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ADHD and Preschoolers
Q: My five-year-old son is a preschooler and I have some concerns about his behavior. I think he may be ADD or ADHD. His doctor doesn't seem to want to do anything about it until he's in kindergarten, but I feel that getting on top of it now will make kindergarten better for him and his teacher. Do all ADD/ADHD children have to be on Ritalin? Are there other effective ways of managing them? I feel like I'm always yelling at him to calm down, and he never does. I just want to have a good relationship with my kids, and I'm at my wits' end!
A: Your concerns are certainly understandable. It's not at all unusual for parents to suspect that their preschooler might be exhibiting signs of ADHD. In fact, in detailing the diagnostic criteria for ADHD, The Diagnostic and Statistical Manual of Mental Disorders (4th edition) notes that to be considered ADHD, the symptoms must be present before the age of seven years, persist for at least six months, and be "inconsistent with a child's developmental level."
Unfortunately, diagnosis of ADHD is not an exact science. There is no one sure test to make an absolute judgment about the presence or absence of the condition. Diagnosis is particularly challenging when viewing young children. Youngsters mature at different rates and there is a range of what might be considered "normal." Normal differences in temperament, personality, and energy level may lead some to label a child as ADHD when he is merely immature or just exuberant. That said, however, a clinician with a strong background in normal development as well as ADHD can help to tease out whether your child fits the criteria and might need some direct intervention at this point.
And no, all young children diagnosed with ADHD do not have to be medicated. Many times a behavioral intervention plan monitored by a professional may have a significant impact. If your pediatrician is not willing to give you a referral for an evaluation for ADHD, try contacting Children and Adults with Attention Deficit Disorders (CHADD) at 1-800-233-4050. This parent advocacy group has branches throughout the country and is an excellent resource for parents and professionals. They should be able to help you to make a connection with a professional who can give you some guidance and support. Some branches even sponsor parent education groups that can help you to learn new strategies for coping with your child's behavior. Equally important, they will give you an opportunity to share concerns and ideas with other parents who are in the same situation as you. You might also want to read Dr. Larry Silver's Advice to Parents on ADHD. This is an excellent resource for guiding parents to handle behavior problems.
You are right to try to get a handle on your child's needs while he is still very young. Early intervention can help to make your child's adjustment to kindergarten a smoother one. Good luck!
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For more than 20 years, Eileen Marzola has worked with children and adults with learning disabilities and attention deficit disorders, and with their parents and teachers. She has been a regular education classroom teacher, a consultant teacher/resource teacher, an educational evaluator/diagnostician, and has also taught graduate students at the university level. Marzola is an adjunct assistant professor of education at Teachers College, Columbia University, and Hunter College of the City University of New York. She also maintains a private practice in the evaluation and teaching of children with learning disabilities and attention deficit disorders.