ADHD and preschoolers

Attention-deficit/hyperactivity disorder (ADHD) is no longer diagnosed just in schoolchildren.

ADHD has already become the most common mental health diagnosis for children ages 3 to 5. Researchers have now begun to explore the use of drugs and other treatments for preschoolers, reports the September 2007 issue of the Harvard Mental Health Letter.

At the preschool age, it can be hard to tell whether certain behaviors represent a real problem or just “kids being kids.” Clinicians compare a child with others the same age to determine whether the symptoms are inconsistent with the developmental level. Preschoolers with ADHD are not just rambunctious. They seem unable to wait their turn or think before acting. Despite warnings, they may play with matches or rush into traffic. They are noisy and constantly interrupt others, and they can sow chaos at home or in day care.

Stimulant drugs are increasingly prescribed for younger children, although the FDA has not approved them for children under age 6. The first large, controlled trial of methylphenidate (Ritalin and others) in children ages 3 to 5 found the drug was not quite as effective as it is in school-age children.

The most popular alternative to drug treatment is parent training, which is based on the belief that parental negligence, intrusiveness, or harsh discipline might trigger hyperactive behavior in a child with a predisposition to poor impulse control. Parents are shown how to set appropriate limits and use moderate rewards and punishments. The bottom line, according to the Harvard Mental Health Letter: Be slow to make the diagnosis, and consider parent training and specialized day care before resorting to stimulant drugs.