Can ADHD Be Diagnosed Younger Than Age Five?

The upcoming issue of ADDitude magazine will publish a thoughtful review of the question, based on a study sponsored by the National Institutes of Mental Health.  More below the fold.

The study is known as  Preschool ADHD Treatment Study (PATS).  According to ADDitude, it was

conducted by a consortium of researchers at six sites, PATS is the first long-term, comprehensive study of treating preschoolers with ADHD. The study included more than 300 three- to five-year-olds with severe ADHD (hyperactive/impulsive, inattentive, or combined type). Most exhibited a history of early school expulsion and extreme peer rejection.

Pay attention to the previous sentence.  These kids aren't just "normal kids"--they're really suffering.  Peer rejection in the three- and four-year-old universe really hurts.  The article went on to say:

Diagnosing ADHD in preschoolers

Is it possible, then, to diagnose children with attention deficit disorder when impulsivity, opposition, and extreme activity are normal preschool behaviors? Yes, but the tipping point in diagnosis is usually a matter of degree. “Children with ADHD are much more extreme than the average three-year-old,” says Alan Rosenblatt, M.D., a specialist in neurodevelopmental pediatrics. “It’s not just that a child with ADD can’t sit still. It’s that he can’t focus on any activity, even one that’s pleasurable, for any length of time.”

Larry Silver, M.D., a psychiatrist at Georgetown University School of Medicine, says that an experienced teacher, one with a baseline of appropriate three-year-old behavior, can be a tremendous help. “You have to look at whether or not the behaviors are consistent in more than one environment,” he notes.

But experts caution that, even with “red flags,” early diagnosis of ADHD can be difficult. “You have to delve deep into the root of certain behaviors,” says Silver. “A child might have separation anxiety, his fine motor skills or sensory problems could be making it hard for him to behave, or it could be evolving Pervasive Developmental Disorder,” he says.

Nonetheless, Laurence Greenhill, M.D., of Columbia University/New York State Psychiatric Institute, points to two behavioral patterns that often predict ADHD diagnosis later in life. The first, preschool expulsion, is usually caused by aggressive behavior, refusal to participate in school activities, and failure to respect other children’s property or boundaries. The second, peer rejection, is one that parents can easily identify. Children with extreme behaviors are avoided by their classmates, shunned on the playground.

Go read the whole article.  If you know a family with a "wild" pre-schooler, print it out and share it with them.

Early intervention is really important.

Update: John Wills Lloyd has more details about the study and the papers that have come out of the study.

This post appears at I Speak of Dreams and More Joy in Your Family

Comments

[Karoli]

Thank you for posting this! The social aspects were one of the primary reasons I had Sticks evaluated when he was four. He was getting tossed out of just about every group he was part of, and that stuff stays with a person forever.