- What is ADHD?
- What are the signs & symptoms of ADHD in toddlers?
- How do I differentiate ADHD from normal toddler behavior?
- What causes ADHD in toddlers?
- What are the misconceptions about ADHD’S causes?
- How is ADHD diagnosed in toddlers?
- How is ADHD treated in toddlers?
- What are some alleged cures of ADHD?
- How can parents manage ADHD?
- Teaching a preschooler with ADHD
If your toddler is being extra cranky, fussy, and disobeying rules, if he is being too anxious or too hyper – don’t just let it go! These aren’t just signs of misbehavior. They could be signaling at a condition called ADHD where the toddler may not be in control of his actions.
Talking to a therapist or a psychologist can help your toddler get better. In this post, MomJunction acquaints you with ADHD symptoms, diagnosis, and treatment methods. Remember, a little help initially, will go a long way in helping your toddler.
What Is ADHD?
ADHD stands for attention deficit hyperactivity disorder and is a mental/psychological problem. As the name suggests, it is an inability of the toddler to maintain constant attention or concentration. The toddler tends to daydream and often forgets things that he had learned.
There is also hyperactivity, which prevents the preschooler from being calm and obedient. Attention deficit and hyperactivity may occur independently or together.
According to a survey conducted by the US Centers for Disease Control and Prevention (CDC), about 237,000 toddlers suffered the condition in 2011-12. The number had increased by 50% since the last study in 2007-08 (1).
The precursor to ADHD was ADD, attention deficit disorder. This definition only included attention deficit symptoms and did not encompass hyperactivity. In 1994, researchers merged attention deficit and hyperactivity into a single syndrome and named the condition ADHD (2). Since then, ADHD has been broken into three types – predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation. Each category presents its unique symptoms.
What Are The Signs & Symptoms Of ADHD In Toddlers?
ADHD symptoms depend on the sub-type a toddler suffers. Here is what to look for in each category.
1. Predominantly inattentive
Here, the toddler is inattentive and gets distracted easily. This condition was originally called ADD as no hyperactivity and impulsive behavior was noted. A baby, who is predominantly inattentive, has the following symptoms.
- Daydreams and lacks attention towards the task at hand, whether it is a game or an activity
- Has trouble following instructions and even if he does, forgets them immediately
- Does not seem to listen when someone speaks directly and looks around, seeming distracted
- Misplaces and loses objects such as toys even at familiar places like home
- Usually avoids activities that involve cognitive effort
- Has trouble organizing objects such as stacking building blocks, and may abruptly lose track of the number of blocks
- Get easily distracted while playing and doesn’t stay focused on the toy.
2. Predominantly hyperactive-impulsive
The symptoms here are divided into two sections – hyperactivity and impulsiveness.
The toddler is excessively energetic to the point that he seems reckless. Below are the symptoms of a hyperactive toddler.
- Does not remain seated in one place, and is always sprinting around with no regards to the place and people
- Fidgets with things around irrespective of the object
- Runs, jumps, and clambers around even when scolded for doing so
- Talks too much and too frequently without any reason.
- Babbles and makes loud noises while playing despite being repeatedly asked to stay quiet
The toddler is brash and displays an innate lack of patience and discretion. The symptoms of the condition are:
- Interrupts those speaking around whether it is adults or other toddlers
- Appears impatient when waiting for his turn, such as in a game, and jumps the queue to get to his turn quickly
- Answers a question even before it is complete; also, during a game, will shout the answer even when instructed not to do so
- Will intrude others, for example, will snatch a ball from a toddler to play with it himself
- Will do dangerous things such as ride a tricycle into a busy road despite heavy traffic
Unlike the symptoms of hyperactivity or inattentive behavior, which may not last long, symptoms of ADHD last for at least six months!
3. Combination presentation
Toddlers in this category suffer from inattentiveness, hyperactivity, and impulsiveness. Therefore, they display combined symptoms of predominantly inattentive and predominantly hyperactive-impulsive.
Here we give you the gist of all the symptoms:
|Inattention||Daydreaming and lack of attention|
|Trouble following instructions|
|Distraction during conversations|
|Misplacing and losing personal items|
|Inability to organize objects|
|Avoiding cognitive effort|
|Lack of focus and repeated distraction|
|Hyperactivity||Sprints around restlessly|
|Fidgets with objects|
|Clambers even when scolded|
|Talks too much repeatedly|
|Always makes loud noises while playing|
|Impulsivity||Interrupts those who are talking|
|Gives unsolicited answers to questions|
|Takes things without permission|
|Does impulsive and dangerous actions|
The signs of ADHD seem to perturb. But did you know, they do not develop overnight, and there is a way to spot the condition early? There are some signs you can notice.
