ADHD in Preschoolers

Medically Reviewed by Jabeen Begum, MD on December 07, 2023
Written by Shishira Sreenivas
5 min read

If you have a toddler or preschooler, you know they can be hyper, run around a lot, and find it hard to sit still. But when that behavior is too disruptive or difficult to manage, you may wonder if it is cause for concern.

Attention deficit hyperactivity disorder (ADHD) is a developmental and behavioral disorder that usually starts to show up in school-age children. But doctors can diagnose kids as young as 3. In fact, 1 in 3 children who get an ADHD diagnosis are preschoolers.

 

 

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 to the front of the line, for example – and they may talk excessively.

Some children outgrow the telltale signs of ADHD like hyperactivity, impulsivity, and inattentiveness. But research shows that kids who show symptoms around age 3 may go on to meet the criteria for a diagnosis when they are 13.

It’s important for you to observe your child’s behavior and see if it’s right for their age group. If not, it’s never too early to get help.

Your preschooler may have signs of ADHD if they:

  • Dislike activities that last 5 or more minutes
  • Talk a lot
  •  and make more noise than peers
  • Lose interest in activities very quickly
  • Climb onto things often
  • Get injured often by moving too fast
  • Behave recklessly in ways that can lead to a dangerous situation
  • Behave aggressively at day care or preschool
  • Don’t pay close attention to detail
  • Fail to follow instructions
  • Are unable to wait their turn
  • Interrupt others often

 

 

To diagnose your preschooler, a doctor will rely on detailed descriptions of your child's behavior from you, day care providers, preschool teachers, and other adults who regularly see your child, along with their own observation. It’s important to talk about all symptoms with your doctor.

Just because your child has some hyperactivity and impulsivity doesn't mean they have ADHD. For example, problems with sight, hearing, talking, or sleep can cause symptoms that look a lot like ADHD. Your child may need testing to rule out other possibilities. When your pediatrician looks into your child’s ADHD symptoms, they may first rule these out. 

Kids usually need to show signs of ADHD for at least 6 months to get a diagnosis. The signs should noticeable at home and at school, day care, or on play dates. If you notice symptoms at home, ask your child care provider or preschool teacher if they have seen similar things.

Severe ADHD can make it hard for your child to learn at school. In rare cases, kids whose behavior is too disruptive face suspension from day care and bans from play dates.

If you think your preschooler has ADHD, talk to a trained professional familiar with children’s developmental disorders. This can be a pediatrician, child psychiatrist, clinical social worker, or other mental health professional.

Experts say early diagnosis and nondrug treatment are key in preschoolers with ADHD. When children’s brains are in the early years of development, parents and professionals can teach learning skills and positive behaviors. Children can also build important coping skills during this time. This can help them grow up to do better in school and in social situations.

Doctors take some or all of the following steps to diagnose ADHD in preschoolers:

  • A detailed review of your child’s medical and behavior history at home and school
  • A look at concerning signs and symptoms
  • Talk with or observe your child directly
  • Questionnaires to evaluate your child’s behavior
  • Psychological tests to check thinking and learning skills
  • Health checks for conditions other than ADHD

 

Experts recommend behavioral therapy over stimulant drugs as the first treatment for preschoolers who have ADHD. Your doctor may refer you to a therapist who specializes in treatment for ADHD in children who are preschoolers.

You might also need counseling and training yourself to help your child through this process. Counseling can give you ways to teach your child the skills and behaviors they need. This can help them in school and in their relationships with other kids. It can also help improve self-esteem and self-control.

If your child is under 5, their brain is in its early years of development. Experts say this is an ideal time for you to positively influence your child’s behavior and work on their ADHD symptoms under the supervision of a therapist.

Therapies can include:

Play therapy. A therapist encourages your child to talk about their feelings during sessions of play or other fun activities.

Talk therapy. Experts talk to young children to treat their emotional or mental disorders. Parents may learn to use the exercises at home, in between sessions.

Parent training can be hard, and it takes a lot of effort and time. But the benefits may pay off in the long run. You may have to meet with a behavior therapist for multiple sessions and make time to teach the skills and strategies to your little one at home.

If your child’s symptoms are too severe to benefit from behavior therapy, your doctor may prescribe a stimulant that boosts neurotransmitters in the brain. Children usually start these meds at age 4 or after. Not all ADHD medicines are FDA-approved for children younger than 6. But many doctors prescribe these drugs for preschoolers with ADHD.

Your child’s doctor will start the medications on a low dose and change the drug or dosage if necessary. Experts recommend that preschoolers stop ADHD medications after 6 months so doctors can check to see if they’re working. If necessary, your doctor may continue giving the drugs.

Although there can be side effects, the American Academy of Pediatrics believes that the benefits outweigh the risks in young children who aren't getting better with behavioral therapy.

A study found that young children are more sensitive than older children to the side effects of methylphenidate, one of the more commonly used medications. Those side effects may include delayed growth, loss of appetite, weight loss, insomnia, and anxiety. The side effects, including delayed growth, reversed once the kids stopped taking the medication.

There aren't any studies on the long-term effects in children who start ADHD drugs at such a young age. But studies of children in elementary school have not shown any long-term side effects of treatment.

Deciding whether to make medication part of your child’s treatment isn’t easy. It's a decision that’s made after carefully weighing the pros and cons. What’s right for one child (and family) may not be right for yours. Talk to your child's doctor, and together you can decide what’s best for your child.