Experiences with ADHD in Preschool

[Anonymous]

Based on ongoing issues in school and at home (regulation, sensory processing, and other), and after consultation with school counselor and special services team, I took my preschool child to get a neuropsych exam with a psychologist experienced with dealing with kids in this age group. The psychologist was recommended by the school. She did 2 days worth of exams, conducted a classroom observation, and interviewed at least one teacher. She prepared a detailed report that resulted in a diagnosis of ADHD. I took the report and diagnosis to our pediatrician to consult on options. Pediatrician dismissed the diagnosis out of hand. She outright scoffed and essentially criticized the psychologist because she did not believe that children this young could be diagnosed or should be diagnosed with ADHD. And, she basically cross-examined me on the reasons leading up to getting the neuropsych in the first place. I was quite taken aback and not remotely expecting that type of response. I found the whole exchange upsetting. At this point, I am not sure who is out in left field - the pediatrician or the psychologist.

Are there others here who have recently had a preschool child diagnosed with ADHD, and if so, what was your experience?

[Anonymous]

Public or private school OP?

Typically neuropsychological exams aren't given or considered very reliable until ~6. If a diagnosis is given that young it usually comes from a developmental pediatrician.

[Anonymous]

Sounds very unusual to have a diagnosis this young.

[Anonymous]

We got one then. Not that unusual. Severe ADHD isn't subtle.

[Anonymous]

How old is your child?

Personally I would change pediatricians if mine scoffed at or dismissed any issue that I was concerned about. There are ways to present other points of view, but that's not it!

Find a child psychiatrist. You may not need to consider medication at this age, but that is the person you want to start building a relationship with, who will know your kid and the baseline behaviors and will be able to make a recommendation on when and if it's time to consider meds. (Psychiatrists have much more experience than pediatricians in this area.)

[Anonymous]

I have been told by multiple therapists (child psychologist, child psychiatrist, and OT) that ADHD would not be diagnosed in a 3-4 year old unless the hyperactive behavior was extremely severe and distruptive, like they literally can't focus enough to eat, run into the street constantly, danger to themselves. I don't know if this is what you are dealing with. In our case I strongly suspect we will get an ADHD diagnosis in a few years but the most anyone had ever said to us now (at 4) is "keep tabs on his attention."

[Anonymous]

Anonymous wrote:I have been told by multiple therapists (child psychologist, child psychiatrist, and OT) that ADHD would not be diagnosed in a 3-4 year old unless the hyperactive behavior was extremely severe and distruptive, like they literally can't focus enough to eat, run into the street constantly, danger to themselves. I don't know if this is what you are dealing with. In our case I strongly suspect we will get an ADHD diagnosis in a few years but the most anyone had ever said to us now (at 4) is "keep tabs on his attention."

This is what we have, diagnosed at 4.

[Anonymous]

Anonymous wrote:I have been told by multiple therapists (child psychologist, child psychiatrist, and OT) that ADHD would not be diagnosed in a 3-4 year old unless the hyperactive behavior was extremely severe and distruptive, like they literally can't focus enough to eat, run into the street constantly, danger to themselves. I don't know if this is what you are dealing with. In our case I strongly suspect we will get an ADHD diagnosis in a few years but the most anyone had ever said to us now (at 4) is "keep tabs on his attention."

I'm not sure why the therapists told you that, but my kid didn't meet any of the criteria you listed and was diagnosed at 4 by a developmental pediatrician. His behaviors were never this extreme. We waited until school age to start medication, especially b/c the behaviors got worse.

OP, I think what you need is a differential diagnosis. I would make an appointment at Children's or KKI with a developmental pediatrician. It will take a while, but I think will be worthwhile to have some confirmation.

