ADHD in toddlers (pre-school)

What are the signs of ADHD in toddlers and pre-schoolers?

Attention deficit hyperactivity disorder can be very difficult to diagnose in young children as many of the typical signs we associate with ADHD, such as being hyperactive and impulsive, are completely normal in this age group.

For example, pre-schoolers aren’t usually able to concentrate on anything for very long, not would we expect them to be able to sit still for long periods. Like puppies, they are likely to be fidgety, messy, not be able to follow instructions and jump off furniture. For this reason, ADHD is often not diagnosed until children are a little older. There are various rating scales available but these need to be used with a proper clinical assessment to be useful.

Medication is almost never used in the UK in younger children, so “treatment” is all about finding strategies and ways of coping.

Here are some of the common signs. They become more useful for diagnosis the older the child and especially if they continue for more than six months. It’s also important to note whether the signs are there in all situations or just at home. For many children, nursery or pre-school are places where they try to behave and when they come home, they can finally let all their feelings and fidgets out!

1. Always on the move

Lots of children with ADHD need to move constantly. Your child may struggle to sit for more than a minute – more than other children their age, and this might become noticeable at nursery or pre-school. However, modern life generally involves too little movement for growing children. All children, both those with and without ADHD, benefit from more playing and movement, especially outdoors – ideally at least an hour a day. For children who have a diagnosis of ADHD, increasing the amount of movement every day has been shown to help. That could just be dancing in the kitchen or jumping up and down twenty times!

2. Easily upset

Children with ADHD often find it hard to manage how they are feeling . They may throw tantrums quickly. This is often made worse because their behaviour can be seen as “naughty” or “silly” and they may be told off more than other children.

3. Easily distracted

Children with ADHD frquently struggle with staying focused even for a few minutes – they will become easily distracted by noises or interesting things going on around them. Following instructions can be hard too – breaking things down into one step at a time or having visual prompts can help. Some children with ADHD are not hyperactive but may be off “in a world of their own”.

4. Not listening

Having ADHD can make either hard to focus on what others are saying. Children may run off in the middle of you speaking or change the subject – while this is completely to be expected in a toddler, listening skills should gradually develop as children approach school age.

Other possible reasons for ADHD-type symptoms:

Unrealistic expectations and variation of normal. Just like adults, children vary in the amount of physical activity they need, how easily they can follow verbal instructions, how quickly they mature and how they handle feelings of worry and anxiety. Not all children who are very fidgety, or inattentive, will have ADHD. The key is to look at how things develop over time and get expert advice if you are worried or unsure of what might be expected at different ages.
Disruption and trauma Children who are going through a disruptive time such as moving house, divorce or another stressful event may also display symptoms similar to ADHD, but these should improve over time. If behaviours are not improving over period of more than six months and occur in different places e.g nursery and home, then that is important. The resources here are a useful starting point to help you decide whether you should go and see your GP.
Iron deficiency Children who are iron deficient may sometimes have similar symptoms and low iron is not uncommon in toddlers. Your GP might refer your child for consideration of a blood test if they are concerned.