Parenting a pre-school child is damn hard, (to be fair parenting full stop is damn hard!). Their short attention spans and energy levels leave any parent exhausted. But when should you be concerned that maybe you are not just dealing with a child full of beans and the dreaded ‘terrible twos’ and that maybe it is something more? Maybe it is ADHD?
Symptoms of ADHD and Pre-school Children
Let us look at the symptoms of ADHD in school-age children to start:
Inability to stay focussed on one activity.
- Difficulty completing a task before moving on to another; bored or frustrated by it.
- Being over fidgety and needing to move.
- Unable to sit calmly for example at mealtimes or during story time.
- Unable to listen without getting distracted.
- Finding it challenging to listen and then process instructions or information given.
- Constantly talking or making noise.
- Unable to wait their turn when playing with other children.
- Interrupting, blurting out and emotional outbursts.
However, when reading that list, doesn’t that sound like all pre-schoolers?! Do you know many/ANY that do not do the above? They are all an abundance of energy. I think I would have been more concerned if my child HAD sat still.
The number of times I set one of my twins off by giving them the wrong-coloured plastic cup. Or throwing away their dinner having offered it to them numerous times before going cold, only to be told 10 seconds later, ‘I WANT MY DINNER!’. This is why it is so hard to know when your child is ‘just being a child’ and when you should see the red flags.
My Pre-school Experience with ADHD
I knew my daughter was ‘different’ from about 2 years of age. Having read about early diagnosis now, I would not have assumed it was ADHD. Early signs apparently include poor sleep, she was a great little sleeper; poor feeding, she ate so well! However, for my daughter, it was the inability to self-soothe that struck me. She would get into such a tizz so quickly and then be unable to calm down without intervention. Obviously, when they are little, it is all about the cuddles, but there was something I could not quite put my finger on.
She was so vastly different to her twin. I know they do not have to be the same just because they are twins. But watching certain things they did, really made it obvious. Things like being able to watch a movie. My DS would pull up his bean bag and watch the entirety of a movie, which is probably one extreme! So engrossed in Wizard of Oz, he would not move! My DD, however, would be able to watch just odd bits and then be off doing everything and anything. DS had a favourite toy and a favourite bear to sleep with DD had nothing that really interested her.
When she started preschool, her teachers could not get over how clever she was, and how ‘resourceful’. The preschool had many outdoor activities but only one swing. Everybody wanted to go on the swing, yet she managed to not only convince them that she should sit on the swing but that it was far more fun to push her! Genius? Calculating? Who knows! She had worked out a way not to have to share. Despite being a twin, she was not the best at sharing yet did it in a way that the other person felt they had won! Gifted! I digress..
Does my Pre-schooler have ADHD?
If the above ‘symptoms’ are more extreme than their peers it could be a sign of ADHD. Or, if your child is constantly having meltdowns, causing disruptive behaviour, or you are frequently asked to be collect them from preschool/nursery due to another ‘bad day’. When their behaviour is noticeable, not only to you but, to other adults in varying situations, these can be early warning signs.
All kids have uncontrolled outbursts and emotional meltdowns at some point. My DS without ADHD lost it because he dropped one of his gummy bears on the floor and I refused to let him eat it. In hindsight, I really should have utilised the 10-second rule and let him eat the dusty thing after a quick brush-off. That meltdown, compared to DD meltdowns, was different. That was equivalent to a pot of pasta boiling over and quickly removed from the heat. DD, well that would be like waiting for Mount Etna to cool off.
The emotions do not always have to be negative either. Sometimes the overreaction can come from a positive thing, that almost turns into mania! Like excitement. Their emotions are amplified x 100.
Basically, tantrums will be more severe, more intense, more frequent, and more disruptive than a neurotypical pre-schooler. Meltdowns seem to come out of nowhere, not because your child is tired, approaching nap time or needs a snack etc. They are so intense and can go on for more than twenty minutes. They are exhausting for both them and you. It appears that nothing can make them calm, except time. Time that feels like hours.
Overstimulation is a massive deal for a pre-school child with ADHD. And we do tend to overstimulate them. Soft plays, activities, playdates, and birthday parties. All highly entertaining for most but not when your child may have ADHD. All that noise, all those people (many unknown), all those activities! My DD hated parties looking back. It was not that she did not like people, she just hated all the unknown of a party. Luckily, being a twin, she would always go in with DS. But as soon as games started, she would defiantly go and find a chair and sit on it with arms folded. She hated it.
Sometimes I felt like she really wanted to join in. If I dared to encourage her, see if I could join in with her, it was as if I had ignited the end of her fuse. I quickly had to extinguish that by backing away before the meltdown ensued.
