Diagnosing a four-year old with ADHD – really?

Child suffering from ADHDA couple of weeks ago, I ran across an article from NPR (National Public Radio) that almost made my eyeballs pop out of their sockets. It was titled “Kids As Young As 4 Can Be Diagnosed, Treated For ADHD“.

Say what??? As parents, we keep hearing of more and more cases of ADHD being diagnosed (and prescribed to) every year. Just like autism is being better diagnosed, ADHD is becoming more “common”. Or is it? Are kids suffering more from ADHD today than 30 years ago? Are doctors better at diagnosing it? Or is it easier to stick a label on children who may behave on the edge of the norm rather than the quieter middle?

Here’s what bugs me about the uphill trend of ADHD diagnoses in the USA. Pediatricians are starting to make the diagnosis on their own, without the help of a trained psychologist. Ask people who got diagnosed 20 years ago how many questions they had to answer and you’ll find out it took hours, even days. Today, a pediatrician may ask just about 10 questions and label your child with ADHD. As if it were that easy. And now it seems some pediatricians want to make it even easier by labeling kids as early as four years of age.

Now, don’t misunderstand me. I completely agree that ADHD can be a debilitating condition that affects many aspects of a person’s life. If that person can’t function without psychological and/or medicinal help on a daily basis, of course they should seek help so they can have a “normal” life.

But here’s what irks me the most about this recent idea of diagnosing four-year-old children with ADHD. According to the pediatrician-led Healthy Children website (linked from the NPR article), here are the main symptoms of ADHD:

Symptom

How a child with this symptom may behave

Inattention

  • Often has a hard time paying attention, daydreams

  • Often does not seem to listen

  • Is easily distracted from work or play

  • Often does not seem to care about details, makes careless mistakes

  • Frequently does not follow through on instructions or finish tasks

  • Is disorganized

  • Frequently loses a lot of important things

  • Often forgets things

  • Frequently avoids doing things that require ongoing mental effort

Hyperactivity

  • Is in constant motion, as if “driven by a motor”

  • Cannot stay seated

  • Frequently squirms and fidgets

  • Talks too much

  • Often runs, jumps, and climbs when this is not permitted

  • Cannot play quietly

Impulsivity

  • Frequently acts and speaks without thinking

  • May run into the street without looking for traffic first

  • Frequently has trouble taking turns

  • Cannot wait for things

  • Often calls out answers before the question is complete

  • Frequently interrupts others

 
Now, let me think about this. I want to guess at least 80% of four-year olds display most of these behaviors on a regular, even daily, basis. Let me share a few examples:

- Often has a hard time paying attention, daydreams? Well, that was me throughout my whole school experience. Most teachers left me alone because my grades were fine, but I was bored to death at school. My favorite activities were doodling and staring at the window, coming up with wild stories in my head. Oh wait, I still do that today!

- Often does not seem to listen? Yeah, my kids consistently don’t listen when I ask them to do things they don’t want to do. That’s definitely a problem. I think most husbands are guilty of that too…

- Is easily distracted from work or play? I’m guilty as charged, especially when working. So are about 90% of the people I have worked with so far in my career. Give them something better/more interesting to do with their time and they’ll jump on the opportunity.

- Is in constant motion, as if “driven by a motor”? Hmm, isn’t that what young kids do with their excess energy? And then doctors complain kids are getting fat from sitting down for too long, go figure!

- Talks too much? I have two chattering boxes competing at home. “Argh, stop cutting my words, I was talking first!”

- Cannot play quietly? I think that’s called imaginary play. I sometimes join my kids on the spaceship ride, and yes, it’s quite loud during take-off.

- Cannot wait for things? “Are we there yet?” “I want a cookie now!” “Is it Sunday/Halloween/Christmas already?”

- Frequently interrupts others? Wait, I know lots of adults like that. They must all have ADHD.

You get my point. If you let a pediatrician diagnose a child using this list, the Ritalin manufacturers would be ecstatic. Who knows what effects Ritalin and other ADHD drugs have on a brain that’s still developing? No studies have been led on this subject. And what happened to using behavior modification before popping pills down a child’s throat?

What do I read through this article? I read that our society wants children to sit down and be quiet. Listen to us and do as we tell them. Not think for themselves and just agree with us. It makes them good little students in school and compliants workers later in life.

