Discuss hyperactivity or inattention in a preschooler at your next well-child visit

Well-child visits are a good time to bring up any concerns about attention- deficit/hyperactivity disorder (ADHD) with your pediatrician. Find out how ADHD is diagnosed and treated in young children.

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After age two, even when your child doesn’t need shots, schedule a well-child visit annually so their pediatrician can monitor their growth and development and address any potential health issues early. Finding issues early gives your child a higher chance at living a healthy lifestyle as they grow.

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Some signs and symptoms linked to attention-deficit/hyperactivity disorder (ADHD) actually can be a sign that your preschooler is developing exactly as they should.

Your child’s behavior can be especially challenging at this age, and that’s perfectly normal as they start to gain some independence.

Consistent check ups with your pediatrician in the preschool years are opportunities to discuss any behavioral concerns you may have.

Occasionally, in cases of severe circumstances such as safety risks, your pediatrician may consider a diagnosis of ADHD in preschoolers. Far more often, behavioral concerns may be resolved by reviewing the preschooler’s diet and sleep habits.

Any young child is easily distracted, can have trouble paying attention or can appear hyperactive and show impulsive behavior at times. Those behaviors alone aren’t enough for an ADHD diagnosis.

Well-child visits, especially each year between the ages of 4 and 6, are a good time to bring up any ADHD symptoms or mental health concerns with your pediatrician. Your child’s health care provider also will ask questions about behavior that could lead to a conversation about ADHD.

If your child’s medical provider suspects ADHD, they’ll ask questions about your child’s behavior and observe the child. The pediatrician will be interested in whether the behavior occurs in more than one setting — for instance, home and day care. If the behavior occurs only in one place, ADHD likely will be ruled out.

The condition can be treated effectively, often without ADHD medication, and can help put your child on track for a successful time in school.

“Hyperactivity or inattention may just be a part of a preschooler’s makeup and something that will change with age. When the behavior meets certain criteria and persists in multiple settings, we start to think about ADHD,” said Matthew D. Kinney, M.D., pediatrician with Norton Children’s Medical Group, affiliated with the UofL School of Medicine.

“At the preschool age, behavior management techniques demonstrated by parents are often successful in charting a child’s future for constructive school years,” said Dr. Kinney, who practices at the pediatrics office in the Novak Center for Children’s Health.

Understanding ADHD in young children

Your child may be rambunctious or have trouble taking turns or following directions. This is common in preschoolers and not necessarily a sign of ADHD. If your child is being suspended from preschool for disruptive behavior, is having difficulty learning concepts or has been placed in special education, you’ll want to talk to your pediatrician.

Annual well-child visits are another opportunity to check on whether your child’s behavior is just part of being a kid or a behavioral health concern.

Boys with ADHD tend to fit the mold of hyperactivity. You may notice they are fidgety, restless and easily bored. Getting them to sit still or stay quiet when needed can be especially challenging. You may notice careless mistakes because they are rushing through tasks.

Girls with ADHD tend to lean toward the inattention part of ADHD and may be less hyperactive. For girls with ADHD, you may think they are excessively social — their hyperactivity can tend to be more of an inner churning that appears as daydreaming, carelessness and forgetfulness. They may appear to have trouble focusing their attention, concentrating and staying on task. They may miss important details in directions and not finish tasks. They may seem absent-minded or forgetful, and lose track of their things.

Treatment approaches for ADHD in preschoolers

If your preschooler shows ADHD behaviors or has been diagnosed, your pediatrician likely will recommend ADHD treatment that starts with training you how to manage your preschool child’s behavior. The training gives you skills and strategies to help your child succeed at school, at home and in relationships. It takes time and effort, but the benefits last.

The training typically involves multiple behavioral therapy sessions and practice with your child between behavioral therapy sessions. Young children will need your help to change their behavior. The therapist will meet with you to review progress, offer support and adjust approaches if needed.

If managing a child’s behavior doesn’t lead to improvement, ADHD medication may be considered for a child with moderate or severe ADHD symptoms. 

ADHD testing in preschoolers

There’s no test for childhood ADHD, and your child’s symptoms may be related to sleep apnea, anxiety, depression, learning disability or even a response to stressful events. Pinpointing an ADHD diagnosis sometimes can be complex.

Diagnosing ADHD isn’t a quick process and requires a finding that there is a persistent pattern of hyperactivity or inattention. A diagnosis of ADHD requires specific symptoms for at least six months, and the ADHD behaviors need to appear in more than one area of life, for instance at home and preschool, church or elsewhere.

If your child’s behavior is overly disruptive to others and occurs in varying situations, you may want to schedule an appointment with your pediatrician. If your concerns are less pressing, be sure to discuss what you’ve been seeing when you come in for a well-child check.

Remember, vaccinations are a good reason for a well-child check, but young children who aren’t due for a shot still need an annual visit. These well-child checks can help identify and address any potential health issues early, sometimes before symptoms develop and when they are easier to treat.