Can a child under 5 be correctly diagnosed with ADHD?

if your older son has the diagnosis, there is a higher probability the younger one does as well

OTOH, its also the first thing your mind will jump to because of the dx

I would put off medication myself but I see no harm in getting an evaluation done

That said, the behavior you describe is not that out of whack for any preschool age child. I taught Montessori preschool for more years than I wish to admit and now work with 0-3 yr olds in Early Intervention

IMO, parents focus in on the best behaved kid they see at the grocery store or the amusement park and become bothered that their child is not like THAT.

Some kids NEED to have their hand held for years. Some kids need to be kept in the grocery cart or left with a sitter.

Ive heard good things about ‘1,2,3,Magic’ on the boards-in fact it was just recommended by a therapist for a rambunctious 2 1/2 yr old I see. I think ADHD kids need immediate feedback. Explaining and excessive talking dont work because they simply cant attend long enough to ‘hear’ much less remember and follow through(ALL weaknesses for a ADHD kiddo). Yet, parents today are encouraged to parent in that manner.

JMO but I think Id try at home remedies at this age

The above post makes a lot of sense. The ADHD “diagnosis” is very subjective and involves a lot of behaviors that are totally normal for a toddler, or even a 4 or 5 year old child, especially if they are male. It is also important to keep in mind that, while medication may have some positive effect in the short term on behavior problems, there is no indication in the literature that ADHD kids on medication do any better on long term acedemic or social measures than kids who are not.

You are fortunate to have seen the issues early and probably have learned a few tricks from your first child. I would suggest that you apply yourself intensively to teaching him to learn self-control right now, while you still have control of the situation. I have a 7-year-old boy who was just like that at 2. We worked really hard with him, and now his first grade teacher can’t believe that he was ever “hyper”. He still has his moments, but he has learned that there are times to be wild and times to be calm, and he can be calm when he wants to. I actually believe (from direct observation) that these children DO have the ABILITY to behave differently in most cases. As Russel Barclay suggests, it is more of an issue of MOTIVATION. These kids need to have a strong reason to behave, they don’t just go along with the program because they are asked to. While this can be realy annoying for us as parents, it is actually a vital quality that too few adults possess - the willingness to question the “status quo” and do what is right even if it means encountering disapproval. It’s more a matter of teaching them when and where it is OK to be challenging, and when it is just too annoying or will get them into trouble. I have found that, whenever I can create a situation where my SON’S goals depend on his behaving, lo and behold, he can behave just fine. So I make sure that he has to be doing his part before he gets any free services out of me. If he wants me to cooperate with him, he has to play the game fairly. While he doesn’t like this sometimes, he has learned that there is no way to manipulate or pressure me into giving in, except by doing as expected. That way, he still can get what he wants, but he has to give me what I want, too. Mutual respect.

Hope that is helpful.

–- Steve

While I don’t see any harm in an evaluation, many doctors would be reluctant to give him a difinitve diagnosis. In a child, the neurons are still growing and developing until the age of 7. Some doctors will not medicate at all until age 6 or 7 due to these facts, so that right there was something that made me uncomfortable. The controversy was enough to keep me from trying meds on my son until he was 7. But I do not walk in your shoes and if the Q of life for him and your family is in jeopardy, only you will be able to weigh the options. On one hand, he might be developing slowly and needs more time to learn self control. On the other hand, if its hurting his relationships, self esteem and general happiness, it might be very hard for you to let him go untreated. Its a tough call for any of us. I was fortunate in that my son wasn’t H and didn’t have behavior problems. I might have made different decisions if he was.

The ADHD dx is nebulous at best so when I hear the word mild to moderate I tend to become skeptical of the original DX.

I would not consider even diagnosing a child under the age of 8yrs and I would not medicate if ever until after 10yrs and other methods have been given an opportunity to work and all other causes of the symptoms that add up to ADHD are ruled out.

