ADHD in Young Children

Understanding Early Symptoms of ADHD

A girl daydreaming in class.

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It's so important to learn about the early symptoms of ADHD in preschool-age children -- and about the ways, ADHD can impair a child’s behavior and learning. When parents, caregivers, and teachers are aware of and educated about ADHD, they can be more proactive in getting positive strategies in place and intervening before the child develops a pattern of negative behaviors or damaged self-esteem. Early intervention may also potentially prevent the emergence of further symptoms and secondary conditions such as anxiety or oppositional defiant behaviors. In addition, when parents and teachers are able to recognize these signs and impairments, they are likely to be more tolerant and understanding of these preschoolers and are more apt to utilize helpful interventions and get an effective plan in place to address the problems as opposed to responding in ways that may exacerbate the symptoms.

Early-Onset Symptoms

It is important to note that it can be very difficult to tease out and differentiate the normal development of regulation of attention and impulses along with the ability to focus and control hyperactivity from abnormal ADHD symptoms. Diagnosing ADHD in a preschool age child requires great clinical expertise. At this young age, it is much harder to separate and distinguish the behavioral features associated with ADHD from behaviors that occur in typically developing children. This article will focus on some of the possible early behavioral features that are most likely to be associated with ADHD at young ages starting with impulsivity.

Signs of Impulsivity

  • Difficulty waiting turn
  • Interrupts others
  • Invades space or boundaries
  • Blurts out verbally
  • Reacts without thought – or is accident prone
  • Difficulty with delayed gratification
  • Difficulty managing unhappy feelings

Kids who are impulsive have trouble inhibiting their behaviors and responses. They tend to react in a rapid way without considering consequences. They go full swing into situations, are often accident prone, and tend to place themselves in potentially risky situations without thought – running out in the street to get a ball, climbing out the second floor window to see the view, being bitten by dogs whose space they have invaded and whose nose they have poked! The amount of constant supervision these little ones require can be exhausting for a parent and teacher.

As parents or teacher, it helps to keep in mind that behavior is a problem, but the child isn’t necessarily a behavior problem. So the point is that kids with ADHD just don’t think the problem through, they simply react and afterward they may feel awful about what happened. Usually, their intentions are good, but the outcome of their behavior can create quite a bit of chaos because they are so driven by the moment.

Waiting for turns and being patient is extremely difficult. The ability to delay a response, as well as delayed gratification or waiting for larger rewards is very hard for a child who is impulsive. They tend to interrupt, intrude and invade others space. Their life may feel so out of control at times that in order to counteract these feelings, they react by trying to have more control, becoming bossy, and taking over charge of play with peers or in interactions with adults. Their behaviors can be very off-putting and they can certainly become aggressive and destructive, as they react impulsively to frustration with hitting, destroying or throwing things. Interactions can quickly become confrontational.

Impulsive kids often have a hard time regulating their feelings especially difficult feelings like anger and frustration. They may have frequent meltdowns or temper tantrums – that are not only more frequent than a child without ADHD but are also more intense and emotion filled. Their moods may be unpredictable – you may never know what you are going to get from day to day, hour to hour, or even minute to minute. One minute they may explode, and then the next they are able to move on and are uncertain what the fuss is all about. On the other hand, they may explode, and take a long time to settle and calm back down.

These kids can also be very sensitive - they feel things very deeply – wearing their heart on their sleeve. They can be very vulnerable and the transition to preschool can be quite challenging. Preschool is a time where children begin to socialize and learn about interacting and getting along with others. They need to learn how to interact in a group setting (cooperate, wait for turns, share, delay gratification), but for kids with ADHD, this can be a very difficult transition.

The impulsive behaviors may be viewed as demanding or selfish and can alienate others - especially when the child shows little remorse for his or her behaviors and doesn’t seem to learn from mistakes. Excessive moodiness, quickness to anger, being easily upset by things, low adaptability, problems adjusting to change – these issues make day-to-day tasks and interactions all the more difficult.

Signs of Hyperactivity

  • Moves about excessively
  • Fidgety, squirmy, wiggly
  • Perpetually on the go
  • Restless
  • Loud and disruptive
  • Like a chatterbox, talking excessively

Hyperactivity is not only a high level of motor activity but also disorganized and seemingly purposeless activity – chronic motor restlessness, moving about excessively, squirming, wiggling, fidgeting, falling out of chairs, climbing, running and jumping around - and doing so at inappropriate times in ways that are disruptive or bothersome when the child is supposed to be listening or sitting still. These kids often seem like they are driven by a motor – they are perpetually on the go and constantly restless. Often they may be so squirmy that they cannot even be cuddled because they can’t stay still long enough. They may be so active that slowing down long enough to eat or go to the bathroom is also challenging.

