This week, the American Academy of Pediatrics revised its ADHD diagnosis and treatment guidelines to include preschool aged children as young as age 4, down from the previous minimum age of 6 years old.
When first hearing this news, parents might have a strong reaction, feeling a 4-year-old is too young to be assessed for ADHD. In most cases, that’s probably true, but the guidelines were expanded to provide a framework for professionals to handle special cases of truly hyperactive/inattentive children having trouble in preschool and at home.
It’s important to know that any professional making an ADHD diagnosis must follow very strict guidelines, especially when preschool-aged children are involved. As a clinical psychologist, with experience assessing children for ADHD, there are certainly challenges to making an accurate diagnosis in a 4-year-old. Given that 4-year-olds are developing and learning rapidly, it’s critical to understand that in order to diagnose ADHD, symptoms that are inappropriate for a child’s developmental level must have been present for at least 6 months. And a child’s inattention and/or hyperactivity must occur in more than one environment—your child should be observed by a professional or qualified teacher in his or her preschool or daycare environment, for example, not just in an office setting or at home.
If after a complete assessment, your child is diagnosed with ADHD, what treatment options are available for children as young as 4? According to the AAP, the first line of treatment should be parent or teacher administered behavior therapy. For a preschool aged child, behavioral interventions will typically involve some sort of reward for desirable behavior. Only “if behavior interventions do not provide significant improvement AND there is moderate to severe continuing disturbance in the child’s function” should the physician prescribe a medication such as methylphenidate (Ritalin), and only after weighing the risks of starting medication at such an early age.
Bottom line: With these new guidelines comes great responsibility for professionals diagnosing and treating ADHD in young children. If you suspect ADHD, talk to your pediatrician to determine what next steps, if any, are appropriate for your child.
—Andrew Schwartz, Ph.D., Consumer Reports survey research associate and a licensed clinical psychologist