By 10 yso you could have quite mess on your hands. Children that go untreated will too often self medicate and not in good ways. Throwing temper tantrums, developing ODD, starting fights, violent and self punishing behaviors are all stimulating to the brain chem. A child will realize how much better he feels after he has raised some hell and made everyone miserable. Not all kids turn out this way, but the odds are pretty scarey and when the end result is ODD or conduct disorder, just try telling them “OK, time for your pill, sweety pie.” About as easy as saying, “Put down the knife and step away from the cat, honey”.

Its hard to determine when the right time is, or when it will be too late. But rest assured, there is often a too late point. Our Jails are overwhelmingly full to capacity with untreated ADDer’s. Every kid is different and unless you have a crystal ball, you are playing Russian roulette with your childs social life, education, happiness and emotional well being by not medicating. The choice is the parents, but the consequences are the childs.

Just a few ideas to bounce around while you wait until their 10th birthday

My parents never medicated me until much damage was done. I’m an adult now with kids of my own. I feel very bad they got it from me. At 10 years old, I was already lying and cheating and stealing and cutting myself. Too much damage by the age of 10. Their problems should be addressed sooner than that. Unless you are home schooling, I say do whatever needs to be done by 1st grade. Its cruel to let a child suffer when they don’t have to. I’ll never forgive my parents for waiting until I was bleeding to get me help.

Before we scare too many people, let us all remember that the reviews of research on long-term outcomes do NOT support the idea that medication as treatment has ANY impact on whether a child becomes delinquent, drops out of school, or even feels better about themself. I refer you to Barkley, R.A. and Cunningham, C.E., Clinical Pediatrics (17) p. 85-92 “Do stimulant drugs improve the acedemic performance of hyperactive children?”, as well as JS Swanson’s “Riview of Reviews” in 1993 in “Exceptional Children”. There have been other review since, and none have been able to refute the conclusion that stimulants are at best a short term intervention that affects the “core symptoms” (hyperactivity, impulsiveness, and inattention) to allow other approaches to be developed and implemented. While impulsive children are clearly more inclined to do impulsive things, and while failing to intervene in SOME way with these children can lessen the probability of a positive outcome, it is clear that the value of medication as a first line treatment has been VASTLY overrated.

This doesn’t mean that I am criticizing folks who make that choice, or that there are not situations where medication really makes a difference in the long term for a particular child or family. But if there are such cases of success, they would have to be balanced out by an equal number of situations where outcomes are made WORSE by medication intervention - hence, they would average each other out to no overall positive gain. So medication is not a panacea or automatic cure to the effects of impulsivity. In fact, it is quite possible (and this is also supported in the literature) that kids receive LESS personal attention after being put on medication, because in some cases, they become more compliant and less demanding of attention.

I have a 7-year-old boy who clearly met ALL the criteria for ADHD, and probably ODD as well, as a three year old. We talked about his hyperactive tendencies with his first grade teacher at the end of the last school year, and she was totally amazed to think that he had anything approaching and ADHD profile. We had been well educated by our oldest child (who also met all the criteria, and is now 19, graduated from HS with honors, and never used medication) and had learned a wide range of creative and mostly fun approaches to teach Kevin that he DID have the ability to control his behavior, and that we expect him to choose to control himself in certain settings. Over the course of several years, he has learned to make decisions rather than do whatever comes into his head. He still can be extremely difficult at times, but no one these days would view him as ADHD, even though at 3 or even 4, he clearly met all the criteria.

There are other ways to approach this kind of problem besides or in addition to medication. There are WAY too many variables to make generalizations about what to do. I believe each and every one of us is responsible to make the best parenting decisions we can. Creating fears about possible future damage is not productive in my view. It is also important to keep in mind that medication can have some really drastic side effects in some cases, and that even “mild” side effects may be very distressing to children and have to be weighed carefully against whatever benefits may occur.

I encourage the writer to look over her options and carefully consider the pros and cons of a diagnosis or of medication. I want her to know that there are other options, and that the decision to medicate or not is NOT a make-or-break decision that will irreversibly decide her child’s future success. I encourage her and anyone to be fully infomed of all sides of this very controversial debate, and then decide in accord with his or her own family values. To pretend that we understand enough about this problem to tell everyone else what to do is a big mistake. Everyone has to find their own path, and medication is only one of many possible choices that can lead to a successful future.

