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Attention Deficit and Hyperactivity Disorder (ADHD) is a group of disorders that include inattentiveness, over-activity, and/or impulsivity. Daycare providers must recognize the signs of symptoms of ADHD as well as how to manage children diagnosed with the disorder.

In Part 2 of our interview with special educator and author of A Parent’s Guide to Developmental Delays, Laurie LeComer, details the important aspects of ADHD in the daycare or preschool setting.

OwnADaycare: What can parents or early childhood educators do if they suspect children are exhibiting ADHD behaviors?

Laurie LeComer: If parents or early childhood teachers believe a child of theirs may be exhibiting symptoms of ADHD they should take a close look at the behaviors of suspicion. When and where are they occurring? If the environment is modified in some way, is there a difference in behavior? Parents should bring up their concerns with their pediatrician, and ask daycare providers or teachers for cooperation in noting suspicious behaviors – so that they have a good picture of their child’s behaviors in various settings.

OwnADaycare: Could you give us some tips to help preschool teachers or daycare providers help manage ADHD behaviors?

Laurie LeComer: Daycare providers and preschool teachers can help children who may be exhibiting ADHD behaviors. They should:

• Take care to be encouraging to the child. It is more helpful to take a “Partner in Success” or “Guide” approach when a child is missing information or not able to control impulses.
• Look at the daily routines and make sure there are frequent opportunities for gross motor activities. Gross motor movement that is timed carefully before a child needs to sit and focus can make a big difference for kids.
• Teachers can incorporate little jobs or bathroom/drink breaks to get a child up and moving.
• Use the child’s name to gain their attention, or get down to the child’s level and get their eye contact before relaying an important piece of information.
• When talking to the entire class, placing a hand on the child’s shoulder briefly can help them maintain focus.
• Be generous with repeating directions when needed. First and foremost, with strengths and weaknesses, the children are there to learn.
• Set up a reward system, where the child (or class) will earn preferred objects or activities for good behavior. Choose the expected behaviors carefully. You want to place positive focus on something the child does well.
• Sit the child near you during learning times. Close proximity can help the child maintain focus.
• Teach the child a secret signal – one between just you and the child. The signal may signify “I need your eyes on me,” or the signal may mean the need for a break, for example, ”walk to the water fountain and walk back.”
• Be clear and simple with your instructions and realistic with your expectations. Children with ADHD are not trying to be bad, and at young ages, they are truly not aware of how their behaviors are affecting others.

OwnADaycare: Do you have anything else to add?

Laurie LeComer: One additional comment: ADHD, inattentiveness, hyperactivity, impulsivity, and disorganization  – none of these mean diminished intelligence. Children with ADHD have the same ranges of intelligence as their typical peers, but they usually have more negatively and discouraging messages directed at them. As teachers, and parents, model the encouragement, patience, and kindness you would want for your own family members.

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Attention Deficit and Hyperactivity Disorder (ADHD) is a group of disorders that include inattentiveness, over-activity, and/or impulsivity. Daycare providers must recognize the signs of symptoms of ADHD as well as how to manage children diagnosed with the disorder.

Our interview with special educator and author of A Parent’s Guide to Developmental Delays, Laurie LeComer, details the important aspects of ADHD in a daycare or preschool setting.

OwnADaycare: What is ADHD?

Laurie LeComer: The letters ADHD stand for a common disorder called Attention Deficit Hyperactivity Disorder. It is believed that approximately 9 percent of children have one form of ADHD. It most commonly occurs in boys. Some children are considered to have ADD, Attention Deficit Disorder, which is marked by inattentiveness, confusion, distractibility, and an avoidance of tasks that require focus and effort. Others have Hyperactivity Disorder, which causes excessive physical activity along with impulsivity. Children that are hyperactive have difficulties with waiting, tend to interrupt, and often act before thinking. Some children have the “combined type” of difficulties, meaning they struggle with both compromised attention and hyperactive behaviors.

OwnADaycare: How is ADHD diagnosed?

Laurie LeComer: ADHD in children may be diagnosed by a pediatrician, or by an evaluation team in your local public school system. Children may also be diagnosed at a child development clinic at a university or hospital center. Doctors and child professionals may try to observe a child’s behavior in a couple different environments.  They will also have parents, teachers, or daycare providers fill out detailed checklists on the child’s symptoms, strengths, and weaknesses. Though brain scans have shown slight differences in the brains of children with ADHD, the disorder is diagnosed through observable behaviors that have occurred over time in multiple environments. No scans or blood tests are currently used to diagnose a child with ADHD.

OwnADaycare: Many times, diagnosis of ADHD comes sometime after the age of 6. Can you please explain why? In other words, why is early diagnosis difficult and when is the earliest that a child can be diagnosed with ADHD?

