what child does not do this?! This is a question I have heard over
and over in my practice.) The child may also have difficulty with
organization, struggle to follow through on instructions and may
often lose things. The child is easily distracted, and often forgetful
in daily activities. Task-avoidance, avoiding a task which requires
a lot of attention, may also be noted.
Hyperactive-Impulsive symptoms include having difficulty in
remaining seated. Fidgeting with hands and feet, or squirming in
a chair may be identified as a predictable behavior. There can be
a problem participating in or engaging in activities quietly. The
child acts as if driven by a motor. He or she can run about or climb
excessively. There can be excessive talking. Blurting out answers
before questions have been completed and interrupting others is
often noted, as well.
KIDS' STUFF
behavioral treatments are not available, the clinician needs to weigh
the risks of starting medication at an early age against the harm of
delaying diagnosis and treatment. (2)
Before stimulant medication is prescribed, the AAP and
the American Heart Association recommend careful physical
examination of the child, and complete patient and family history
of any heart disease. This includes patient history of palpitations,
syncope or chest pain and family history of sudden death or
cardiac disease in children or young adults. Any concerning signs
or symptoms warrant a complete cardiac workup before beginning
medication. (3)
The Combined type of ADHD is, as its name implies, a
combination of the Inattentive and Hyperactive-Impulsive type Additionally, the American Academy of Child and Adolescent
Psychiatry (AACAP) Preschool Pharmacology Working Group
recommends that preschoolers who are taking ADHD medication
have their medication stopped (under the prescribing doctor’s
direction) after six months to reassess the symptoms and to consider
symptoms. whether the medication should be continued.
If some of the troublesome behaviors mentioned above are
noted in your child, report this to your child’s physician. The child’s
preschool teacher may really assist here as well. It’s one thing to find
that troublesome behaviors are seen in the home, but if there are
several different sources all identifying the same type of behavior,
this can be indicative of the need for a medical and psychological
evaluation. If you have concerns about your preschool child having ADHD,
do not delay discussing this with your child’s physician.
The preschool years are a time when significant brain growth
occurs. This is an optimal time for children to learn positive
behaviors, and for the parent to acquire skills that effectively help
his/her/their child to learn. It’s best to address problem behaviors as
soon as possible. Getting your child evaluated will give you a sense
of direction for intervention. Dr. Wampler is the UofL School of Medicine Assistant Clinical Professor of Pediatrics.
However, diagnosis of ADHD in the preschool years is difficult.
In addition, many children have other disorders such as sleep apnea
that may masquerade as ADHD. They may also have co-morbid
disorders such as anxiety, depression, oppositional defiant behavior
and conduct disorders, or learning and language disorders, all of
which can complicate the diagnosis. Therefore, a thorough history,
physical exam and indicated lab work should be performed.
“A treatment method or an educational method that will work
for one child may not work for another child. The one common
denominator for all of the young children is that early intervention
does work and it seems to improve the prognosis” -Temple Grandin
Resources
1. Egger HL, Kondo D, Angold A. The epidemiology and diagnostic issues
in preschool attention-deficit/hyperactivity disorder. Infant Young Child.
2006;19(2):109–122
2. Pediatrics November 2011, VOLUME 128 / ISSUE 5 From the American
Academy of Pediatrics Clinical Practice Guideline ADHD: Clinical Practice
guideline for the diagnosis, evaluation and treatment of Attention-Deficit/
Hyperactive disorder in children and adolescents
3. Perrin JM, Friedman RA, Knilans TK, Black Box Working Group, Section on
Cardiology and Cardiac Surgery. Cardiovascular monitoring and stimulant
drugs for attention-deficit/hyperactivity disorder. Pediatrics. 2008;122(2):451–
453pmid:18676566
The American Academy of Pediatrics (AAP) guidelines for
treatment of preschool children diagnosed with ADHD are as
follows:
For preschool-aged children (four to five years of age), the
primary care clinician should prescribe behavioral therapy as the first
line of treatment. Subsequently, methylphenidate can be prescribed if
the behavioral interventions do not provide significant improvement
in behavior, and there is moderate-to-severe continuing disturbance
in the child’s ability to function. In areas where evidence-based
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