What is society missing when it trains children to become quiet peons? No more creativity, no more imagination. This means no more design engineers, architects, artists, graphic and web designers, people thinking outside the box, you name it. There’s a creative drain in the US, which is great for foreigners willing to fill the void, but it can make for quite a boring society and no ideas to create new jobs.

What is your take of such an early diagnosis for ADHD? Would you let doctors label your child at such a young age or use behavior modification and see if things get better or worse down the road?

As a follow-up to this post, I wrote Follow-up thoughts on ADHD and divergent thinking a couple of weeks later, with a very interesting video speech from Sir Ken Robinson discussing how school systems around the world are really getting it wrong with our kids when it comes to preparing them for the 21th century. A very inspiring, yet depressing speech, well worth listening to!
 
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19 responses to “Diagnosing a four-year old with ADHD – really?

  1. Amen, and amen. And amen. Spot on post. Psychiatric diagnosis of any kind before they are old enough to even go to school bugs me.

    • Thank you for your feedback! It baffles me so many people want children to fit a specific mold and not allow personal expression and creativity to come out. What kind of boring world are we really trying to create?

  2. If I had a 4 year old exhibiting these symptoms . . . I would join him or her in play sessions . . . I wouldn’t drug them into a stupor.

    You might enjoy this:

    http://nrhatch.wordpress.com/2011/09/12/changing-education-paradigms/

    • Thank you for the video link! I’m going to use it as a follow-up post. I’ve been discussing the education system a lot recently with my friends and reading a lot on divergent thinking (my oldest is prime example of that) and schools are great at turning it into convergent thinking in just a few years. No wonder kids are no ready to taking on this world’s difficult challenges and nobody can come up with ideas for growth. It’s a really sad situation we’re in.

  3. Very good points here.

    Most children fit a lot of those areas at some point, and are fine! But anyone on the extremes of normal is at risk of ‘not fitting in’ – for example a really bright child with a specific need, such as dyslexia or dyspraxia may use some of thees behaviours as coping mechanisms. if in doubt, wait and certainly don’t medicate….

    • I completely agree and I think most parents can sense if something is not just right with their kids. My kids are both super active and need to burn off a lot of excess energy. But until recenly my 3 year old could sit and play or do some activity for 20 minutes on his own while his 5 year old brother could barely sit 10 minutes before he got distracted, even if he was doing something he really liked. And things seemed to get worse month after month.

      I did some online research and found several articles recommending to supplement the active, non-focused child with magnesium, calcium and zinc. So I did, and in less than a week my son was sitting down quietly and on task for a long time. He’s now very focused (at least when he does something he likes) and creates great writings, drawings, etc.

      Sometimes a child’s behavior may just have to do with what their diet is lacking and it would be a shame to pop a pill instead of looking for a more natural solution. I think parents know best when something’s off.

  4. Well, pretty much describes my little girl right now & after asking around, seems like a lot of her peers are exactly like this. I think it’s sad that we as a society are quick to diagnose ailments & pump our children with drugs when they may just be very active little things. I like to believe that’s the case with my child & will get 2nd & 3rd … possibly 4th opinions if I’m ever told otherwise.

    • I have seen very mellow young kids and it always strikes me how little they know and understand about the world surrounding them. They’re not very curious, don’t ask a lot of questions and don’t seem to learn much. On the opposite a very active and curious child asks a lot of questions (and sometimes we don’t have all the answers!) and is eager to learn. I’d be more worried about the kid without curiosity as he may not develop as well as his peers. I’ll try my best not to crush my kids’ curiosity and creativity, especially when I know how much of that happens in schools…

  5. I have way too much to say about this topic, but will start by saying I agree emphatically with you and the comments. As a teacher of gifted kids, I can tell you that we ID them with nearly the same checklist as ADD. Being bright and creative can make school torture. So many things can be done to encourage school accepted behavior without meds. I would be worried if a 4 yr old was calm, quiet and lethargic, that would be so much worse. Labels of any kind are not useful for young children. I know some parents that excuse bad behavior with ADD or OCD labels. Even if properly diagnosed, you don’t just throw your hands in the air and give up, you work with the child and teachers to give the kiddo coping mechanisms and strategies. Not oh well, you can just be obnoxious, you can’t help it. I know so many divergent thinkers that do poorly on standardized tests because they see so many possibilities that the test makers did not. Ahh, way too much to say.