Laurie LeComer: It is very difficult to diagnose ADHD before the age of seven-years-old. Typically, children from ages 2 to 6 develop self-regulation skills and “in seat/focus” behaviors at different rates. There are even some differences exhibited between male and female children. It is important to make sure that the behaviors in question are not environmentally caused or situation-based. Different styles of family life, structured/unstructured home or daycare settings, even personal traumas can affect children’s behavior. While many young children “develop out of” ADHD-like behaviors as they naturally grow and develop new skills, children with true ADHD continue to struggle. The symptoms of ADHD cause children to begin to fall behind both socially, and academically.

OwnADaycare: What are the symptoms of ADHD in preschool children?

Laurie LeComer: It is very difficult to diagnose ADHD in preschool children. Though some children may exhibit inattention, learning and social difficulties, these symptoms may be indicative of other delays or disabilities, or not be anything other than a difficult -yet typical- stage of the child’s development. Congruently, some children who have ADHD may not show clear symptoms before the age of 4 or 5.

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Attention Deficit and Hyperactivity Disorder (ADHD) is a group of disorders that include inattentiveness, over-activity, and/or impulsivity. Daycare providers must recognize the signs of symptoms of ADHD as well as how to manage children diagnosed with the disorder.

Part 3 of our interview with child neurologist Dr. Sara J. Dorison provides tips for child care center educators dealing with ADHD behaviors.

OwnADaycare: Could you give a few tips to help preschool teachers or daycare providers help manage ADHD behaviors?

Dr. Dorison: It is often difficult for a preschool teacher to know how to manage an ADHD child.  This is especially true of the teacher has a large class, an assistant who is not highly trained or if there are several ADHD children together in one class.

1.  Set expectations that the child can meet.  For example, insisting that a child sit for extended periods of time is likely to be unattainable and for this reason a teacher would be wise to allow ADHD children a bit more leeway in terms of physical activity.  If the child is not able to meet expectations, then the expectations need to be changed or accommodations can be made such as allowing a child to run class errands or hand out snacks (instead of trying to wait quietly).

2.  Identify one or two “problem behaviors” to target.  For example, if an ADHD child is physically aggressive, then the teacher and child can sit down and talk about “angry hands don’t touch.”  If all behaviors are targeted at once, the child will be confused and unable to meet the demands.  This will result in frustration and poor cooperation.  Other behaviors such as not cleaning, fidgeting, etc. should be dealt with after the aggression has resolved.

3.  Set up a positive reward system that might be done at first every hour (depending on how bad the problem is).  So, a child might receive a sticker every hour if she did not push/hit another child.  Then, the system would be changed to a sticker for before lunch behavior and after lunch behavior.  The important thing is that the child feels that the teacher feels warmly towards her and that the teacher be encouraging with comments such as, “Well, this morning did not go well since you pushed Jacob, but let’s try this afternoon to have no angry touching.  I know you can do it!”

4.  It is essential that the teacher comment positively at unexpected on times regarding good behavior.  “Catching” an ADHD child being good and complementing her will help tremendously in terms of increasing the positive behavior and the child’s interest in complying.   It will keep the child motivated to succeed.

5.  Keep close communication with parents without a negative overtone.  So many times parents come to pick up their children and the teacher starts to run down a full list of negative behaviors the ADHD child had during the day.  A simple, “She had a tough day today, but tomorrow will be better!”   Negative comments should be written in a note or discussed over the phone and not in the presence of the ADHD child who will feel confused and sad to hear his teacher convey negative comments.  Frequent negative remarks from a preschool teacher often result in school anxiety and worsening of ADHD symptoms.

6. A preschool teacher might ask for a professional behavioral consultant to come and help make a behavioral plan for an ADHD child.   This might be a psychologist that works in the school or the community.

7. The teacher should keep the class feeling positively towards an ADHD child.  Often the other children in the class feel negatively towards a child that hits and gets reprimanded by the teacher. When an ADHD child has a good day, the teacher can say to the class, “Let’s all cheer for Jane since she had a great day with no angry hands touching!”

8. Give intermittent and unexpected rewards.  If an ADHD child has a good morning, for example, perhaps she can be the line leader to recess or pass out the snacks.  Compliments and positive reinforcement are the best ways to increase good behaviors.

9. Make the ADHD child feel special.  Often days are full of frustrations for ADHD children since they can elicit so many negative interactions from other children and teachers (as well as parents).   Parents frequently report that 90% of their verbal interactions with their ADHD child is negative.  A preschool teacher should be sure to give the ADHD child a special hug in the mornings and special compliments when the child does something well.  The teacher should make an effort to recognize something in which the child excels such as art, athletics, helping, etc.  Increasing an ADHD child’s confidence will decrease anxiety, frustration and improve her behavior.

10.  Avoid telling parents that you feel the child has ADHD and definitely do not mention the possibility of medications. Most parents feel upset when a teacher suggests a medical diagnosis and even more upset when a teacher suggests that the parents begin medication.  Even though the experienced preschool teacher will likely recognize ADHD, most parents appreciate a discussion of the symptoms with a suggestion to discuss it with a pediatrician.