–- Steve

I have read very new, reputable genuine studies that do indeed prove children left untreated have a higher rate of drug abuse and criminal behavior.

Please share references. I will stress again that 35 years of studies have not shown any such improvements. Science is based partly on the ability of studies to be replicated. New studies have often shown certain results only to be refuted by later studies. At earlier times of our scientific understanding, Thalidomide was supposed to be safe, Benzadrine was supposed to be non-addictive, and formula feeding was conisdered healthier than breastfeeding. There are endless examples. Reviews serve the purpose of looking over a large number of studies to see if replication of findings leads us to any conclusions. So far, the conclusions are pretty clear. I am always open to new data, but I need to read the studies, and they need to be replicated.

In any case, it is clear that many “non-treated” children do very well, including two of my three. I am not arguing against medication for those who find it helpful. I am arguing against the blanket assumption that all or most children who go unmedicated are destined for a grim future, and that all or most children who are medicated will turn out great. The literature doesn’t support those conclusions, nor does my personal experience. There are too many other variables to think that giving medication is the best or only answer in every case. We all have to make up our minds, and I think it is fair to point out that alternatives exist to medication, and that the benefits of medication, while sometimes quite dramatic, appear to be primarily in the short term in the overall picture, and that they definitely don’t work for everyone even in the short term. People should know this before making their decisions. There is a lot more involved in raising these special kids than just deciding whether or not to medicate.

–- Steve

[quote=”Anonymous”]I have read very new, reputable genuine studies that do indeed prove children left untreated have a higher rate of drug abuse and criminal behavior.[/quote]

Could you share some of those studies? I would take them with very few grains of salt because in Europe where medication is used at about 1/10 the rate as it is in the US juvenile crime is much lower.

http://www.futurepundit.com/archives/001030.html

Published in Pediatrics pretty recently

There were a lot of mights and mays and it does not address the question as to why alcohol abuse is lower in Europen countries who’s children consume far less stimulants.

It is also interesting to note that Europeon countries have lower drinking ages.

I would not choose to put a child on a stimulant based on the weak proof that it might stop them from becoming an adult drunk.

I would guess that the ADHD kids who were not medicated were probably not treated in any manner and most likely neglected so I would say that the study is inconclusive at best. Neurological findings are often misleading and that is why in reporting these studies hedge words like might and may are so frequently used.

There is incontrovertable statistical data that casts doubt of the assertion of that study.

I think that it is important to realize that when it comes to a question of the brain what appears to be an answer is really a lot more questions.

My son’s insurance company refused to allow an evaluation until after his 7th birthday. The kindergarten teacher he had the previous year had been able to handle him (full day) and worked with us above and beyond. He had shown definite symptoms since toddlerhood beyond those considered “normal” that put the entire household at risk. He is now in sixth grade, and though he still requires meds (otherwise he cannot even function in school, at home, or socially), he is doing wonderfully. An earlier diagnosis would have only confirmed what I already knew, but his pediatrician would have still refused to medicate him until the ADHD was causing significant difficulties in school. However, an earlier diagnosis would have been nice for those times when people thought I was terrible mother because my child had been through 2 babysitters in 6 months after I went back to work part time when he was 3. Sometimes that diagnosis would have helped me to understand that I wasn’t going crazy.

DEFINATELY!!!!!!!! My son was diagnosed at age 4! He was diagnosed as Extreme to Severe ADHD at age four. He is now 8 years old. I finally convinced his pediatrician to refer him for testing after he was kicked out of preschool. He couldn’t handle the structured invironment. They would be having circle time and he would just get up and walk around the room and not even consider the consequences of his actions. They tried to tell me that they don’t like to test children before they start school. Well it didnt take much convincing, she realized for herself that he was more than likely ADHD. And if he is, its ok. ADHD is not a disease or anything. It is just a brain that likes to think about too much at once.