Does your toddler or preschooler struggle with hyperactivity, impulsivity, or inattention? Are they prone to tantrums or appear overly sensitive? If so, you may wonder if these are just normal phases of childhood, or if they indicate attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD).
Many children can demonstrate the early signs of ADHD, such as restlessness, outbursts, or lack of concentration. Parents may expect them to “grow out” of these tendencies by their later years. But if they do have the neurodevelopmental condition and carry it into adulthood—especially if they remain undiagnosed and/or untreated—it can negatively impact their entire lives.
Today, we have more knowledge than ever about this common mental health condition, which affects 7 million (11.4%) children ages 3-17, according to the Centers for Disease Control (CDC). Children who are found to meet the criteria for ADHD can be diagnosed as early as 4 years old.
Recognizing the earliest warning signs of ADHD is key to getting kids the help they need. In this blog, you’ll discover seven ADD symptoms every parent needs to know.
EARLY-CHILDHOOD RISK FACTORS FOR ADD/ADHD
A retrospective study of risk factors for ADHD in different stages of infancy found that eight elements were significantly associated with the condition’s later development. At 0-1 month old, these factors were:
- Advanced maternal age
- Lower maternal education
- Family history of ADHD
- Social problems (such as divorce, socioeconomic difficulties, and parental illness)
At 3 and 18 months, a decrease in head circumference growth was associated with later ADHD. And, at 9 and 18 months, there were correlations found between ADD, delays in motor and language development, and having a difficult temperament.
A 2023 systematic review of 48 articles also found that temperament in infancy or toddlerhood could indicate an early risk for childhood ADHD. Moderate associations were found with activity level, negative emotionality, and sustained attention.
The first two of these were found to be “predictive of all three symptom dimensions (i.e., inattention, hyperactivity/impulsivity, and combined).” The third, sustained attention, was associated only with combined symptoms.
Further research will help explore the links between ADHD’s development and sustained attention and inhibition in a child’s earliest months and years.
Finally, in an overview published in Health Psychology Research, a variety of genetic, neurobiologic, and neurochemical factors were explored as contributors to ADHD in young children. These include:
- Heredity and genetics
- Brain structure, neurobiology, and neuropsychology
- Cognitive dysregulation
- Pregnancy or birth complications
- Exposure to environmental toxins
- Parenting styles
- Diet
EARLY SIGNS OF ADD/ADHD
What does this mean for parents who are concerned about possible early symptoms of ADHD in their child? Here are some early signs of ADHD to look out for in your toddler or preschooler:
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Poor coordination and a tendency to be accident-prone.
The overview mentioned above notes that ADHD in children can manifest with poor motor coordination or motor performance and balance.
These children are also more prone to accidental injuries and physical trauma, including head trauma, which itself can lead to or exacerbate ADHD symptoms.
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Impulsivity.
One of the hallmarks of ADHD, impulsivity in a preschooler or toddler may present itself as speaking before thinking, impatience while waiting, or interrupting others.
An impulsive child may also yell or scream when they’re frustrated, get physical with other kids, or run into the street without looking for oncoming vehicles.
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Impaired academic performance.
Once a child reaches preschool, their performance may already be compromised by the academic challenges associated with ADHD. One of the early signs of ADD in preschoolers, trouble with paying attention, impacts their ability to learn in a traditional classroom.
Parents working with their child’s teachers may be instrumental in helping children with ADHD perform better, which is one benefit of early diagnosis.
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Sleep disruption.
A 2022 study published in Frontiers in Pediatrics noted that children with ADHD are more likely to have sleep disorders.
This association works in both directions. Not only does the degree of ADHD symptoms correlate with sleep disorder severity, but sleep disorders can trigger or worsen the symptoms of ADHD.
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Sensitivity and intense emotions.
In the retrospective study mentioned above, researchers found that temperamental and behavioral problems in children 9 and 18 months old are “an important predictive factor for the development of ADHD.”
This may take the form of excessive crying during infancy. Later, these children displayed issues with sensory integration, attention, and behavioral development.
Emotional hyperarousal, emotional dysregulation, and rejection sensitive dysphoria are some of the common emotional issues faced by those who have ADHD.
Parents may notice that their child has intense reactions or stays “stuck” in emotions for longer periods than would be expected. Or perhaps their child has more, or longer-lasting, tantrums and outbursts, or frequently shows signs of frustration.
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Behavioral issues.
A 2021 study reported that 40% to 60% of children with ADHD also have oppositional defiant disorder (ODD). Another behavioral disorder that may overlap with ADHD is conduct disorder. Harming oneself and/or others (with behaviors such as biting) may also become an issue in children with ADHD.
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Constant movement.
Young children with ADHD can be excessively restless or fidgety, with difficulty sitting still and paying attention. They may be constantly in motion and excessively talkative. Parents may have trouble getting them to sleep, eat a meal, or focus on tasks.
TREATING ADHD IN TODDLERS AND PRESCHOOLERS
According to the American Academy of Pediatrics’ (AAP) Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, ADHD criteria can be applied to children as young as ages 4-6. The guidelines advise medical professionals to note symptoms across multiple settings, such as home and preschool.
The most common treatment prescribed at these early childhood ages is parent training in behavior management (PTBM). The AAP explains that this consists of helping parents learn:
- What to expect in terms of age-appropriate development
- Behaviors that will help strengthen the parent’s relationship with the child
- Useful skills to help manage problem behaviors
Parents who have spent time implementing and incorporating these strategies at home can then report their results to the medical professional, as well as provide a picture of the child’s persistent symptoms and struggles. This enables a more accurate ADHD diagnosis.
Brain SPECT scans can also help in the diagnosis of ADHD in toddlers and preschoolers. Because there are seven different types of ADD/ADHD, it’s crucial to pinpoint which type is interfering with a child’s development. With brain scans, clinicians can then determine an effective and personalized treatment plan.
Many doctors rely on prescription medications for childhood ADHD, and they can be highly beneficial for some kids. However, stimulant medications are not effective for all ADD types—and they may even cause harm. In addition to ADHD medication or in lieu of it, children can reap significant benefits from all-natural lifestyle changes, including:
- An elimination diet that removes sugar, gluten, dairy, corn, soy, and artificial dyes and sweeteners from the diet (to rule out potential allergies)
- A higher-protein, lower-carbohydrate diet
- More exercise
- Sleep hygiene and increased sleep duration
- Less screen time
- Supplements such as omega-3 fatty acids
Parents can also help by rethinking traditional discipline measures, which may not be helpful for children with ADHD. Instead of yelling, threats, and anger, these children tend to respond to different strategies. Remaining calm and positive will help better guide their behavior.
Finally, because there is a genetic component associated with the condition, parents of children with attention problems may want to undergo screening for ADHD themselves. At Amen Clinics, many adults with ADHD only learn about their condition after bringing in their child for an evaluation.
HELPING ADHD TODDLERS, PRESCHOOLERS, AND PARENTS
It’s never easy to be a parent. But it can be even more challenging when you’re parenting a child who shows the early signs and symptoms of ADHD.
Fortunately, we know more than ever about what to watch for in our toddlers and preschoolers—as well as the benefits of early diagnosis. With vigilance, patience, and understanding, we can help ensure that they are given the best chance of success in life.
Reviewed by Amen Clinics Inc. Clinicians
