due to the fact that newer research has demonstrated that the diagnosis persists in a large number of children who are diagnosed before the age of 7, which was the age previously used to guide diagnosis.

How early can my child be diagnosed with ADHD?
In fact, the American Academy of Pediatrics’ newest guidelines on the diagnosis and management of ADHD now states that regular pediatricians can diagnose ADHD in children as young as the age of 4, and some children with severe symptoms may get diagnosed even earlier by pediatric psychiatrists.

Why won’t my doctor run any tests?
There aren’t any tests that can accurately rule in or rule out the diagnosis of ADHD.  As long as, after a careful interview and examination, your child doesn’t show any developmental delays or signs of physical illness, most experts recommend that no further testing be done
Older children may be asked to do psychometric testing to determine if they really are inattentive or if there is another reason for learning difficulties.  Some patients may undergo a special form of EEG if the diagnosis is in doubt.
The vast majority of children are diagnosed based on behavior checklists after a discussion with the doctor and an examination.  The CDC has a symptom list you can check out for free on their website.

Why is my doctor unwilling to give my 3 year old a diagnosis of ADHD?
It is normal for children ages 2-4 to be hyperactive, impulsive, and inattentive at times.  The issue with children with ADHD is that they are a lot MORE of all of those things than normal children.  However, unless your job is to work with preschoolers (ie. you are a preschool teacher or mother of multiple children) you probably are not experienced enough by yourself to determine that your child is not like other children who will grow up normally.

Also, the DSM-5 criteria for ADHD requires a child to have symptoms that interfere with functioning or development.  What this usually means in preschoolers,  is that a child fails preschool.  This is difficult to do unless your child is getting kicked out of school due to multiple episodes of violence to other children. 

What can I do now for my child if I think (s)he has ADHD but my doctor isn’t ready for a diagnosis?
  • Make sure that physical problems are ruled out and/or treated appropriately.    Young children respond to any number of medical and social/emotional problems by acting out behaviorally.  They may not know to complain that their hearing or vision is off, or that they are in pain or anxious, or they may not understand that this is what is causing them to feel wrong.  It’s important to get at least a vision and hearing screening done in all children who have suspected ADHD, and to make sure that they can get a good night’s sleep on a regular basis.

  • Get a handle on what is normal behavior in this age group.  Try to observe your child in several settings where there are several children his age.  If your child does not go to preschool, try a playgroup, Sunday School, or other preschool program such as MOPS or MOMS Club.

  • Address developmental problems.  Preschoolers with suspected developmental delays, including social and emotional delays, usually qualify for a free evaluation by early intervention.  Also, many medical insurances will pay for therapy even with a looser diagnosis of “disruptive behavior disorder” when a doctor isn’t ready to use “ADHD”.

  • Investigate  non-medical therapy.  Preschoolers often respond to behavioral therapy (in the form of special parent classes).  Also, diets free of artificial coloring and/or rich in omega 3 fatty acids have been shown to help some preschoolers. 



Reference:
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. "ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents." Pediatrics (2011): n. pag. Pediatrics. American Academy of Pediatrics, 16 Oct. 2011. Web. 25 Nov. 2013. <http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011-2654.full.pdf+html>.


This article is part of a planned series on Preschool ADHD, including: Diagnosis, Treatment Options, and Medication.



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