Toddlers: Just Rambunctious or is it ADHD?

Toddlers: Just Rambunctious or is it ADHD?

Eric is a toddler not quite 4 years old. He is a very busy little boy, moving frequently from one activity to another. He pays little attention to his parents’ instructions and often impulsively kicks or hits his older sister. His mother does not think he sleeps as much as most kids his age, and he gave up naps when just a baby.

Eric’s pediatrician referred him to speech therapy due to his delay in forming certain sounds and words. His therapist has difficulty getting and keeping his attention. She has to get down to his level and insist he look into her eyes when she gives him instructions. Some people tell Eric’s parents they need to have him evaluated for attention deficit/hyperactivity disorder (ADHD). Others say, “Boys will be boys. Cut him some slack.” His often exhausted parents ask themselves, could it be ADHD, or is Eric just rambunctious and will outgrow this behavior?

Are Rambunctious Children Overly Diagnosed with ADHD?

Allan J. Frances, M.D., professor emeritus at Duke and chair of the Diagnostic and Statistical Manual, Fourth Addition (DSM-IV) task force wrote in Psychology Today that too many active children are “carelessly” diagnosed with ADHD. He says that recent studies show that ADHD is both “over and under treated.” Those who need medication and treatment do not get it, while many who get it do not need it.

Dr. Frances believes that parents are the best ones to determine whether or not their child needs to be evaluated for ADHD. When other parents or relatives shake their head and comment, “You should have your child tested,” remember that they do not see the child every day.

Parents need to ask themselves if their child’s problems are “severe, persistent, and pervasive enough to warrant medical attention.” Is the behavior really hyperactive or just “enthusiastic and energetic?” Therein lies the rub. How can a parent tell the difference?

Toddler Behaviors That Indicate ADHD

According to the Kennedy Krieger Institute in Baltimore, which is dedicated to helping people with developmental disorders, approximately 40 percent of children by age 4 have significant attention problems. Dr. Mark Mahone, Director of Neuropsychology at the Institute notes that some of the problems are only normal behavior for the age. He lists ten specific toddler behaviors parents can watch for when deciding whether or not to have their child evaluated for ADHD.

In preschool-aged children, those between 3 and 4 years old, Dr. Mahone recommends that parents look for the following behaviors. If a toddler exhibits some of these behaviors, parents should consult their pediatrician or a health care professional who is a developmental expert.

  1. The child cannot pay attention to an activity for more than one or two minutes.
  2. Moves quickly between activities and cannot engage more than a few moments.
  3. Makes more noise and is louder than other children the same age and talks and talks and talks.
  4. Does not follow instructions about what to do and not do.
  5. Cannot hop on one foot by age 4.
  6. Always moving, kicking, jiggling, twisting in the seat, unable to be seated more than a few minutes.
  7. Seems fearless, so often gets into dangerous situations.
  8. Warms up too quickly to strangers.
  9. Is aggressive with siblings and playmates.
  10. Has been injured because of moving too fast or running when instructed not to do so.

Dr. Mahone encourages parents not to become discouraged because there are ways to manage the symptoms. Parents can learn coping skills to help change the negative behaviors into positive ones so the child can ultimately succeed both academically and socially.

The editorial team at Healthline notes that the average age for an ADHD diagnosis is 7, although some children can be diagnosed as toddlers. In addition to the behaviors Dr. Mahone identifies, the Healthline team has listed additional  behaviors that parents need to watch for that will help in diagnosing ADHD.

  • A child is self-focused, often interrupts others, and has trouble playing games with other children or taking turns.
  • There may be frequent anger outbursts or temper tantrums since the child is often in emotional turmoil.
  • The child starts projects but does not finish them and moves quickly from task to task with a very short attention span for staying on task.
  • Inability to focus. They might say they heard the instruction, but are unable to repeat it back.
  • Since the child has trouble listening to instructions, he or she may make lots of mistakes. This is sometimes misinterpreted as a child’s lack of intelligence when that is not the case.
  • Some toddlers with ADHD are not rambunctious, but quiet, staring into space and daydreaming, essentially ignoring everything that is happening around them.

Toddlers, ADHD, and the DSM-5

According to the National Resource Center on ADHD, the very ADHD term, named in the DSM-5 and previous editions beginning in 1994, indicates the “importance of the inattention aspect of the disorder as well as the other characteristics of the disorder such as hyperactivity and impulsivity.” Since some of this type of behavior is normal for children under the age of 4, it is difficult to diagnose the disorder in toddlers. A child must exhibit at least six of the behaviors that have been listed above.

All toddlers at one time or another exhibit some of the behaviors that have been listed. Parents who notice their child exhibits these behaviors consistently and in a way that negatively affects interaction with others should consult a professional who can make a proper diagnosis and develop a treatment plan with the parents. With proper treatment, the toddler can grow into a productive and successful adult.

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Rebecca has a background in medical writing and as a freelance writer with a B.S. degree in nursing, she has written on a variety of topics for physicians and other health services entities and worked for a number of years as a Certified Public Health Nurse.

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