ADHD in Five-Year-Old Children

Attention Deficit/Hyperactivity Disorder (ADHD) is a term often used in describing school-age children. When chil­dren enter the school environment and are required to sit in a seat and attend to auditory directions with 20 or more other five year olds around them, difficulties with attending skills often become apparent. The child who has difficulty following directions or waiting his turn or who acts differently from peers is often identified first by a kindergarten teacher as a child who may have ADHD. What exactly is ADHD, and how many chil­dren are actually identified with this disorder?

ADHD is defined by the Diagnostic and Statistical Man­ual P/ (DSM-IV) as a disorder characterized by two basic symptoms: inattention and hyperactivity-impulsivity. These symptoms can also be seen in combination. Onset is before age seven and has a duration of at least six months. Difficulties from these symptoms are present in two or more settings, and there is evidence of impairment in social, academic, or occupational functioning.

Inattention can be seen in children who make careless mistakes in schoolwork, have difficulty sustaining their atten­tion, appear not to listen to directions, or have difficulty follow­ing instructions. They often fail to complete activities, are disorganized and "scattered," are easily distracted by other things around them, and interrupt tasks to attend to minor noises or events that are easily ignored by others. Daily activi­ties can be easily forgotten, and inattention can be seen in difficulty in following a conversation or rules in a game. If six or more of these symptoms are displayed, the diagnosis would be considered ADHD, Predominantly Inattentive Type.

Fidgety, squirmy, out-of-seat behavior is often a manifestation of hyperactive behavior. Excessive running or climbing in situations that are inappropriate (for example, church or school), difficulty engaging in "quiet" activities, and excessive I talking are also signs of hyperactivity. Children who are unable to wait their turn and who interrupt and blurt out answers may be displaying signs of impulsive behaviors. Six or more of these symptoms would meet the criteria for ADHD, Predominantly Hyperactive-Impulsive Type.

Upon close examination, many of these "symptoms" would be typical characteristics if you were observing a two-year-old child. What is normal behavior for a toddler, however, becomes a significant problem for the three to five percent of children who are eventually diagnosed with ADHD. Their impulsivity, inattention, and hyperactive behaviors can often lead to difficulties in school and social problems. They also present a significant strain for parents who try to deal with an unman­ageable child.

Children with ADHD are often labeled early on as "bad" kids whose parents have little control over their behavior. They often have difficulty in nursery school because they can't fol­low a routine or have difficulty interacting with peers. At home, these children may not be able to sit at the table long enough to eat dinner or may be seen switching from one toy to another until every toy has been taken out of the closet. Yet parents often report that their child can sit for extended periods of time if they are interested in a video or playing a Nintendo game. This is not unusual and is often very typical of ADHD children. In a new setting, on a one-to-one basis, or when involved in an interesting activity, signs of ADHD may be minimal or absent.

A diagnosis of ADHD should only be made after ruling out other possible causes, including medical, emotional, and envi­ronmental variables that can cause similar symptoms. A multi-disciplinary evaluation should incorporate findings from medi­cal examinations; psychological, educational, and speech and language testing; behavioral rating scales completed by both teacher and parents, and a neurological evaluation.

Such characteristics as inattentiveness, impulsivity, and underachievement can also be seen in non-ADHD children who may suffer from emotional difficulties, such as depression or anxiety. A differential diagnosis, using the results of the multi-disciplinary evaluation, is therefore essential before an effec­tive treatment plan can be put into place.

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