In the mean time, I'd look into behavioral therapy as well as try to a functional behavioral assessment with the preschool so that he gets the support he needs in the classroom. If they don't want to do this, I'd look for another preschool.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have been told by multiple therapists (child psychologist, child psychiatrist, and OT) that ADHD would not be diagnosed in a 3-4 year old unless the hyperactive behavior was extremely severe and distruptive, like they literally can't focus enough to eat, run into the street constantly, danger to themselves. I don't know if this is what you are dealing with. In our case I strongly suspect we will get an ADHD diagnosis in a few years but the most anyone had ever said to us now (at 4) is "keep tabs on his attention."

I'm not sure why the therapists told you that, but my kid didn't meet any of the criteria you listed and was diagnosed at 4 by a developmental pediatrician. His behaviors were never this extreme. We waited until school age to start medication, especially b/c the behaviors got worse.

OP, I think what you need is a differential diagnosis. I would make an appointment at Children's or KKI with a developmental pediatrician. It will take a while, but I think will be worthwhile to have some confirmation.

In the mean time, I'd look into behavioral therapy as well as try to a functional behavioral assessment with the preschool so that he gets the support he needs in the classroom. If they don't want to do this, I'd look for another preschool.

they told me that because ADHD is diagnosed and it is extremely hard to distinguish between normal 3-4 year old behavior and abnormal. The criteria are very subjective. Even just a year later (now close to 5) it has become much more clear what aspects are what. eg he has a fine motor delay and now it's easier to tell what is short attention span, and what is frustration with legitimate challenges. Also I think it might have to do with the fact that it would be very hard to justify medicating a 3 year old if the symptoms weren't having extreme impacts (eg risking their life by running into the streets). Later when the academic impacts are relevant the calculus would change.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have been told by multiple therapists (child psychologist, child psychiatrist, and OT) that ADHD would not be diagnosed in a 3-4 year old unless the hyperactive behavior was extremely severe and distruptive, like they literally can't focus enough to eat, run into the street constantly, danger to themselves. I don't know if this is what you are dealing with. In our case I strongly suspect we will get an ADHD diagnosis in a few years but the most anyone had ever said to us now (at 4) is "keep tabs on his attention."

I'm not sure why the therapists told you that, but my kid didn't meet any of the criteria you listed and was diagnosed at 4 by a developmental pediatrician. His behaviors were never this extreme. We waited until school age to start medication, especially b/c the behaviors got worse.

OP, I think what you need is a differential diagnosis. I would make an appointment at Children's or KKI with a developmental pediatrician. It will take a while, but I think will be worthwhile to have some confirmation.

In the mean time, I'd look into behavioral therapy as well as try to a functional behavioral assessment with the preschool so that he gets the support he needs in the classroom. If they don't want to do this, I'd look for another preschool.

they told me that because ADHD is diagnosed and it is extremely hard to distinguish between normal 3-4 year old behavior and abnormal. The criteria are very subjective. Even just a year later (now close to 5) it has become much more clear what aspects are what. eg he has a fine motor delay and now it's easier to tell what is short attention span, and what is frustration with legitimate challenges. Also I think it might have to do with the fact that it would be very hard to justify medicating a 3 year old if the symptoms weren't having extreme impacts (eg risking their life by running into the streets). Later when the academic impacts are relevant the calculus would change.

No it's really not.

[Anonymous]

It's not hard to distinguish and nobody is medicating three year olds. It's just goal post shifting really. They've always said that ADHD is not a developmental disability and recent research indicates that sometimes ASD is odds ignored as ADHD at a young age. But that's not really the case. It's like the kids with pdd nos back in the day - most went on to have ADHD. Minor delays, plus hyperactivity and a low attention span but not social connection - who knows if it's a different form of spectrum or what. But I knew my son had ADHD at 3. He did. I could tell you know in my daughters class what kids have ADHD at 3. Maybe some will grow out of it a bit.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have been told by multiple therapists (child psychologist, child psychiatrist, and OT) that ADHD would not be diagnosed in a 3-4 year old unless the hyperactive behavior was extremely severe and distruptive, like they literally can't focus enough to eat, run into the street constantly, danger to themselves. I don't know if this is what you are dealing with. In our case I strongly suspect we will get an ADHD diagnosis in a few years but the most anyone had ever said to us now (at 4) is "keep tabs on his attention."

