Of all the kids with ADHD (Attention Deficit Hyperactivity Disorder), the preschoolers can be particularly tough to handle. They have so much baseline energy, and are still figuring out things like social norms and that they actually can't fly or that fire and certain animals might be dangerous.
But it's not just their capacity for hurting themselves (and others) or making their parents and caregivers completely crazy that worries me. I worry that many if not most of them aren't getting the help they need--and that this may have real and bad implications for their future.
According to data from the Centers for Disease Control and Prevention (CDC), 11 percent of kids overall have ADHD. The more severe the ADHD, the more likely children are to be diagnosed early, like around age 5. For all children with ADHD, therapy can make all the difference when it comes to future health and life success. For preschoolers with ADHD, the American Academy of Pediatrics recommends they get behavioral therapy--and only get medication if the behavioral therapy alone doesn't work.
However, a study recently released says that almost half of the 4- and 5-year-olds with a diagnosis of ADHD are on medication--and half of those kids are on medication alone. Overall, only 53 percent of 4- and 5-year-olds with ADHD get behavioral therapy--and 31 percent aren't getting any therapy at all.
This is bad news for these children. We know that ADHD is a chronic condition that can last into adulthood--and that adults with ADHD are more likely to have mental health problems, substance abuse problems, trouble holding down jobs, and legal trouble. It's not good that we aren't helping them in the way that they need to be helped.
I've had parents of those really tough preschoolers come begging me for meds--anything to make Junior a bit more manageable at daycare or the park or just around the house. But the problem with medications is that they don't teach kids with ADHD any of the skills they need to learn to self-manage--and they don't help with the self-esteem problems that often happen when you are That Kid getting in trouble at daycare or the playground. Even more important for this age group, meds don't teach parents how to help their children--and kids really need their parents' help.
It's not just about looking for easy fixes, though. It's not easy to get behavioral therapy for a preschooler and their parents. In fact, it's really hard. There's not enough providers, insurance doesn't always cover it, the appointments aren't always possible for working parents. There are plenty of parents out there who want to do the right thing and can't.
There are also plenty of parents who don't recognize (or ignore) the signs of ADHD, who chalk it up to being a little kid (or, as I too often hear, "boys will be boys") and do nothing at all. Because the behavior can be so, well, challenging, parents often end up either catering to it or punishing it, neither of which works very well.
Those kids weren't included in this study, because it only included kids who had been diagnosed with ADHD. If we include those kids, the number of untreated kids obviously gets a whole lot higher.
So here are my four take-homes for parents of distractible and active preschoolers:
1. Know the signs of ADHD. Boys may be boys (they certainly aren't girls) but that doesn't make it okay for them to be constantly in motion, frequently distracted and liable to be impulsive (especially in ways that are possibly dangerous or hurtful).
2. If you find yourself wondering at all if your son or daughter might have ADHD, talk to your doctor. Together you can work to figure out if it might be the case--and if so, how best to help your child and family. Sometimes a visit with a behavioral pediatrician can be useful.
3. If your child does have a diagnosis of ADHD, ask for help--and keep asking until you get it. Ask your doctor, ask your child's teacher or daycare provider, ask your insurance company...just keep asking. Don't take no for an answer.
4. Understand that there are no quick fixes for ADHD (or most other problems in life, sadly). There is no one pill, no vitamin or diet, no one approach that will work for every child. It takes patience and perseverance and a team.