Abstract
The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) is rising. It is now considered the most common neuropsychiatric syndrome in US school-age children, affecting 3% to 5%, or approximately 2 million children. ADHD is a chemical imbalance in the brain resulting in inappropriate degrees of inattention, hyperactivity, and impulsivity; these symptoms must be present prior to age 7. ADHD is difficult to diagnose as it is linked to many other conditions such as learning disabilities, conduct disorders, bipolar disorders, and manic-depressive illnesses. The authors offer information on behaviors signaling the need for referral in very young children and describe the positive and negative effects of common medications. They suggest specific behavioral coping strategies for both home and group care settings.
IN THE PAST decade many young children were diagnosed with a disorder that was not commonly recognized in earlier years. This condition, attention deficit hyperactivity disorder (ADHD), has become the most common neuropsychiatric syndrome in children, reported to affect 3% to 5%, or approximately 2 million school-age children according to the US Department of Education. 1,2 If this condition were diagnosed prior to school entry, then there would likely be a formidable surge in the request for early intervention services. By extrapolating population figures we can estimate these numbers. According to the US Census Bureau, there were over 18.9 million children under the age of 5 years in 1999. 3 Applying the 3% to 5% range to this number, we can estimate that 568,260 to 947,100 children could show early signs of ADHD.
It is likely that the number of very young children who may later be diagnosed with ADHD will be higher among those who have already been diagnosed as having special needs, or those who get services because they are at high risk for poor school performance. According to one study, 4 this problem accounts for as much as 50% of child psychiatry clinic patients. A recent study of the 1,200 children in foster care services in Broward County, Florida reported 675 (56%) had a mental health diagnosis. The most common diagnosis was adjustment disorder (38%) followed by ADHD and/or "disruptive behavior disorder," which accounted for another 19%. 5 Unfortunately, few early childhood programs exist to assist family members in addressing their child's behavioral manifestations of this syndrome.
The rise in ADHD has recently come to the attention of the national media. 6-8 Specifically, many young children are being diagnosed after the parents describe their child's problem behaviors to their pediatrician. In instances in which the pediatrician is not able to spend considerable time investigating the problem with the child and family, one of two things frequently happens: (1) the pediatrician will tell the parent that the behavior is normal and the child will outgrow it or (2) medication is prescribed based on the concerns and pleas of the parent and the pediatrician's diagnosis. Unfortunately, it is rare for parents to present careful documentation of the troublesome behaviors or the strategies they have used in attempts to address the problems. This kind of evidence might alleviate premature diagnoses or provide a firm basis for more definitive diagnoses.
Parents and professionals who are well informed as to the distinctions between typical behaviors and behaviors that are extreme, and are thus possible signs of more serious problems, are better positioned to participate actively in the diagnostic process. Not only are they prepared to make a referral when one is appropriate, but also they may be able to begin some successful interventions before the troublesome behaviors escalate. Given that ADHD or attention deficit disorder (ADD) are seldom diagnosed in very young children, few early childhood specialists and therapists receive adequate training in their own discipline-specific programs to recognize the signs of this condition or to assist family members to address the child's behavioral manifestations of this problem. The purpose of this article is to provide an overview of information on the signs of ADHD-type behaviors as seen in very young children and to suggest referral guidelines and intervention strategies.