I'm not sure why the therapists told you that, but my kid didn't meet any of the criteria you listed and was diagnosed at 4 by a developmental pediatrician. His behaviors were never this extreme. We waited until school age to start medication, especially b/c the behaviors got worse.

OP, I think what you need is a differential diagnosis. I would make an appointment at Children's or KKI with a developmental pediatrician. It will take a while, but I think will be worthwhile to have some confirmation.

In the mean time, I'd look into behavioral therapy as well as try to a functional behavioral assessment with the preschool so that he gets the support he needs in the classroom. If they don't want to do this, I'd look for another preschool.

they told me that because ADHD is diagnosed and it is extremely hard to distinguish between normal 3-4 year old behavior and abnormal. The criteria are very subjective. Even just a year later (now close to 5) it has become much more clear what aspects are what. eg he has a fine motor delay and now it's easier to tell what is short attention span, and what is frustration with legitimate challenges. Also I think it might have to do with the fact that it would be very hard to justify medicating a 3 year old if the symptoms weren't having extreme impacts (eg risking their life by running into the streets). Later when the academic impacts are relevant the calculus would change.

No it's really not.

Severe ADHD is not what I'm talking about. I am talking about the 3 year old who is extra wiggly, tempermental, and uninterested in playing with blocks for long periods of time. That is hard to diagnose at 3. By 5-6 becomes much more clear. This is what I have been told by more than one professional.

[Anonymous]

Anonymous wrote:It's not hard to distinguish and nobody is medicating three year olds. It's just goal post shifting really. They've always said that ADHD is not a developmental disability and recent research indicates that sometimes ASD is odds ignored as ADHD at a young age. But that's not really the case. It's like the kids with pdd nos back in the day - most went on to have ADHD. Minor delays, plus hyperactivity and a low attention span but not social connection - who knows if it's a different form of spectrum or what. But I knew my son had ADHD at 3. He did. I could tell you know in my daughters class what kids have ADHD at 3. Maybe some will grow out of it a bit.

lol I am sure you can diagnose all those 3 year olds by looking at them. Give me a break.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It's not hard to distinguish and nobody is medicating three year olds. It's just goal post shifting really. They've always said that ADHD is not a developmental disability and recent research indicates that sometimes ASD is odds ignored as ADHD at a young age. But that's not really the case. It's like the kids with pdd nos back in the day - most went on to have ADHD. Minor delays, plus hyperactivity and a low attention span but not social connection - who knows if it's a different form of spectrum or what. But I knew my son had ADHD at 3. He did. I could tell you know in my daughters class what kids have ADHD at 3. Maybe some will grow out of it a bit.

lol I am sure you can diagnose all those 3 year olds by looking at them. Give me a break.

I can certainly tell what's outside the bounds of normal behavior. Sorry. It's not that hard.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It's not hard to distinguish and nobody is medicating three year olds. It's just goal post shifting really. They've always said that ADHD is not a developmental disability and recent research indicates that sometimes ASD is odds ignored as ADHD at a young age. But that's not really the case. It's like the kids with pdd nos back in the day - most went on to have ADHD. Minor delays, plus hyperactivity and a low attention span but not social connection - who knows if it's a different form of spectrum or what. But I knew my son had ADHD at 3. He did. I could tell you know in my daughters class what kids have ADHD at 3. Maybe some will grow out of it a bit.

lol I am sure you can diagnose all those 3 year olds by looking at them. Give me a break.

I can certainly tell what's outside the bounds of normal behavior. Sorry. It's not that hard.

it is actually very hard to make judgments about normative 3 year old behavior when it comes to attention and activity level (particularly in a class that spans a whole year + in ages). even harder to attribute any perceived outlier behavior to a specific diagnosis. people like you are exactly why adhd is overdiagnosed.