Well-meaning parents would tell me that she would grow out of it, it was not that bad, she was lovely. I knew she was lovely, but my gut was telling me something was not right. I went to the Dr’s at 18 months with her the first time. They were so nice, but there was nothing they could do except watch her diet and take notes, a diary. I knew her diet was fine. The twins were my first, I had only ever given them homemade food, no salt, no sugar etc. (not like the next baby, who probably had chocolate buttons before his first teeth, but that is another story…). But I waited and I waited, and it got worse, not better.
Can ADHD be diagnosed in Pre-schoolers?
In the US, children as young as 4 can be diagnosed with ADHD. Some may grow out of the symptoms presented, whilst others may not. In the UK, children are generally not diagnosed before the age of 6, after starting school. Arguments for early diagnosis are simple, early intervention. However, the reluctance to diagnose too early is due to many reasons. Maturity, as we have said; the terrible twos; needing to see the issues clearly for at least 6 months previous; fear that the child will be medicated too young.
It is especially important that you rule out other possible conditions first before you jump down the ADHD route. Vision or hearing could cause extreme frustration for a child if undiagnosed. This could be presented as meltdowns. Whilst my daughter does most definitely have ADHD, it was discovered at 11 that she has dyslexia, and more recently at 12, dyscalculia. That cannot have helped with her frustration and boredom levels! Sleeping can also be a big problem. Anyone that does not sleep can suffer from low mood, depression and probably a short fuse. We all know how we feel when we have not had a good night’s sleep. I would always recommend that these are the first things you rule out. As I say, I am no professional, just a mum offering my advice for what it is worth.
ADHD in Pre-schoolers and Medication
Due to the young age of these children, it is highly recommended that behavioural therapy be addressed first before even considering medication.
Supporting your Pre-schooler with ADHD
Become their emotional regulation. When they are angry, stay calm (I know this can be so hard sometimes, but fire and fire make one massive fire).
Validate their feelings when they are angry. Let them know you can see they are angry/sad whatever.
Do not try to teach them how they should have reacted at this time, they are far too heightened to hear you. A child’s brain is constantly developing. In fact, the human brain does not finish developing until the age of 25! The final part of the brain to develop is the frontal cortex. The frontal cortex is the part for higher cognition; memory, impulse control, problem-solving etc. It is the rational, thinking part! In a pre-schooler, this is nowhere near developed. So, in the heat of the moment, the emotional brain takes over. Part of this, the amygdala, is responsible for regulating our perceptions or reactions to aggression and fear. So, lecturing your child on correct behaviour at this point is, well pointless. They are using their emotional brain, not their rational one.
Let them know how loved they are. Let them feel safe. Give them times throughout the day to remind them of this, not just when there has been an outburst. Children with ADHD are highly likely to suffer from self-esteem issues due to all the negativity around their behaviour. Be sure to praise the good times!
My kids loved spending time with animals. They were (are!) such caring kids and animals can be very calming for them. Animals do not try and steal toys, answer back or enforce rules on them. They can be very therapeutic.
I still wish she had been diagnosed earlier. Not so I could put her on medication, but I could have understood what I was dealing with and I could have helped her more. Instead of parenting her as a neurotypical child, I would have understood more about triggers and strategies. More about what she needed.
ADHD diagnosis is not about getting a label, it is about knowing how to best help your child. You would not bake bread for the first time without looking at the instructions or just guessing that you make it like a cake. You would find the instructions specific to those ingredients. That is basically what a diagnosis gives you. Specifics to work with.
Early intervention is critical I now believe. I read recently that neurotypical babies learn to look away from situations/objects that are upsetting them. This helps them to self-soothe and control their emotions. Children with ADHD do not do that. I wish I could look back and see how DS and DD reacted. I did not know to look out for those sorts of behaviours! If I had known that maybe I could have guided her?
If you’ve read any of my other blog posts, you will know that I am a firm believer in going with your gut. Go to your doctor, discuss your concerns. Remember they will want to know how long you have noticed this behaviour and it has to be at least six months. Start keeping a diary so you can show them your evidence. It may be that your child does grow out of it as they mature. I would so recommend reading up on ADHD if you are concerned. I do wish I had known about ADHD so I could have intervened with my daughter early instead of trying to parent her as I did my neurotypical child. So many battles could have been saved. Good luck, reach out and go with your gut.
PS. I run a private FB support group for parents with children with ADHD, please feel free to join.
PPS. There are a few good ADHD books out there, I will list my favourites in the Useful Links at the bottom of the home page.