While the features of ADHD are common in the under-five age group, it doesn’t necessarily mean they have it, but rather that diagnosis before five is challenging.
“Toddlers are rapidly developing, so if they are showing features of ADHD, they may grow out of those features as they mature,” explains Dr Poulton.
“The key concern is whether the child is going to outgrow those features sufficiently to be able to manage once they start school.”
Dr Poulton explains that ADHD affects a child’s learning as they find it difficult to concentrate on a task.
“For ADHD children to be successful in a task, that task has to be short, easy or sufficiently interesting, motivating or rewarding for them to carry that concentration through,” she says.
“Quite a lot of tasks at school require a level of concentration and time, and a child with ADHD may not have the patience to put the time into that task.
“If they aren’t concentrating and engaged in the task, they may start to get bored and become disruptive to their peers.”
It is also important to understand the impact a child with ADHD may have on the family.
If parents notice that their child’s behaviour is making them unduly stressed, if it’s impacting on their relationship, on their mental health and on the family dynamics, Dr Poulton says these signs should not be dismissed.
“My approach is not to look for a problem until there is a problem that you can’t ignore,” advises Dr Poulton.
“I would prefer to give preschool children the benefit of the doubt for as long as possible to avoid diagnosing a child who may be exhibiting normal preschool behaviour, instead of ADHD.
“Essentially, some questions to think about are, is this child causing unreasonable stress or disruption within the family and is the child unmanageable in a preschool as they are always getting angry and hitting out at other children?”
What can parents do?
Children tend to be diagnosed with ADHD once they start school as they don’t meet the cognitive demands of schooling.
Dr Poulton recommends that children with the signs of ADHD should not start their primary schooling too early.
“A child at school has to be able to sit and concentrate to get through a task,” she explains.
“Every year a child is at school, the tasks become more demanding.
“If a child is one of the youngest in the year, the tasks they are presented with may be harder for them than their peers.
“A bright child with ADHD might cope with the demands in the early years of school as they don’t have to concentrate too long to pick up the skills.
“As they go up in the years, the demands of the tasks might go beyond their ability to cope.
“They may reach a stage where they can’t meet the demands on their concentration.
“This is likely to happen sooner in children who are young for their school year.”
Dr Poulton recommends good classroom management by the teacher as one of the strategies to support the child through the learning environment.
She also recommends parents of ADHD children take their parenting level to ‘super parenting’ and be consistent in the behaviour management strategies they use.
“This doesn’t mean that the parents aren’t good parents or haven’t been parenting their child properly, rather that they need extra skills to be able to cope and manage a child with ADHD,” she adds.
Dr Poulton suggests parenting courses such as 123 MAGIC, Circle of Security and Triple P Parenting.
Parents need to remember that ADHD is not due to bad parenting, but it is an inherited condition and parents need to support each other and avoid allocating blame.
Finally, a paediatrician may prescribe stimulant medication which has been found to be effective in improving a child’s concentration, impulse control and hyperactivity.