Screening for ADHD in Preschool: 10 Things To Look For

Young children often have problems paying attention or concentrating, but when are these problems serious enough for parents and teachers to be concerned? Most of us just think this is normal at this age, right?According to the Centers for Disease Control, 1 in 11 school-aged children are diagnosed with Attention-Deficit/Hyperactivity Disorder, but research suggests that the warning signs often appear even before the demands of school begin. As many as 40 percent of children have significant problems with attention by age four, and ADHD is now the most common mental health disorder diagnosed in the preschool years.

Dr. Mark Mahone, director of the Department of Neuropsychology at the Kennedy Krieger Institute in Baltimore, Md. encourages parents to be especially observant of their young child’s behavior.  I had the pleasure of hearing Dr. Mahone speak at a recent CHADD conference.  He impressed me very much and I have followed his work.

Dr. Mahone says, “Research shows that children with ADHD have abnormal brain development, meaning that ADHD has a biological basis that often makes it a lifelong condition.”  “We want to catch ADHD early because it has such a profound effect on learning and academic development. Children whose symptoms begin in early childhood are at the highest risk for academic failure and grade repetition.”

Dr. Mahone and his colleagues at Kennedy Krieger are among the first to use neuroimaging to study the brains of preschool children with symptoms of ADHD. They recently discovered that children with ADHD have a smaller caudate nucleus—a small structure in the brain that is associated with cognitive and motor control—than their typical peers. By identifying the biological markers of ADHD, they hope that intervention can begin earlier to facilitate better educational outcomes.

In preschool-aged children (3-4 years), Dr. Mahone recommends that parents look for the following signs that are associated with an ADHD diagnosis when children reach school age:

1. Dislikes or avoids activities that require paying attention for more than one or two minutes
2. Loses interest and starts doing something else after engaging in an activity for a few moments
3. Talks a lot more and makes more noise than other children of the same age
4. Climbs on things when instructed not to do so
5. Cannot hop on one foot by age 4
6. Nearly always restless – wants to constantly kick or jiggle feet or twist around in his/her seat. Insists that he/she “must” get up after being seated for more than a few minutes
7. Gets into dangerous situations because of fearlessness
8. Warms up too quickly to strangers
9. Frequently aggressive with playmates; has been removed from preschool/daycare for aggression
10. Has been injured (e.g., received stitches) because of moving too fast or running when instructed not to do so

“If parents observe these symptoms and have concerns about their child’s development, they should consult with their pediatrician or another developmental expert,” says Dr. Mahone. ”  You may be saying, the doctors will just write a prescription for medication and that doesn’t interest you.  There are many interventions besides medication to improve your child’s behavior.

As a Parent Coach, I provide ADHD support to parents and come up with a plan to deal with the challenging behaviors of pre-schoolers whether they have ADHD or not.  For more information on my services, go to ADHDC.  You may also follow me on FacebookTwitter and sign up for my monthly newsletter.


Exercise Improves Your Social Life

Most parents and professionals agree that exercise is paramount for children with ADHD.  It helps regulate their body, improves attention, and decreases impulsivity.  I recently read about a study that produced empirical evidence supporting the importance of exercise.  Claudia Verret, a University of Montreal kinesiology graduate showed in her doctorate that a 10-week physical activity program can significantly improve the cognitive behavior and functions of children aged 7 to 12 struggling with ADHD.

“Three afternoons a week, we brought together a group of 10 children, who,  for 45 minutes, took part in a team sport like basketball or soccer,” explained Verret. “The physical exercise was meant to achieve a moderate to high heart rate.” These children were compared with 11 subjects also with ADHD, but who did not participate in the activities.

Before and after the program, the children underwent a battery of neuropsychological tests to measure their attention. Their parents and teachers also completed questionnaires regarding their behavior and social skills.

“Following the program, parents and teachers reported that all measured problem behaviors such as aggression, anxiety, and depression decreased, particularly social disorders,” said the professor.

She said that the positive effect of exercise on social interaction is a “major” finding. “The clinical picture of children with ADHD reveals that they often find it difficult to adapt to others. Taking part in structured group physical activities helped them overcome this difficulty, even if the program was not specifically aimed at social reinforcement.”

The children were also less impulsive. “The teachers told us that when the children returned from the exercise session they were able to sit longer than usual,” said Verret.

Attention problems also decreased. The children still made mistakes on the neuropsychological tests of course, but they completed the tests faster. “Ultimately, they were more effective, suggesting that their attention was better,” said Verret.

Physical activity, a supplement to therapy

Claudia Verret recognizes that this research is still exploratory because of its small sample. But, she adds, the results are encouraging to the point that it would be worthwhile to eventually consider physical activity as a supplemental aid to traditional therapies.

“In cognitive behavioral therapy sessions, we work on self-control, self-esteem, and social skills, among other things. We could integrate this structure within a sports program. Children could then apply what they learned during therapy. It would be a great way to provide enjoyment and increase their motivation.”

She notes that such an initiative would require further training for the professionals who supervise the children. “Our study shows that group sports are better for these children because of the influence at the social level. But in reality, looking after a group of children with attention deficit is not easy when you lack the required training. We need to develop tools to facilitate the work of these professionals.”

It will be some time before CBT incorporates physical exercise.  In the meantime, this summer require that your child gets rigorous exercise every day before all that screen time!

Katherine Price coaches parents on everything from behavior modification plans to IEP goals.  She helps DC area parents get the ADHD help and resources they need by guiding them through the options available to them, connecting with the right people, and making a workable, affordable plan for the whole family.  For more information about her company, go to