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Attention Deficit and Hyperactivity Disorder (ADHD) is a group of disorders that include inattentiveness, over-activity, and/or impulsivity. Daycare providers must recognize the signs of symptoms of ADHD as well as how to manage children diagnosed with the disorder.

Part 2 of our interview with child neurologist Dr. Sara J. Dorison details the important aspects of managing ADHD in the preschool setting.

OwnADaycare: What are the symptoms of ADHD in preschool children?

Dr. Dorison: Preschool children with ADHD often have difficulty sitting still during story reading (“happy circle”), finishing little projects and waiting their turns.  Often they have low frustration tolerance which can lead to impulsive aggression.  For example, an ADHD child is more likely to push another child when that child grabs for a toy.   Due to impulsivity, many children with ADHD have a hard time following the rules.   Often it is hard for the ADHD child to “keep his hands to himself” since impulsivity is such a prominent feature.   Transitions such as going from the playground to the classroom can be difficult for them and they have a great deal of difficulty waiting quietly.   They might have difficulty learning their letters since paying attention in class is hard for them.   Low frustration tolerance can lead to tantrums.

OwnADaycare: What can parents or early childhood educators do if they suspect children are exhibiting ADHD behaviors?

Dr. Dorison: Parents must educate themselves and seek professional advice.  Reading about ADHD is very helpful so that parents can see whether their child indeed meets the typical profile of an ADHD child.  Pediatricians are generally able to guide parents in the right direction which is often towards a psychologist, child neurologist or child psychiatrist.  In general, a preschool child with ADHD does not need medication.  They can be helped significantly with behavioral management techniques that stress consistency, positive reinforcement and encouragement.  They must be given adequate exercise and reasonable expectations should be set.  An ADHD child might not be able to sit quietly so teachers and parents must tolerate a degree of fidgetiness. A preschool child that suffers severe ADHD where the impulsivity is dangerous (running in parking lots, running across the street, climbing onto the cooktop, jumping from high places) or where aggression is a prominent feature (hitting other children),might need medication.

Parents must be careful when consulting professionals to seek those who know about ADHD.  Many young children with ADHD are incorrectly diagnosed with Oppositional Defiant Disorder (ODD) and Bipolar Disorder.  Incorrect diagnosis can lead to damaging labeling of children and inappropriate use of medication.

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Attention Deficit and Hyperactivity Disorder (ADHD) is a group of disorders that include inattentiveness, over-activity, and/or impulsivity. Daycare providers must recognize the signs of symptoms of ADHD as well as how to manage children diagnosed with the disorder.

Our interview with child neurologist Dr. Sara J. Dorison details the important aspects of ADHD in the preschool setting.

OwnADaycare: What is ADHD?

Dr. Dorison: Attention Deficit Hyperactivity Disorder is a syndrome characterized by the presence of clinically significant levels of hyperactivity, impulsivity, disorganization, difficulty staying on task, short attention span, and difficulty waiting on line, interrupting, and low frustration tolerance. The diagnosis is based on the DSM-IV criteria which outline the criteria necessary to make the diagnosis.  It is felt to be present in about 5% of children.

OwnADaycare: How is ADHD diagnosed?

Dr. Dorison: ADHD is a clinical diagnosis and is made by taking an appropriate history and physical examination of the child and their behavior.  Unfortunately, there is no blood test, genetic testing, brain wave test or brain imaging test that can currently make the diagnosis.  The diagnosis is often made with the assistance of psychoeducational testing, or with a clinical interview, generally with a child psychiatrist or child neurologist.  The clinical features must be present in at least two settings and over a period of time.   Often doctors or psychologists use the Connor Rating Scales which ask parents and teachers to fill out forms regarding behaviors.   It is important to rule out other disorders that can present similarly in a young child.  These include Asperger Syndrome, Developmental Delay, Pervasive Developmental Disorder, Autism, deafness, lead poisoning and severe anxiety.

OwnADaycare: Many times, diagnosis of ADHD comes sometime after the age of 6. Can you please explain why? In other words, why is early diagnosis difficult and when is the earliest that a child can be diagnosed with ADHD?

Dr. Dorison: Toddlers and very young children normally exhibit many of the features of ADHD.   Two year olds, for example, are impulsive and disorganized.  They can’t sit for an hour listening to a lesson.  So, it is difficult to discern whether a young child has a “normal” amount of impulsivity or disorganization or a clinically significant amount of these features.   Over time, however, children without ADHD mature and gain more control in these areas and the ADHD children are left behind in terms of their difficulty with their symptoms.   As their peers mature, children with ADHD generally become more obvious to both the teachers and the parents.   Also, as the academic demands of school increase, children with ADHD often begin to lag behind their peers and not perform to their potential.

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