Typically, attention deficit hyperactivity disorder (ADHD) is not diagnosed until school age or, less commonly, older preschool age. But children with ADHD before the age of 4 are already different from other babies. What are the signs of attention deficit and hyperactivity disorder at an early age?  

ADHD or childhood impulsivity?

ADHD stands for Attention Deficit Hyperactivity Disorder and is one of the most common childhood disorders today. Symptoms include inattention, impulsivity, and hyperactivity, but their manifestations vary in severity. 

ADHD can occur in both children and adults, but symptoms always begin in childhood. Children may have difficulty sitting quietly, following adult directions, and completing assignments at home, kindergarten, and school.

At an early age, almost all children are especially active and impulsive, and self-determination crises are a real engine of disobedience and contradiction. How to distinguish classic signs of character formation and common childhood tantrums from ADHD symptoms?

The child stands out from the rest

Compared to other children their age, children with ADHD often find it difficult, if not nearly impossible, to sit still, even for a few minutes.

They cannot wait for their turn, for example, in games where there is a host, blurt out answers or go to the beginning of the queue, and they can also talk too much.

Expert commentary

James Perrin , M.D. , Professor of Pediatrics at Harvard Medical School

Young children with ADHD are incredibly active all the time. Most 4-year-old children are generally very active, but they calm down, sometimes doze off, sit while eating, and can play quiet games. A child with ADHD is constantly on the move.

What sets these children apart is the degree and frequency with which they are hyperactive and impulsive. Compared to other babies, these children are perpetual motion machines, and they work at a high pace.

“Terrible” childhood tantrums and ADHD: when is there a connection?

Any parent or anyone who spends time with children has seen these outbursts of anger. Most children may argue, refuse to cooperate, and disobey adults from time to time. 

But when this anger and hostility occurs frequently, leading to problems with friends, in kindergarten or at home, the cause for concern can be justified. In this case, one must be able to distinguish between “normal” hysterics in a baby from a problem one. How?  

Typical tantrums can start when a young child is tired, hungry, or upset, or during daily rituals and routines such as lying down before bed, eating or getting dressed. 

What’s not okay?

• When an outbreak comes out of nowhere or is so intense that the child becomes exhausted. From an excess of emotions and tears, vomiting may even begin . If such situations become regular, it is a marker of ill health. 
• It is also not normal to be hostile to people, objects, or both. It is possible that the child will want to hit or kick the parent out of frustration from time to time. But when this happens in more than half of the tantrums, a problem can arise.
• Hostility can also be self-directed . Children may try to bite themselves, scratch their skin, bang their heads, or get hurt by hitting something.
• It is extremely difficult for a child to calm down. Popular advice, attempts to give a shout , ignoring, talking, hugs do not help . You have to constantly carry away in your arms from an annoying environment and engage in “bribery”, promise to give something, give, do – and so every time. 
• Numerous tantrums: 10-20 outbursts of anger per month. If this happens five times a day, and then there is a long break (while the baby is generally healthy and well), this is also a cause for concern.
• Very long tantrums. If they usually last more than 25 minutes, it could signal an underlying problem.

What could be the reasons for such “explosions”? Experts say they may be associated with ADHD, high painful anxiety associated with neuroses, learning disabilities, autism spectrum disorder , sensory problems, and so on.

Since ADHD is the most common disorder of the above (and can be combined with other features), first of all, the attention of a specialist can be directed precisely to this syndrome.

How is ADHD diagnosed?

ADHD is a common diagnosis in childhood, but its frequency depends on the country’s diagnostic criteria. If we look at it as a whole, then this disorder is detected in about every tenth child, and in Russia, about one in twenty. In adulthood, it persists in 75% of people.

ADHD is diagnosed based on symptoms of inattention, hyperactivity, and impulsivity. But inattention is often not so obvious in preschoolers: many activities at this age do not require assessment.

Sometimes the parents themselves, as well as kindergarten teachers or teachers at school, may suspect that a child has attention deficit hyperactivity disorder. But the suspicions of even specialists in the field of working with children are not enough. A full doctor’s assessment is required for a diagnosis.

To diagnose a preschooler, the doctor will collect detailed descriptions of the child’s behavior from the parents. It is good if there is also the opinion of preschool teachers or other adults who can regularly observe the child’s behavior. It is very important to discuss all the symptoms with your doctor without exaggerating or hiding the features.

Just because a certain child has some excess activity and impulsivity does not mean that he has ADHD. For example, a child who is upset about vision, hearing, or speech problems may behave just like a child with ADHD.

Therefore, before making a diagnosis, the doctor may prescribe additional examinations to exclude other possibilities.

It is believed that ADHD is a problem mostly in boys. However, in recent years, it has been increasingly said that many girls remain undiagnosed, since they often have this syndrome manifested more smoothly: there is attention deficit, and hyperactivity and impulsivity are not expressed. 

Such children are often included in the category of “dreamers”, “forgetful”, “eternal C grade”, accusing them of unwillingness to concentrate. While the cause of the problem is attention deficit. And you also need to remember about these features and consult a doctor, not only in case of hyperactivity, but also if the child is unable to concentrate on something arbitrarily, especially if this does not pass by school age.