Did you know that many children with severe symptoms of ADHD are diagnosed before 6 years of age? Young children with ADHD need the right treatment for ADHD. Learn about using Behavior Therapy first to help young children with ADHD.
ADHD is one of the most common enduring conditions of childhood and affects many children, including very young children. Those with more severe symptoms are often diagnosed earlier. — Read about trends in diagnosis and medication treatment for ADHD.
Being easily distracted, impulsive, and highly active is normal for young children, but when the symptoms are severe and persistent, it can cause problems. Young children with ADHD are more likely than those without ADHD to have difficulties in daycare or school, including problems with peer relationships, learning, and a higher risk of injuries.
My Young Child has been Diagnosed with ADHD, Now What?
For older children, the best treatment is often a combination of behavior therapy and medication. But for children under 6 years of age, experts recommend that ADHD be treated with behavior therapy first, before trying medication. Behavior therapy is the recommended treatment for ADHD in children under 6. The type of behavior therapy that is most effective for this age is parent training in behavior therapy, meaning that therapists work with parents and teach them the skills needed to help their child better manage their ADHD.
How Can Parent Training in Behavior Therapy Help my Child?
Children who have ADHD act in ways that are often challenging for parents. Children may forget things they are told, be overly active, and act before thinking. They might not be able to get positive attention the way that other children can; they tend to misbehave and might be punished more frequently than other children. Even if children with ADHD really try to follow rules, they might not be able to. This can have a negative impact on their self-image, and cause them to give up trying or to act up more often.
A therapist skilled in behavior management can help parents understand how ADHD affects their child. Parent training in behavior therapy is used to help change problem behaviors by building parenting skills, improving the relationship between parents and their child with ADHD, and helping children manage their own behaviors.
Others (daycare providers, preschool teachers, and other caretakers) can also help to manage the behavior of preschoolers who have ADHD by becoming educated about the disorder and by being trained in behavioral techniques.
The Recommended First Choice
Behavior therapy is the recommended ADHD treatment for children under 6 and should be used first, before medications that treat ADHD.
- Children under 6 are more likely than older children to experience side effects from ADHD medications, such as increased heart rate and blood pressure, trouble sleeping, loss of appetite, and a loss of energy.
- The long-term effects of ADHD medications on children under 6 are not known since ADHD medications have not been well-studied in young children.
- Behavior therapy works as well as medication in young children with ADHD in helping to manage symptoms. Studies have shown that families who receive training in behavior therapy notice improvements for several years after treatment.
Parent training in behavior therapy has evidence as an effective treatment. There are several programs that meet the criteria of the Agency for Healthcare Research and Quality for effective treatments. Read more about these behavior therapy training programs for parents of young children here.
. What is CDC Doing?
CDC works to help families get the right care, at the right time. The data available so far show that almost half of 4-5 year olds with ADHD did not get behavior therapy in 2009-2010.
- CDC is working with states and partner agencies to increase awareness as well as to identify best practices in support of behavior therapy for ADHD.
- CDC is using national surveys to understand how many children have ADHD and how they are treated.
- CDC is learning more about how children with ADHD are diagnosed.
- CDC funds the National Resource Center on ADHDto provide evidence-based information about ADHD to families and professionals.
What You Can Do:
- To get the recommended treatment for your young child with ADHD, talk to your doctor about behavioral therapy first. Learn more by visiting the National Resource Center on ADHD’s webpage on preschoolers or by calling 1-800-233-4050.
- Share your experience on behavioral therapy with other families.
Symptoms and Diagnosis
Is it ADHD? Symptoms Checklist
Deciding if a child has ADHD is a several-step process. This page gives you an overview of how ADHD is diagnosed. There is no single test to diagnose ADHD, and many other problems, like sleep disorders, anxiety, depression, and certain types of learning disabilities, can have similar symptoms.
If you are concerned about whether a child might have ADHD, the first step is to talk with a healthcare professional to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a pediatrician.
The American Academy of Pediatrics (AAP) recommends that healthcare professionals ask parents, teachers, and other adults who care for the child about the child’s behavior in different settings, like at home, school, or with peers. Read more about the recommendations.
The health professional should also determine whether the child has another condition that can either explain the symptoms better, or that occurs at the same time as ADHD. Read more about other concerns and conditions.
How is ADHD diagnosed?
Healthcare professionals use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5)1, to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD, and how public health is impacted by this condition.
Here are the criteria in shortened form. Please note that they are presented just for your information.
Only trained health care providers can diagnose or treat ADHD.
DSM-5 Criteria for ADHD
People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
- Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
- Is often forgetful in daily activities.
- Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
- Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
- The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
Changes in the DSM-5
The fifth edition of the DSM was released in May 2013 and replaces the previous version, the text revision of the fourth edition (DSM-IV-TR). There were some changes in the DSM-5 for the diagnosis of ADHD:
- Symptoms can now occur by age 12 rather than by age 6;
- Several symptoms now need to be present in more than one setting rather than just some impairment in more than one setting;
- New descriptions were added to show what symptoms might look like at older ages; and
- For adults and adolescents age 17 or older, only 5 symptoms are needed instead of the 6 needed for younger children.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.
- Content source:
- National Center on Birth Defects and Developmental Disabilities; Division of Human Development and Disability; Attention-Deficit/Hyperactivity Disorder.
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