Early Signs Of ADHD In Toddlers
Parents can get a hint of ADHD with these first signs:
- You get a feeling that he never listens to you – almost as if you were invisible.
- You send the toddler to his room to get something, and he does not come back. When you check on him, you see him playing with his toys with no regards to the instructions you just gave.
- He asks too many questions almost to a point that he seems obsessed with the topic. Despite that, he does not remember the answer for very long.
- The preschooler loses countless lunchboxes and water bottles almost every month.
- He does not remember what was done at preschool that day or the activity he was in with you yesterday.
- His preschool teachers and caretakers use words such as hyperactive, reckless, or extremely aloof to describe his classroom behavior.
Not every toddler who displays the above signs has ADHD. The American Academy of Paediatrics (AAP) states that it is hard for parents to tell for sure if the little one has ADHD until he is of school age (3). Therefore, it is good to learn ways to distinguish ADHD from normal toddler behavior.
How To Differentiate ADHD From Normal Toddler Behaviour?
The symptoms of ADHD may seem to overlap with typical toddler behavior, but there are ways parents can discern ADHD from normal demeanor:
- ADHD behavior lasts at least six months: Unlike typical hyperactive and inattentive behavior, which fluctuates, ADHD symptoms can last for six months straight. The preschooler displays consistent symptoms irrespective of external stimuli such as place or people.
- Toddler’s conduct is not right: As parents, you may be able to guess that something is not right with the little one. Some traits appear abnormal and not at par with how other toddlers at that age should behave. Their behavior could make the toddler badly stand out in a group.
- Lags in development: When you set a benchmark against other toddlers, you realize your preschooler lags behind. This is because while other toddlers progress in their behavioral development, a toddler with ADHD continues to be slow.
- Normal life of the toddler is impacted: ADHD affects a preschooler’s day-to-day routine. The disorder has an impact on a toddler’s social skills and ability to learn at preschool. Hyperactivity can cause anger issues while inattentiveness may lead to low self-esteem – attributes that are obstructions to a normal life.
A toddler who displays ADHD-like symptoms only in one particular environment is quite probably facing some other problem and does not necessarily have ADHD. For example, a healthy toddler could become inattentive at preschool because he finds it boring. However, when preschool subjects are taught at home, he pays attention and learns well. This makes it important to discern attention deficit and hyperactivity carefully as they have different causes.
What Causes ADHD In Toddlers?
There is no single precise reason for ADHD, but anomalies and conditions that have been noted to lead to ADHD (4) are:
- Hereditary: It is a leading cause of ADHD, and inheritance of an ADHD gene is a scientifically-proven reason behind ADHD in toddlers (5). The AAP states that ADHD runs in families and is most common in toddlers when the parent or siblings have it (6).
- Neurological problems by genetic mutations: Genes that code for nervous system develop unfavorable mutations that affect the function of neurons and impact the overall health of the brain. For instance, toddlers with ADHD have low levels of neurotransmitters, which are chemical messengers that transmit impulses between neurons (7). A 10-year-study by the US National Institute of Mental Health, has found that toddlers with ADHD have 3-4% smaller brains than those with no ADHD (8). Therefore, neurological abnormalities through genetic mutations exacerbate the chances of ADHD behavior.
- Mother’s lifestyle during pregnancy: Smoking, consumption of alcohol, and coming in contact with toxins and harmful chemicals during gestation increase the risk of ADHD during toddlerhood (9).
- Environmental factors: The presence of toxins and chemicals in the air or in a toddler’s food may cause ADHD. Lead is one such toxic element that has been linked to ADHD, and toddlers can be exposed to it through contaminated food and water (5).
- Premature birth: A preterm infant is at a higher risk of suffering from ADHD. The underdeveloped nervous system of a premature baby is susceptible to random genetic mutations, which can cause neurological problems and thus ADHD.
- Low birth weight: Low birth-weight of a normal full-term infant has been associated with ADHD, although it is less common, and does not have a precise reason for it.
- Brain injury: A brain injury sustained due to problematic delivery may cause ADHD. Severe brain injuries, caused due to a fall, can also cause the condition. However, ADHD due to brain injuries happen rarely and are uncommon.