    • The recent book I read called “Dreamers, Discoverers and Dynamos” made an interesting point about divergent thinking about school gifted programs. It explained that most kids who are naturally gifted are divergent thinkers. However the gifted programs don’t reward the divergent thinking kids, but rather the kids who are good at taking tests, and they may not be specifically gifted. That’s why so many kids who enter the gifted programs, when they get their IQ tested down the road, don’t have higher IQ scores than kids in regular classrooms. Schools just get it wrong so much, it’s amazing to think educators don’t understand how the child mind works. I’ll be posting that video from Nancy soon, it’s very interesting.

      And I completely agree with your point on parents sometimes taking the easy road to put up with their kids’ behavior and going for labeling and Ritalin, rather than work hard at modifying the behavior. Some parents think getting their kids labeled with ADHD will give them an easy pass at school. Instead they’re not preparing them for adulthood, very sad.

  6. Sometimes kids get bored because they’re not being challenged enough, which would also make them not stay as focused…I agree with you about how society is treating what are normal 4 year olds as if there is something wrong.
    My sister-in-law just had her 5 year old diagnosed with ADHD…..She started Kindergarten this year and I know she gets in trouble a lot, but I didn’t necessarily think she was ADHD. They did do testing and got to a special doctor, not JUST a pediatrician for the diagnosis, though and my husband was diagnosed as ADHD when he was a kid, too, years before he was found to be bi-polar as an adult….so they could possibly be on to something with her but then again, 5 is so young….it seems like they could try other tactics first before medicating.

    • Is the 5-year old being medicated? I really think addressing the behavior and helping the child with coping techniques is the first thing to try. Even medication is not enough in older kids and adults.
      My son is the type who will find “interesting” things to do in class if he’s doing with the assignments because he doesn’t just sit quietly with nothing to do. So he finds creative ways to keep busy, which may not suit his teacher. We’ve worked on this issue all together and the problem is now over. It does take a cooperative teacher and cooperative parents to make things work. And work is the word.

  7. As you know my son has severe ADHD. He was diagnosed age 9 which retrospectively was a little late, but came about because doctors couldn’t agree.
    At age four I found him challenging but did not suspect ADHD or any other disorder. In fact at that age I let him take part in a psychological study for the local research university. Harmless, I was there, they wanted to see how children of that age played on their own/with their mum/ with a stranger in the room. When I wasn’t in the room I could always see him through a one way glass. He was in the room with a bunch of psychologists watching him and not one of them noticed anything ‘abnormal’ about him.
    By the way aged 12, he’s now diagnosed as severe ADHD, with OCD traits, autistic traits and verging on a personality disorder. And that’s after 16 weeks in a psychiatric unit.

    My personal opinion is ticking a few boxes on a form does not mean a child is ADHD. The child needs to be properly observed by a good, trained therapist.

    Like you say many children age 4 tick these boxes, so I really think it’s far too early to tell.

    I recently met the mother of a 5yo who’s doctor and the Kindergarten have raised the issue that her daughter is probably ADHD. They told her it’s too early for a proper diagnosis. However, they want early intervention in the form of therapy. I talked to the mother at length. The daughter has never been able to do a puzzle and has real problems sitting down. I watched the little girl and I could tell something wasn’t right. She behaved very impulsively and had a lot of difficulty focussing.
    I think the early intervention is a good thing. She has no ‘label’ but it has been recognized that she is not developing at the same speed as her peers. She has the opportunity to have concentration training and support. She can start school a year later if necessary as a late bloomer. No one has offered or even mentioned medicating her at such a young age and I think that’s exactly the right way to go.

    • Thanks for sharing your story, Sarah. I think you make a good point showing that even though this article mentions doctors should try diagnosing ADHD early on, they can also miss it, especially if the signs develop later.

      I think parents know their children best and can see if there seems to be an underlying problem and discuss it with their pediatrician. A five-year old child that can’t still down long enough to do a pleasant activity may need to be further examined, but I think behavior observation and modification should always be the first step.

  8. I’m a little late to this party, but I just started on WordPress yesterday. My initial reaction to hearing that ADHD can be diagnosed in children as young as 3-5 was similar to yours. What child doesn’t have a hard time focusing? What four-year-old is patient enough to always wait his turn?

