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Dear Debi,
Iíve noticed that my 4-year-old niece can't seem to concentrate on any one game or activity. Is this typical for her age, or could this be a sign of ADD?
Tonya Daniels
Debi's Tips
Debi Gutierrez
Debi Gutierrez
  • The subtypes of ADHD are: inattentive, hyper-active impulsive, and combined
  • If you suspect your child may have attention deficit disorder, contact your health care provider
  • Effective treatments include behavioral therapy, medications or both
  • Expert Advice
    Susan Ashley, Ph.D.
    Susan Ashley, Ph.D.
    Clinical psychologist
    ADD is Attention Deficit Disorder. Symptoms of ADD include: inattentiveness, distractibility, poor concentration, trouble sticking to tasks Ė especially if theyíre not very exciting Ė and trouble completing tasks. Itís not typically referred to as ADD anymore, but instead as ADHD, and then classified into one of three categories.

    ADHD is Attention Deficit Hyperactivity Disorder. The symptoms of this include the same symptoms as ADD, but with the added symptoms of excessive physical activity and impulsiveness, which is challenging to manage. If a diagnosis of ADHD is made, it will be classified as either:
    • ADHD predominantly inattentive type
    • ADHD predominantly hyperactive-impulsive
    • ADHD combined type
    Age 5 is not uncommon for a diagnosis of ADHD predominantly inattentive type. ADHD predominantly hyperactive-impulsive and combined types are more challenging to diagnose at such a young age because many of the symptoms have some overlap with typical behavior, such as some hyperactivity and some impulsiveness, especially as kids are still in the process of learning social skills. Despite this overlap of symptoms, signs of ADHD can be observed in some kids as young as two. In some instances, a diagnosis of ADHD can be made as young as 5 years old, but the most common age is around 9 years of age.

    If a child is showing some signs of ADHD, parents can ask the childís teacher, pediatrician or other health care provider who could suggest a specialist who could diagnose it. A developmental pediatrician would be the best bet. A developmental pediatrician is a pediatrician who specializes in recognizing delays and tracking developmental milestones.

    One sign of ADHD in preschoolers is physical aggression above and beyond whatís considered typical for their age. That means that the aggression is more severe, more aggressive, and more frequent. A child may even be asked to leave a preschool because of those symptoms. At this point, itís beginning to interfere with their lives.

    Once a diagnosis is made, typically, behavioral therapy would be the next step. Parents are asked to set up a highly structured household and learn behavior modification techniques. A highly structured household is necessary for kids who have ADHD because they are more likely to cooperate and retain positive behavior within a predictable household.

    For children as young as 5, we encourage behavior therapy first, and see how they respond. The biggest benefit of diagnosing ADHD early is the prevention of unacceptable behavior. When the unacceptable behavior that accompanies ADHD isnít addressed early on, kids arenít given the opportunity to learn that their behavior is unacceptable. By the time theyíre older, it becomes much more difficult for them to refrain from those unwanted behaviors.

    In addition to behavior therapy, there are medications that can help manage ADHD. For preschool age children, however, we typically wonít prescribe any medication and instead choose to focus on behavior therapy. If behavior therapy doesnít seem to be enough, we prescribe medication and will continue with the therapy in addition to the medication.

    ADHD is commonly misdiagnosed because it tends to mimic so many other disorders, especially Oppositional Defiant Disorder, or ODD. In children with ODD, there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster's day-to-day functioning.

    Then, as kids get older, learning disorders are often misdiagnosed as ADHD. There are also other emotional issues that can be confused for ADHD because they might have some similar symptoms. Family issues, divorce, mood problems (if a child is depressed or anxious) can all contribute to the behaviors that would normally accompany ADHD.

    Since these disorders arenít typically diagnosed until children are of school age, it can be difficult to obtain free services before the child starts school. However, once the child starts school Ė as early as kindergarten Ė parents can work together with teachers to determine if an assessment is necessary. Together theyíll decide if the childís behavior is severe enough that itís interfering with his learning. A plan of action can be determined from that point.

    There are national organizations online that can also help provide parents with support. Managing ADHD can be challenging for parents and providers, so there are places they can go for support.

    It used to be believed that ADD and ADHD could be outgrown, but new research is indicating that if the disorder is not treated, it remains through adulthood and just has different symptoms, like being extremely unorganized or ďscatteredĒ and getting into more serious trouble, including trouble with the law and more traffic accidents.

    If thereís no intervention and it gets overlooked, or if parents know the child has the disorder but never obtains services, the outcomes arenít that great. But with early intervention, the outcome can be just as good as anybody elseís. The key is early intervention.
    Child Care Provider Comments
    Christina Lara
    Christina Lara
    Mother of a 4-year-old
    My son hasnít been diagnosed yet. Iíve noticed that he can focus on a 150-piece puzzle, but if you ask him to go to the bedroom to get something, he will forget what you sent him in there for. He will focus for awhile but then he quickly wants to do something else. He is doing well in his academics but he just canít seem to focus. I was even wondering if he was hyper and acting this way because he is so smart. Maybe he is just choosing what he wants to focus on.
    Janie Hodge
    Janie Hodge
    Grandmother of three
    We all have to be very patient with my grandson. Even though heís very smart for his age, we need to do everything we can to support him. We need to work on helping him focus so I encourage my daughter to get him involved in other activities. Heís starting soccer soon, so Iím hoping that helps channel some of his energy. I do think, though, that he could benefit from a professional opinion.
    Marianella Hickery
    Marianella Hickery
    Child care provider for 20 years
    I let the parents know that a child with ADD or ADHD is no different from any other child in my care. They just have different qualities. We treat them the same, but we will work more closely with them, and we offer more one-on-one attention for children with severe issues.

    We also work closely with the parents. Itís important for parents and I to communicate through a journal to show how their child is progressing. We do referrals for an early diagnosis so that a child can have an early intervention. I do my best to educate the parents.

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