These little ones can be very loud and disruptive. They may talk incessantly, making sounds and noises, asking questions, and chattering on and on with a running commentary. They have extreme difficulty regulating their activity level and can’t seem to stop themselves, and require almost constant redirection and interventions by parents and teachers.

Sleep is often an issue. It can be hard for these kids to settle down enough to go to sleep, and then when they do sleep it is often very restlessly. They are often up and raring to go in the early hours of the morning. This again is very exhausting for parents...not to mention the symptoms of ADHD can worsen as the child doesn’t get the sleep he or she needs. So they are even more irritable, quick to frustrate, overactive, and distractible.

Of course not all children with ADHD display this hyperactivity and impulsivity; there are actually three different types of ADHD – the Predominantly Hyperactive-Impulsive Type, the Predominantly Inattentive Type, and the Combined Type – in which the child exhibits both the inattentive and hyperactive/impulsive symptoms.

The hyperactivity and impulsivity, however, are typically noted as the main problems in these younger children. Attention issues usually become more noticeable when a child gets older, enters grade school and faces increased demands for sustained focus. Also, the hyperactive and impulsive behaviors tend to get noticed earlier simply because they are so much more disruptive.

Signs of Inattention

  • Difficulty keeping attention on tasks or play activities
  • Easily distracted
  • Shifts from one unfinished activity to the next
  • Does not seem to listen when spoken to
  • Difficulty following directions
  • Often forgetful in daily activities
  • Plays alone, “in his or her own world”
  • Daydreamy

The term attention deficit is a bit misleading. Kids with ADHD actually have trouble regulating their attention. There may be some things, especially activities that are stimulating and interesting that they are able to focus intently on, and in fact have great difficulty shifting their attention away from. While there are other tasks that they have trouble focusing on or maintaining focus on. They also may have trouble concentrating on only one thing, because they often pay attention to everything going on around them – sights, sounds, or even thoughts in their own head. So the child becomes distracted by everything, shifting from one thing to another.

A child with ADHD may have lots of trouble listening, remembering, and following directions. It may appear that they are being oppositional when they don’t follow directions when in actuality they simply missed some of the directions. They either started the task without hearing the complete instructions or they tuned in at the beginning and then tuned out at the end of the directions so they only process partial directions and become confused when others become frustrated at them.

Another thing that can happen is that these young children can develop gaps in learning because they often miss so much of the information that is presented to them. Kids with ADHD tend to be less mature developmentally than their peers anyway, so this on top of the gaps in learning may result in delays in developmental tasks such as toilet training and motor or language development.

A child with inattentive symptoms might be described as daydreamy or zoning out or spacey. They may play alone a lot. They become easily bored, so move from one unfinished activity to the next. They may even have a rather inconsistent pattern in their behavior, remembering one day, but distracted the next...but again the inattention isn’t usually noted as a problem in the younger years. It’s not as disruptive as the hyperactive/impulsive behaviors and usually doesn’t become as obvious until a child enters grade school. That’s not to say these inattentive symptoms aren’t present and causing problems, they just may not get noticed and identified as easily.

Associated Parenting Stress

There can be quite a bit of stress for parents when ADHD symptoms already present so significantly in these early years. Preschoolers with ADHD are more likely to be expelled from daycare and preschool, so parents often have fewer childcare options. These youngsters also tend to have higher rates of accidental injuries -- injuries from falls off furniture after excessive climbing, falling or jumping out of windows or off decks, unbuckling restraints and standing up in the car or stroller, even accidentally drinking poison -- resulting in more emergency room visits. They require an extremely high level of monitoring and constant supervision. Obviously, these intense behaviors and the need for constant supervision in order to keep your child safe can be quite draining.

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Article Sources
  • George DuPaul, Gary Stoner. ADHD in the Schools: Assessment and Intervention Strategies. Guilford Press. 2003.
  • Richard Lougy, Silvia DeRuvo, David Rosenthal. Teaching Young Children with ADHD: Successful Strategies and Practical Interventions for PreK-3. Corwin Press, 2007.
  • Cathy Reimers, Bruce A. Brunger. ADHD in the Young Child: A Guide for Parents and Teachers of Young Children with ADHD. Specialty Press. 1999.
  • William Sears, Lynda Thompson. The A.D.D. Book: New Understandings, New Approaches to Parenting Your Child. Little, Brown, and Company. 1998.