Getting a Diagnosis for ADHD in Preschool

Archived Q&A and Reviews

ADHD in a 3-year-old?

Feb 2010

Hello All, I have a good friend whose son was diagnosed with ADHD, and he's 3. We both find this rather crazy, as most three year olds are well, a little crazy. Although she does say that while in preschool she can see he's different. Here is the issue, the pediatrician.

The doctor said because of the aggression and his flight response he wants to do meds and then come up with a plan. She feels the exact opposite.

Calling all parents of kids with ADHD. Books, websites, tips whatever you got. She does not want to do meds, he is only 3 after all.

I recently moved here from Washington state where I was on a team that conducted developmental evaluations of children under the age of three. I strongly encourage this parent to seek the advice of another pediatrician and/or pursue a developmental evaluation through your local school district. I do believe this is much too young to make a diagnosis of ADHD and to medicate on that basis alone. If the child's behaviors are truly dangerous to himself or others, medication may be warranted (a second opinion would certainly be appropriate), but there should be severals attempts at behavior modification before that point. A thorough evaluation would work to rule out sensory processing differences and medical anomalies, including vision or hearing concerns first. In addition, I would expect that preschool teachers and parents be interviewed at length and the child observed in both home and school settings if possible, to gain a thorough understanding of the problem behaviors -- both what the triggers and typical consequences are (sometimes called a Functional Behavior Analysis). Good luck to your friend. Amy

In my opinion a parent should not give ADHD meds to their 3 year old child unless that parent is comfortable doing so. My child was diagnosed with ADHD at age 4. Both the doctor and I opted to wait until my child was in Kindergarten to determine whether or not to prescribe meds. My child is now 6 and I'm convinced that medication is the right way to go, however, I needed time to research and evaluate my child before becoming comfortable with this decision. Good luck! ADHD Mom

Your friend is right to be extremely cautious about medicating a 3-year-old and I applaud her for finding other ways to deal with her son's behavioral issues. A few thoughts: 1) You said the pediatrician wants to medicate because of aggression and flight response. Neither of these is a symptom of ADHD. And aggression, in general, does not improve when ADHD meds are given. Aggression needs to be treated behaviorally (with rewards for not being aggressive, and carefully administered negative consequences when the child is aggressive). 2) Pediatricians who do prescribe meds for ADHD do so because that is their only resource. They can't provide behavioral therapy or other alternatives. Your friend should find a psychologist or psychiatrist, or even a developmental pediatrician, who is not inclined to medicate and can offer other treatment strategies. She could start with the San Francisco Bay Area Center for Cognitive Therapy ( 3) Websites: and Liz O.

Since his mom sees his behavior is ''different'' from other kids in his class, it would be good to help him in whatever way seems best to the family. I think this little boy is very lucky to have people like you looking out for him, and staying on the case, because you want this child to have positive experiences at school in the next several years.

My main point is, you want to avoid the scenario where everyone decides to wait-and-see, and in first grade the child is still hitting a lot and ends up being avoided or in trouble at school. We have one good friend with ADHD, whose behavior is mostly fine, and who is on medication (but is much older than your friend's child.) It has been a lot of work for the parents, but their son is doing well. anon

Po Bronson (''NurtureShock'') has written about the connection between ADHD and sleep disruption caused by snoring and other problems. He says that 25 % of cases of ADHD have been helped by having the child's tonsils removed. Evidently some very serious brain development occurs during certain stages of sleep, and when that sleep is disrupted, it can have long-ranging effects. Lisa in Oakland

Three years old is probably too young to start most medication. I started trying to get my daughter diagnosed when she was about 4 years old. It tool several years just to get hte diagnosis to get medication. Meanwhile I tried auditory processing therapy which did do some good and you might try that for a child under 5 with ADD/ADHD. You might also try cutting out all sugar and certain other foods. Cut out as much television and video and computer games a possible and no TV, etc. for at least a half hour before bedtime to let their brains rest. (This is actually the hardest thing to do because if spouse is in there watching a football game or someone is working on the computer, its very hard to get junior to NOT do the same thing as everyone else in the family.) There are certain neurological stimulation therapies that some clinics do also. I think that normally, most kids won't start medication until age 5 or 6. For most insurances, the diagnosis of ADD/ADHD has to indicate that the problem satrted before they were age seven and rule out any head injuries or other problems. My daughter was in the 4th grade before I got a diagnosis and then I had trouble getting souse on board with the medication. Some kids cannot handle the medication. Some kids recognize that it makes them feel better. Both parents have tobe positive about the medication. By itself, it won't fry your child's brain and studies show that children with ADD/ADHD who are not treated as children are more likely to use drugs and alcohol as adults to ''self medicate.'' I think it is pretty well accepted that most people do not ''outgrow'' ADD/ADHD. Some people just learn to handle it better as they get older. Others need medication throughout their life. It is also familial. So medication - if the child can tolerate it - is a good thing if other avenues don't work but its also important to get them started early because once those kids hit middle school things get really tough. I think 4 to 5 years old is the best time to start medication - you could wait until part way through Kgarten to see if adding medication improves his attention and behaviour in that environment so that you have a basis to go by. parent of ADD child

Has anyone thought about speech and language processing issues in this child? I would at least suggest a consult with a Speech and Language Pathologist. Frustrated communication can manifest in behaviors like this. There was lots of good food for thought in the other posts. Linda