While the reasons behind ADHD are complex, parents may confuse several conditions to be the cause for ADHD. In reality they have nothing to do with the disorder.
What Are The Misconceptions About ADHD’s Causes?
The CDC states that ADHD in toddlers is NOT caused by (10):
- Family stress
- Traumatic experiences
- Watching too much television
- Eating excess sugar
- Poor parenting skills
- Side effect of medicines and immunization
While the fundamental cause of ADHD lies in the genes, doctors rely on mental composure of the toddler to diagnose the condition.
How Is ADHD Diagnosed In Toddlers?
Toddlers as young as two can be diagnosed with ADHD. Experts state that there is no single test to detect the condition but several diagnostic steps are needed to conclude its presence (11). The diagnosis of ADHD is made by a pediatrician, specialist psychiatrist, or psychologist through a series of procedures (12):
- Medical examination: The doctor conducts speech, vision, hearing, and cognitive tests to assess if the toddler has any developmental delay or problem instead of ADHD. The toddler may be referred to a therapist to confirm if the preschooler has any development issues. If all tests turn out normal, then the doctor proceeds to the next set of procedures.
- Interviewing guardians: Parents are asked about the conduct of the toddler at different places – home, outdoors, and school. The medical history of the toddler is also analyzed to assess if he suffered from any mental or physical developmental problems in the past.
- Using the ADHD checklist: Doctors give parents and caretakers a questionnaire on ADHD in preschoolers. This ADHD-related quiz is taken from Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. The list primarily contains the above-stated symptoms.
- Parents observe their toddler for a couple of weeks and tick the symptoms displayed by the toddler. The doctor then checks the sheet and diagnoses by counting the number of symptoms displayed. The AAP states that at least six symptoms are needed to confirm ADHD in a toddler. Also, these symptoms should manifest across a minimum of two environments, for example at home and preschool (13).
- General observation: ADHD is the most difficult to diagnose in toddlers since several typical toddler behavioral traits overlap with ADHD symptoms. Therefore, the doctor will ask parents and caretakers to be extra observant. Symptoms of ADHD are noted with date, place, and time. This helps the doctor detect a pattern, determining the disorder.
A conclusive diagnosis is made once all the steps point towards ADHD. The treatment steps are then initiated right away.
How Is ADHD Treated In Toddlers?
There is no precise treatment for the condition and fundamentally there is no cure for ADHD. The treatment only aims at managing the disorder effectively (14). The leading choice of ADHD treatment in toddlers is behavioral therapy, and medicines are used as a last resort. Below we present the multifaceted approach to treat the condition.
- Behavioral therapy: There are two components of this treatment – parent training and toddler training. Toddlers are trained to reinforce positive, non-ADHD behavior, while parents are trained in the right ways to encourage such conduct. Behavioral training varies for different ADHD toddlers. It depends on multiple factors such as the toddler’s age, overall temperament, and severity of the symptoms. In toddler training, the therapist conducts sessions to bolster habits that slowly deviate the little one from the symptoms. It is achieved through unique games and activities that involve a coherent cognitive function, which is opposite of ADHD symptoms. These do not work overnight, and a toddler has to attend sessions every day for an extended duration.
Parents are also trained to stimulate non-ADHD behavior at home and monitor the toddler’s progress. Parents are taught counseling techniques to control hyperactive and inattentive toddlers. A combination of parent and toddler behavioral therapy is the best to tackle ADHD in a preschooler. And, most experts attribute behavioral therapy as the safest and most efficient form of ADHD treatment for toddlers.
- Medications: Medicines are seldom used with toddlers. Nevertheless, they could be considered by a doctor when behavioral therapy fails due to severe ADHD. Medications are of two types – stimulants and non-stimulants.
Stimulants are medicines that mimic neurotransmitters (brain chemicals) such as dopamine. These medications affect the brain function, slowly altering and normalizing the behavior of an ADHD toddler. Stimulants are most effective form of medical treatment of ADHD, providing relief to almost 80% of patients and showing quick results. However, their effects last for a few hours, thus making them useful only when prescribed as a course of dosage.
Non-stimulants tackle specific symptoms such as hyperactivity and inattentiveness. These medicines help improve the toddler’s attention, and cut down impulsivity. Non-stimulant drugs are slow at showing results, but once an effect sets in, it can last for up to 24 hours. These medicines are prescribed when a toddler shows adverse effects to stimulant medication.
