ADHD in Children Health Center

ADHD in Preschoolers?

Young kids are notoriously impulsive. So how young is too young to tell if a toddler or preschooler might have ADHD?

ADHD can be diagnosed in children as young as 4, according to guidelines published by the American Academy of Pediatrics (AAP) in 2011.

But given the nature of kids that age, how could you tell a toddler with ADHD from one who doesn't have it? And if a child that young is diagnosed with ADHD, what is the treatment?

Standing Out From Other Tots

In a young child, it can be hard to tell normal toddler behavior from ADHD. But there are some things that may stand out.

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 in the front of the line -- and they may talk excessively.

"Young kids with ADHD are incredibly active all the time," James Perrin, MD, tells WebMD. "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." Perrin directs the general pediatrics division at Massachusetts General Hospital and is a pediatrics professor at Harvard Medical School.

"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 and chairman of Lehigh University's education department. "These kids are literally plowing through activities and people at a high pace."

New Guidelines

In 2011, the AAP issued new guidelines about diagnosing and treating ADHD. Those guidelines state that children as young as 4 can be diagnosed and treated. Previous guidelines limited the diagnosis and treatment of ADHD to children at least 6 years old.

"The medical community, in general, seems supportive of these [new] guidelines," says DuPaul, a member of the AAP group that wrote the guidelines. There is concern that some kids may be misdiagnosed, but the benefit of being able to identify and intervene with kids early on is important, he says.

"This is a disorder that begins in an early age and is chronic with lasting consequences," DuPaul tells WebMD. "If we can identify kids who have ADHD earlier, we may be able to circumvent some of the risks that they have down the road."

Without effective treatment, ADHD can take a toll on a child's social, academic, and personal development. Kids with untreated ADHD often have trouble making and keeping friends, struggle in school, and have low self-esteem. Very young children with untreated ADHD are also at risk of injuring themselves and others.

Diagnosing and Treating ADHD in Preschoolers

ADHD is diagnosed based on symptoms related to inattention, hyperactivity, and impulsivity. But inattention may be less apparent in preschoolers.