It is uncommon to diagnose ADHD in children while they are in their early years settings. However, there will often be signs and symptoms of ADHD in children at this age. As an early years practitioner, you can play an important multidisciplinary role in getting a child diagnosed later on in their school years.
What is ADHD?
ADHD (attention deficit hyperactivity disorder) is a neurological development disorder. Symptoms include inattention, impatience, difficulty with memory, difficulty with executive functioning, and problems sleeping and sitting still.
People with ADHD have a dopamine deficiency (dopamine being a brain chemical involved with pleasure and relaxation) which means they automatically engage in pleasure-seeking behaviours.
Nobody knows exactly why ADHD exists. It was discovered in the early 1900s, but the disorder still remains largely misunderstood. In the 1990s, there was a dramatic increase in ADHD diagnoses thanks to increased awareness and research.
There's also a theory that there has been an increase in ADHD prevalence. Since we don't know the root cause of ADHD, it's not possible to know why an increase in prevalence might exist.
How is ADHD Diagnosed?
In the UK, a GP can refer a child to a paediatrician if there are signs of ADHD present. The paediatrician will send some forms to the child's parents and the school. The forms will include questionnaires that analyse the child's social, educational and executive functioning skills.
The results are then compared to that of an 'average' child. If it is clear from the results that ADHD could be present, a diagnosis can be made. There is no blood test for ADHD.
The paediatrician will also want to check for similar neurological development disorders like Autism and rule out general behaviour problems masking as ADHD.
Once a diagnosis is in place, a plan is made to either support the child socially or give the child medication to help with the symptoms.
Signs and Symptoms of ADHD
It is almost always the parents and early care providers who spot ADHD first. People need to understand that gender plays a role in how ADHD presents itself and that girls and boys can experience it differently.
Girls are very good at masking their ADHD because they are more likely to want to conform socially. Girls are also less likely to have the hyperactivity aspects of ADHD. For this reason, there is an underdiagnosis of ADHD in girls and women. And often, ADHD in girls and women can be misdiagnosed.
Research has indicated that boys with ADHD normally show externalised symptoms, like running and impulsivity. Girls with ADHD typically show internalised symptoms. These symptoms can mean inattentiveness and low self-esteem. Boys tend to be more physically aggressive, while girls tend to be more verbally aggressive.
Across genders, signs and symptoms of ADHD can include:
- - Difficulty sitting still. In early years settings, this can mean finding it hard to do circle time or sit for a story. The child might fidget, run around, or find it hard to keep their legs still.
- - Difficulty focusing for long periods. Now, this is an interesting symptom because people with ADHD are often misunderstood as being inattentive all the time. In actual fact, people with ADHD can hyper-focus on things they are interested in, but will find it hard to focus on things they find boring. Often, a child will excel in subjects they enjoy at school but completely fail in subjects they find boring.
- - Children with ADHD find it hard to remember things, especially if the instruction has several components. For example, if you ask a child to put on her socks, then her shoes, and then get her coat and meet you at the door, she might forget a few of those steps.
- - It is normal for ADHD children to make careless mistakes, have untidy handwriting and make mistakes by becoming easily distracted.
- - Children with ADHD might be less tidy than those without it.
- - Children with ADHD might present as though they have an anxiety disorder. This is where their brains are overthinking and worrying a lot. And they might also feel different or odd or worry that they are going to get something wrong.
- - Low self-esteem is reported in ADHD children, especially in girls. This might include feeling worthless, sad or anxious.
- - Hyperactivity and impulsivity are common symptoms of ADHD and tend to present more in boys. This could mean having excess energy, talking a lot, disrupting the classroom, doing silly or dangerous things, or behaving badly for attention.
- - Small children with ADHD will find it hard to wait their turn.
- - Sleeping problems are common with ADHD. The child might go to bed very late, be tired during the day, or get up very early in the morning.
- - The child might show more interest than his peers in things that are naughty or taboo.
- - The child might 'zone out'. This is often because they are in 'information overload' and they are taking time to process it. Sometimes this makes it seem as though the child isn't listening.
ADHD Comorbidities
Due to the area of the brain ADHD affects, it often comes hand in hand with another disorder or condition. In fact, 80% of adults with ADHD have at least one other condition, and this begins in childhood.
This can also help you to identify ADHD in children.
Common comorbidities in ADHD children include:
- - Dietary issues and stomach problems
- - Hypermobility / flat foot / painful joints
- - Eating disorders
- - Tourettes
- - OCD
- - Learning disabilities
- - Autism
- - Sleep disorders
- - Language processing disorder
- - Fine and gross motor difficulties
It is important that you report any of these conditions, as they could be used to help diagnose ADHD in the future.
When ADHD Meets Autism
Autism is another common neurodevelopmental disorder. It can affect the way a child socialises, senses the world around them and processes information
ADHD and Autism often co-concur. They also can mimic each other. For example, children with Autism can have sensory difficulties around food, but ADHD children can be more prone to eating disorders and stomach issues, creating a similar outcome.
Another example is social skills. Autistic children might have problems making friends due to not understanding or reading social situations. ADHD children can also have problems making friends because they struggle to understand game rules or focus on the conversation.
Autistic children can have different sleep patterns, as can children with ADHD.
And autistic children might seem more anxious - as can ADHD children.
The two are so overlapping that misdiagnosis is very possible. It's important for all professionals to be aware of this and not make any assumptions about which diagnosis might be present. It could be both, just one, or neither.
A paediatrician will want to ascertain if the child has ADHD, Autism or both through a series of questionnaires. In some cases, early years practitioners will form part of this process. You might also be asked to provide a report for their school when they move on from preschool.
How You Can Help
It is important first and foremost to communicate with the parents of a child you suspect might have ADHD. You can also provide educational information and signpost them to the right support.
ADHD children require extra help in early years settings. This might include sitting with them during story time to help them focus or giving them fidget toys to play with during long sitting periods. You might try giving them as much variety as possible and setting firm boundaries about behaviour.
It is very rare to diagnose ADHD in the early years. This is because many symptoms can also be normal preschool behaviour (such as running around / hyperactivity). Normally teachers and parents begin the process of diagnosis after a few years at school. In year 1, children are taught to sit still and in a more structured manner, and this can often highlight who in the classroom might have ADHD. In any classroom, 1-2 children will have ADHD.
There is no cure for ADHD and it is a lifelong disorder. Some people experience it mildly. For others, it is distressing and severe.
ADHD can be effectively managed with behavioural therapy, environmental adaptations, or medication. It is important that the child doesn't feel stigmatised, 'stupid' or 'naughty' because this can lead to low self-esteem and low confidence. Instead, they should learn about their diagnosis and what it means and learn to accept the help they need to thrive in their later life.
Extra Resources
If you would like to learn more about ADHD, click here.
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