Diagnosing children with attention deficit hyperactivity disorder can be difficult depending on the age of the child. The characteristic symptoms of the disorder, inattention, hyperactive behavior, and impulsivity, are more normative in young children than in school-age children. However, there are signs as early as the toddler years that may indicate the presence of ADHD.
Short Attention Span
Toddlers tend to have difficulty paying attention for extended periods of time, but toddlers with ADHD are less likely to sit and engage in a task for any length of time. The ability to focus and concentrate on even an interesting task is limited. Unstructured activities are especially hard, like completing a task independently, but even on structured activities, these children tend to quickly lose interest and struggle to complete any given task. As children become older and enter school, this inattention may present as careless mistakes, forgetfulness, losing supplies, avoiding difficult tasks and not listening to directions.
Hyperactivity and Poor Behavior Control
Toddlers with ADHD are likely to be very high energy, constantly moving. They may be somewhat clumsy and get hurt frequently because they are moving so fast. They tend to be unaware of and unconcerned about their parents' or caregiver's whereabouts, requiring constant supervision to ensure their safety. They also struggle to sit still, wanting to be in constant motion. These children may be more likely to have severe temper tantrums and difficulty getting along with other children. Their difficulty in regulating and monitoring their behavior makes it difficult for these children to think ahead and interact appropriately with other kids. Symptoms stay similar as children become older, with children struggling to stay in their seats, running or climbing excessively, and having trouble playing quietly.
While most young children can be impulsive in their behavior, children with ADHD tend to do so to an extent that can be harmful. They are likely to grab things from other children, hit others or even steal. Their impulsivity may put them in dangerous situations, such as running out into a busy street or running away from their parents in a large store. They tend to quickly jump from one activity to the next, wanting to move on to something new before the last activity is even finished. Impulsivity may continue to be dangerous in older children, or may present as trouble waiting for a turn and interrupting others' conversations.
Difficulty in Diagnosis
It can be particularly difficult to diagnose a child as young as 2 years old with ADHD. Many of the symptoms of the disorder are normal behavior for such a young child. However, the severity and degree of disruption may indicate that there is more going on. As children become older and enter school, the symptoms of the disorder tend to become more defined. In order to diagnose the disorder, symptoms must be present in two or more settings, so typically school behavior that matches home behavior is indicative of a problem. Symptom presentation changes with age, so children should be closely monitored over time to determine if a diagnosis or intervention for ADHD is warranted.