    But I think the list simplifies or skips over some of the more important aspects of diagnosing a child with ADHD; for example, the child must repeatedly demonstrate at least six inattentive behaviors, and at least six hyperactive/impulse behaviors, for six months or longer (which is longer than normal developmental phases or hiccups) to warrant a diagnosis. (Every child has a hard time waiting her turn every now and then; not every child has a hard time waiting her turn every single time, to the point where she compulsively repeats the same phrase over and over again until she is acknowledge or her turn finally comes.) More, a child should be tested by a neurologist and nueropsychologist team or a child psychiatrist to substantiate the claim (as guidelines published elsewhere suggest). NO pediatrician should EVER be medicating children for psychological disorders. They do not have the training. Parents beware!

    And a good neuropsychologist or neurologist will not be tossing medication down a child’s throat at such a young age. In fact, if the psychologist is worth anything, behavior modification therapies, parent education, and diet changes should be among the first suggestions for dealing with any child. Medication should only be suggested when the behaviors interfere with the child’s development–and many young children with ADHD may have challenging behaviors, but just as many are developing at a normal rate. Medication shouldn’t really enter the conversation until that child reaches school-age. Due to the possible side-effects, such as those that can inhibit physical growth, placing a child on medication so young is not considered acceptable unless there is an extreme need. (In this, we agree again!)

    The sad thing is, interventions such as parental education and behavior modification training are essential to helping children with “real” or warranted diagnoses of ADHD, and the sooner these interventions occur, the better off the child will be. Unfortunately, so many people run to the “Ritalin” tree and blast the new guidelines without fully considering how helpful it would be for any parent with a hyperactive child to learn a few behavior modification techniques before that child turns into an aggressive six or seven-year-old. Pediatricians can and should help with that–instead of letting the behaviors continue or blaming it on a stage as seems to be the practice now–and I think that was the true purpose of these new guidelines.

    Of course, purpose and practice are rarely the same thing–and so we’re back to my (and your) initial fear. Fingers crossed!

    • Thanks for stopping by, 2e Mom, and thank you so much for sharing your comments and personal experience! Although I feel for you to see you’ve had to experience your child getting the dreaded AHDH diagnosis, it’s great to read about your pragmatic approach and not jump to conclusions. My oldest is quite hyperactive, super curious, impulsive type and yet, I don’t think he has ADHD, at least not at this point. He’s very bright and learns very fast but he needs help channeling his energy and attention, or else, you leave it up to his imagination to keep himself busy. He often has brilliant ideas and concepts and there’s no way I want to crush that, so I encourage it at home. I’ve also been giving him supplements with magnesium/calcium/zinc and his focus has improved dramatically. While he had a very hard start with kindergarten, he’s doing an amazing job every day now, so I have hope!

      Take a look at the follow-up post I wrote a couple of days ago with a brilliant speech by Sir Ken Robinson describing how our school systems are getting it all wrong with our kids. It’s quite an interesting perspective, which most school administrators, teachers and the government probably disagree with. I hope they get it right eventually, but it will be an uphill battle.

      http://perfectingmotherhood.wordpress.com/2011/11/18/adhd-and-divergent-thinking-sir-ken-robinson-out-of-our-minds/

      I’ll stop by your blog in a few minutes to say hi.

  9. Thanks for this article, my oldest son is 4, and very, very very energetic… He is impulsive, but is able to sit and do a puzzle with me and can focus on things he likes like duplo building for a good amount of time. We even do schoolwork at home in workbooks occasionally and he will get distracted and bored and resist, but if I work with him he can keep focused… I’m concerned with how school will be because he won’t get that individualized attention, but I get good reports from most of his SS/choir teachers at church. However, they do say he is VERY active, and I had one teacher suggest I get him tested. I honestly don’t know whether it’s normal 4 year old stuff, or if it’s going to affect school, it’s frustrating and scary for sure when YOUR kid is the one who can’t stand still in line and jumps around for entertainment. He loves video games, which I HATE, because I feel that only adds to the training of the brain to be fast and inattentive, but he can focus on those for a good while too…. *sigh* I guess I will just have to see how school goes for him, my MIL said my hubby was much the same way, super busy, until he learned to read. Mu hubby is an engineer btw, so with his Master’s degree if he does have any kind of ADHD it wasn’t diagnosed and clearly didn’t hold him back! He’s a math whiz, and my son loves numbers already…. Here’s hoping his generation doesn’t unnecessarily label him and he can be as successful as his Daddy! :) thanks again for the post. I’m glad others have boys who are ‘borderline’… So hard to know at this young age, time will tell!

