Harvard Mental Health Letter

Preschool attention deficit disorder

New studies show that both drugs and parent training can be effective.

Attention-deficit/hyperactivity disorder (ADHD) is no longer just for schoolchildren. As we have been learning, it can be a lifelong disorder: the symptoms of impulsiveness, inattentiveness, and hyperactivity may occur at any age. At one end of the age scale, adult ADHD is taken increasingly seriously. At the other end, ADHD has already become the most common diagnosis for children ages 3–5 who are referred to mental health professionals. Researchers have begun to explore more systematically the use of drugs and other treatments for these preschoolers.

Applying to adults a diagnosis originally derived from the symptoms of school-age children has presented some problems; different problems arise when the diagnosis is used for younger children. It's difficult enough to define standards of hyperactivity, impulsiveness, and inattentiveness for schoolchildren. A three- or four-year-old, not spending most of the day in a classroom, is not facing the same demands for paying attention and following rules. At that young age, being fidgety or inattentive could be considered normal. To show that something more is involved than kids being kids, clinicians and researchers compare a child with others the same age to determine whether the symptoms are, as the American Psychiatric Association's diagnostic manual says, severe, frequent, persistent, and "inconsistent with developmental level."

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