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 two-part interview with Dr. Keith Kanner details the important aspects of ADHD in a daycare or preschool setting. Dr. Kanner is a Licensed and Board Certified Clinical Child, Adolescent, and Adult Psychologist and Psychoanalyst.
OwnADaycare: What is ADHD?
Dr. Kanner: ADHD or Attention-deficit Hyperactivity Disorder is a descriptive diagnosis devised by the American Psychiatric Association to help doctors better diagnose a particular condition which meets certain criteria. The complete diagnostic profile of the ADD disorders, and there are a number of variations, based again on particular symptoms, are listed in the DSM-IV. Before the ADD diagnostic category, such disorders were listed as Minimal Brain Dysfunction disorders, but the diagnosis was changed to ADD over the years. MBD actually made more sense for a “classical case” of ADHD can be seen as early as infancy and is linked to both constitution and temperament. I highlighted the concept of descriptive, for this does not take into account etiology, or cause. In other words, descriptive diagnoses do NOT try to find out “why” a child or adult for that matter, developed the condition, but just describes a list of “symptoms” – if enough of such symptoms are met, then the diagnosis is made. Then depending upon the philosophy of the treating doctor, will then determine how it is treated – in the case of ADHD, either medication, psychotherapy, behavior modification, or a combination of these approaches are commonly used.
What is most difficult about such descriptive diagnoses is that other conditions, such as anxiety, mimic the same criteria as ADHD and sometimes ADHD is misdiagnosed from either an anxiety condition or some other manifestation, such as childhood depression, or some sort of developmental disorder. Therefore, it is imperative that a detailed developmental history and assessment is made before assigning a diagnosis to a child.
OwnADaycare: How is ADHD diagnosed?
Dr. Kanner: Good question for at times, due to the popularity of this diagnosis, many unqualified people try to make this diagnosis. Typically, the diagnosis is made with the utilization of both a semi-structured interview with the parents and child, and at times also a number of psychological tests or checklists given to both the parents, sometimes even teachers, and the child him or herself if old-enough to understand the questions. The results of the interview and/or testing is then compared to the diagnostic criteria and the diagnosis is then made. Again, this is based on symptoms and does not take into account the cause.
OwnADaycare: Many times, a diagnosis of ADHD comes sometimes 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 diagnoses with ADHD?
Dr. Kanner: Typically ADHD is not diagnosed by many until the child is of school-age for two reasons – first, the norming of the tests used to make the diagnosis begins with 7 year olds and not earlier and hence, the diagnosis cannot be made. The second reason, which is one that has been debated by clinicians has to do with the idea that the attentional aspects of the disorder only show up when academic conditions truly begin. This however has been debated and the current diagnosis now demands that the symptoms be in more than one environment. Depending upon one’s training however, many will make the diagnosis earlier without the use of testing materials.
Symptoms of ADHD in preschool children: From a pure diagnostic point of view, the diagnosis of ADHD cannot be made in this age group due to both the lack of test norming and also, I would say, the lack of developmental maturity. However, after 7 years of age, the diagnosis can be made. The DSM IV does state that at least some of these behavior must be present however before the age of 7.
The symptoms break down into 3 categories: Inattention; Hyperactivity; and Impulsivity
Inattention: there are 9 criteria here:
1. Failure to pay attention to detail or makes careless mistakes
2. Has difficulty sustaining attention in tasks or play activities
3. Does not seem to listen when spoken to directly
4. Does not follow through with directions
5. Difficulty with organization
6. Avoids to engage in tasks that require mental effort
7. Often loses things
8. Is easily distracted by outside stimuli
9. Is often forgetful
Hyperactivity:
1. Often fidgets
2. Often leaves his or her seat in the classroom
3. often runs about or climbs when not suppose to
4. Has difficulty playing in leisure activities
5. Is often “on the go”
6. often talks excessively
Impulsivity:
1. Blurts out answers before questions have been completed
2. Difficulty awaiting their turn
3. Often interrupts.
Other criteria for the diagnosis include:
1. Some symptoms present before the age of 7
2. Some symptoms must be present in at least two or more settings
3. Must be impairment in social and/or academic functioning
4. No other diagnosis can be made
As can be seen by this diagnosis, many “spirited” children, or just excited pre-schoolers could easily fit into this category as well as an anxious child. ( separating from mom and dad is not easy for many kids!) Personally, I rarely make this diagnosis due to my training and see many children who have symptoms in this diagnostic category and find the true cause as either anxiety or some developmental immaturity which is often corrected by good parenting, some remediation, and at times. psychotherapy.
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