    • Jessica, let me share what happened to us recently. I think it will help reassure you that your son is fine. Our family therapist my kids have been seeing after repeated abuse from their dad told me one day she wants to refer one of my kids for ADHD testing. First thing I said: what??? When she told me she wanted to refer my youngest, I said: what????? Honestly, if one of my kids has any issue with attention, it’s my oldest. I never got a comment or complaint from his preschool teachers he couldn’t sit still or pay attention. Anyway, I decided to go along with the testing as I didn’t want my refusal to be used against me down the hall. When I made the appointment, I was told it would take 2 hours. When I took my son, he went in with the psychologist. He came out 40 minutes later. He was so fast he was all done super early! I went back in to take with the psychologist, who told me my son has ZERO problem with attention. He’s actually very sharp and quite advanced for his age in reading, math and other cognitive skills. He sat down so nicely, he flew through the test. We discussed making sure he was always challenged since being bored could cause him to keep himself busy with something not OK with the teacher. His brother got in trouble for that in kindergarten until I talked to his teacher, so I’m used to this problem.

      All I want to say here is, don’t listen to anyone who’s not trained in ADHD testing. Even therapists can’t identify it. My kid just acts out in her office because he’s bored out of his mind. I’m glad I did the test, it just reaffirmed what I believed. Here’s who you should listen to: your son’s teachers. They’re the best people to spot any issues that interfere with learning. By the way, just spend one hour in any preschool, or elementary school classroom, and you’ll spot the kids with an ADHD or other behavior issue almost right away. I’ve volunteered in my kids’ classes and it’s the same kids every single time. And there are very few of them, maybe one or two per class. Not 20% like the ADHD experts want you to believe. Young boys are active, immature, and impulsive, but most of them do grow out of it eventually. When kids are among other kids, they believe a lot better than at home. I think it’s the peer pressure effect, or maybe the cattle effect is more accurate. Kids don’t like to be put on the spot, so they blend in and behave. Put your son in preschool a few mornings a week so he gets used to it. Make sure he’s got lots of opportunity to burn off his energy. I’m sure he’ll do just fine once he gets into kindergarten. Good luck and thank you for stopping by!

  10. I don’t think it’s fair of any of you to judge or diagnose without having the faintest idea of what you’re talking about. Yes, I agree that most children exhibit some of these symptoms “often” at this age. However, if you have a child who is exhibiting most of these behaviors so often that it is inhibiting their ability to learn, socialize and be comfortable in their own skin, then perhaps there is something deeper going on. And most of the “tests” that your referring to in order to “diagnose” this child, aren’t age appropriate and wouldn’t give a definitive answer anyway. If you’ve tried behavior modification and consistent rules/discipline, yet your child (who is about to start kindergarten!) still can’t sit still for 5 seconds, stop talking in order to listen, wait somewhat patiently for their turn, still puts everything they touch in their mouth, constantly fidgets with their face, hair, ANYTHING they can touch, can’t get a hold of their emotions… Yet has no learning disability, illness or other diagnosis other than ADHD, what do you propose this parent do? Send them to kindergarten knowing that they will fail in that environment? Continue with the behavior mod plan that isn’t working because the child can’t sit still or focus long enough to understand it? Wouldn’t THAT make them a negligent parent?! Instead, some of these parents are recommended to, by their child’s doctor/psychologist, etc…try a low dose of non-stimulant medication that may allow the child to settle down a bit and become more receptive to learning strategies to cope with this condition and be successful. The medication is closely monitored, as is the progress of the child. And of course the hope is to teach the child how to cope and overcome the need for medication… If you don’t have a child like this and have no education or knowledge in this field, what right do you have to judge parents for doing what they think will best help their child be successful? Isn’t it our job as parents to do everything we can for our kids? Do you think these parents want their 4 and 5 year olds to be on medication?? Don’t you think maybe it makes the parents feel like a failure too?! I’m sure you have made choices, as a parent, that someone else might look at and say “oh my god, what was she thinking?” But you made the choice because you were trying to do what you thought was best for your child at the time. We all do that. You have no idea what these parents and children and going through on a daily basis. So perhaps your opinions should be kept to yourself about it until you have the proper education and information. And maybe you should say a few prayers, thanking god that you don’t have a child who struggles every day.

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