Recognising ADHD in the Under 5's

An astonishing 1500 preschool children aged four years and under were excluded from nursery school in the UK in 2007, according to a recent report on the BBC.

Most of these exclusions happened because of violent or abusive attacks on other children. In response to this recent school exclusion data, politicians have announced new policies to strengthen teacher's authority in the classroom, and have promised to improve on school discipline. But will this really help to address the problems in children so young?

The question must be asked as to whether this data represents a deluge of bad behaviour in schools arising from poor parenting, or if this behaviour is due to another cause. An alternative explanation could be that this data is an indication of the size of the problem of ADHD or attention deficit hyperactivity disorder amongst UK pre-school children. At the moment no can say with certainty.

Diagnosis in the Under 5’s

At present the general consensus amongst health professionals is that ADHD cannot be easily or convincingly diagnosed in children under 5 years old.

Impulsive behaviour, opposition to authority and a high degree of physical activity are quite normal behaviours in a developing child. Young children may be slow to develop their fine motor skills, or have extreme anxiety about being separated from their homes and parents. Additionally, problems with sight or hearing could manifest themselves as an inability to pay attention and sit still.

So how can a doctor tell whether this is normal behaviour or early symptoms of ADHD or ADD behaviours?

ADHD Symptoms in the Under 5's

Whilst a child with ADHD can’t sit still for any activity, and even ones they enjoy, for it to be an attention deficit disorder symptom these problems must be evident both at home and at nursery school. At such a young age, such problems could be early indicators of a deficit disorder.

The defining point would appear to be behaviours that include aggression. Violence is thought to be highly predictive that there could be an ADHD related cause for the bad behaviour. Additionally, a general refusal to take part in activities and an inability to respect other children’s boundaries and property can be strong early indicators of ADHD or ADD symptoms.

If parents find that their child’s behaviour means that other children are always 'busy' when they try to arrange social dates, and their child is consistently left alone and isolated in the playground, early alarm bells should be ringing.

PATS Study

Even if ADHD is strongly suspected, a recent US study (The Preschool ADHD Treatment Study or PATS) has provided hope that a childhood of medication may not always be necessary, even when ADHD is the cause of behavioural problems.

In the PATS study, 303 children aged between three and five with ADHD symptoms were put through behavioural training, along with their parents. One third of the children improved so dramatically that there was no need for medication. Others made dramatic improvements with very low doses of medication.

Take Action

The PATS study indicates that when very young children demonstrate ADHD behaviours, it is worthwhile to take action as soon as possible rather than adopt a ‘wait and see’ approach. Behavioural therapy along with parental training can make a large difference in many children, and there are benefits associated with starting these approaches as soon as possible. If medication is subsequently necessary at a later stage of a child's development, it may be possible to use lower doses of medication and for a shorter period of time.

Parental Steps

Changing nursery school to one with small class sizes, less stimulation and a strong routine can also make a tremendous difference at an early age. Daily routines and behavioural management strategies applied consistently at nursery and at home can help ADHD children to learn positive behaviours, especially whilst rapid brain development is ongoing.

Modifying Diet

ADHD behaviours in a very young child could be an early indication that there is a food allergy or sensitivity, so taking steps to exclude all artificial additives from the diet as soon as ADHD or behavioural problems are suspected is a simple first step that may help your child's behaviour and avoid a need for medication when they are older.

Summary

No one wants to medicate a preschool child, but this is not a reason to exclude the possibility that a young child may have ADHD symptoms and behavioural problems. The earlier behavioural management strategies are used, along with dietary interventions, the greater the chance are that the development of ADHD symptoms can be limited and managed without drugs throughout childhood. For this reason, it is advisable for parents to seek help sooner rather than later when behavioural problems become apparent in a young child.

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