- Skill training: The toddler is given specialized training to make up for the loss of skills due to poor attention and hyperactivity. A set of remodeled skills leads to greater deviation from ADHD symptoms. Training is provided by certified trainers who deal with ADHD toddlers. The skill training works in conjunction with conventional forms of treatment that are behavioral therapy and medication.
Besides the above, there are some cures for ADHD. But these may not always work in treating the condition.
What Are Some Alleged Cures Of ADHD?
The following purported cures for ADHD have no scientific backing and parents must avoid them:
- EEG biofeedback – a process that increases the brain-wave activity
- Applied kinesiology – where the bones of the skulls are “realigned”
- Anti-motion-sickness medication for hyperactivity
- Vision training to improve vision and reduce inattentiveness
- Reducing a toddler’s sugar consumption
- Vitamins and mineral supplements, often given as a natural home remedy for ADHD in toddlers
The AAP states that parents must double check the veracity of any claimed treatment of ADHD (15). It is best to stick to the advice and treatment of a doctor. However, ADHD is a condition that requires rigorous management at home.
How Can Parents Manage ADHD?
A toddler is quite likely to carry ADHD to adulthood since the disorder has no cure. The daily management of ADHD is thus essential to make life convenient. The CDC, suggests the below tips to manage ADHD in toddlers.
- Maintain a daily routine: Hyperactive toddlers may get overwhelmed by unprecedented events. Setting a daily routine helps offset it by making the day predictable. Maintain a fixed time for every activity in the preschooler’s routine from waking up, playing, studying, all the way to going to bed.
- Keep things organized: Maintain a fixed spot of storage for toddler’s personal items and encourage the little one to keep it at the same place after every usage. For instance, after play time, toys go into the same box; clothes go into the same cupboard. It helps the toddler feel confident about living life with ADHD.
- Offer limited choices: Keep the choices minimal and definite so that the toddler is not overwhelmed. It does not mean that you do not allow the toddler to choose. It is just that when offering something, such as a snack, give no more than two options. It improves the decision-making ability of an otherwise impulsive toddler.
- Manage the distractions: Keep the TV off when it is not the time to watch and toys neatly shelved when it is not playtime. Lesser the distractions, the better the preschooler can concentrate on the tasks at hand. If the toddler throws a tantrum, and wants to watch TV, consider an alternative such as playing soft music in the background. Some toddlers with ADHD concentrate better when there is a simultaneous background activity such as music, sounds of birds chirping, or sitting on a rocking chair.
- Give clear and consistent instructions: A toddler with ADHD will have trouble understanding complex instructions, which other preschoolers comprehend easily. Keep the communication clear, consistent, and simple.
- Plan with positive activities: Preschoolers with ADHD may find some games and activities stressful, while they would enjoy others. Stick to the ones that are enjoyable, and leverage the activity to reinforce positive behavior.
- Praise and reward: Appreciate the toddler every time he behaves in a manner that deviates from ADHD symptoms. If the toddler repeats an unfavorable activity, then instead of scolding, use penalties such as cutting down privileges.
- Set goals for improvement: Parental management is of no use unless you keep track of the progress. Set a target to achieve for every step taken to assess if the preschooler has attained the desired outcome. For example, if you reduce the distractions for better attentiveness, then observe the toddler over the course of the next few weeks. If you notice an improvement in concentration levels, then it indicates you have arrived at the desired outcome.
It is essential for parents to observe their toddler and review their management steps. Parents can succeed with it, but the challenge lies in teaching.
Teaching A Preschooler With ADHD
It’s hard to preschool a toddler with ADHD since the symptoms of the disorder often interfere with the learning process. Here are a few tips for parents to get the little one to learn better:
- Seek specialized teachers: Select a preschool with teachers that can teach toddlers with special needs, and are certified to train toddlers with ADHD.
- Follow-along revision: Repeat the topic the same evening the toddler learns it in schools. This will reinforce the topic in the toddler’s mind.
- Use audio-visual materials: Toddlers with ADHD learn better with the use of audio-visual study material (16). Incorporate the use of such study materials in teaching the toddler letters and numbers.
- Check student performance periodically: Meet the teachers regularly and ask them about the progress of the preschooler. It also helps you get insights into the toddler’s behavior at school.
ADHD has no cure, and there is no way to prevent the condition. Nevertheless, toddlers can lead a normal life when the condition is managed successfully. Parents, teachers, and everyone that cares for the toddler play a significant role in deciding the prognosis of ADHD. When the right steps of management are adopted, a toddler smoothly sails through the disorder and lives with the condition in harmony.
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