ADHD in Toddlers 

What Is ADHD? 

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder ⁽¹⁾ . People who experience it have difficulties paying attention, and/or controlling their impulses and regulating their behaviour.  

Children ⁽²⁾ with ADHD are more likely to:  

• Have academic problems 

• Have problems in their social relations (e.g., family and friends) 

• Suffer physical injuries 

• Do drugs and alcohol 

• Have low self-esteem 

• Have problems finding and keeping a job when they grow up 

ADHD is the most common neurodevelopmental disorder with an estimated prevalence ⁽³⁾ of 5%. It usually continues into adulthood although for some people, symptoms lessen with age. Others never completely outgrow ADHD, but they learn to manage it using different strategies.  

Do Toddlers Have ADHD? 

ADHD seems to be a condition we are born with. So, it is possible for toddlers to have ADHD. The issue is that toddlers cannot be diagnosed until they are older. It is not possible to get toddlers diagnosed because toddler behaviour and ADHD symptoms often overlap.  

Toddlers ⁽⁴⁾ usually find it difficult to pay attention, control their impulses and they tend to be quite hyperactive. These three characteristics are typical of children with ADHD. Those children who reach primary school and still find it difficult to develop these abilities may be referred to a specialist to determine if they have ADHD. 

How Is ADHD Usually Noticed? 

Children with ADHD tend to be identified when they are in primary school during middle childhood. Very often these children have trouble with their schoolwork as well as with other children ⁽⁵⁾.   

How Is ADHD Diagnosed? 

ADHD must be diagnosed by a paediatrician, or by a mental health professional, like a psychologist or a psychiatrist. 

Diagnosing ADHD is a process with a few steps. It is a complex process because there is not a single test to diagnose ADHD. Other problems, such as anxiety, sleep disorders, or other type of neurodivergent conditions, have similar symptoms to ADHD.  

The American Association of Paediatrics (AAP) has guidelines to diagnose and treat ADHD in children between the ages of 4 and 6 years old. It does not have guidelines aimed at younger children.  

Healthcare professionals diagnose ADHD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM-V states that there are three types of ADHD: 

Hyperactivity-impulsivity: 

• Often fidgets with or tap hands or feet, or squirms in seat 

• Often leaves seat in situations when remaining seated is expected 

• Often runs about or climbs in situations where it is not appropriate  

• Often unable to play or take part in leisure activities quietly 

• Is often ‘on the go’ acting as if ‘driven by a motor’ 

• Often talks excessively 

• Often blurts out an answer before a question has been completed 

• Often has trouble waiting for their turn 

• Often interrupts or intrudes on others 

Inattention: 

• Often fails to pay close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. 

• Often has trouble holding attention on tasks or play activities 

• Often does not seem to listen when spoken to directly 

• Often does not follow through instructions and fails to finish schoolwork, chores, or duties in the workplace  

• Often has trouble organizing tasks and activities 

• Often avoids, dislikes or is reluctant to do tasks that require mental effort over a long period of time 

• Often loses things necessary for tasks and activities 

• Is often easily distracted 

• Is often forgetful in daily activities 

Combined:

A child with combined ADHD has symptoms of both inattentive and hyperactive-impulsive ADHD.  

Children are diagnosed with ADHD when they: 

• Have symptoms for at least six months.  

• Have symptoms in two or more settings (e.g., home, school, social setting). 

• Have symptoms that impact their ability to function successfully in school, at home, and in other social contexts.  

• The symptoms are not better explained by another mental disorder 

It is important to note that your child might show one or many of these characteristics without having ADHD.  

How Is ADHD Treated? 

ADHD cannot be cured but the correct treatment can help manage the symptoms. The American Academy of Paediatrics recommends that: 

• Children younger than six years old: parents to receive behaviour management before medication is tried.  

• Children 6 years-old and older: they should receive medication (e.g., stimulants or non-stimulants) and behaviour therapy. For children under 12, it is also recommended that their parents receive training in behaviour management.  

A good treatment plan should be closely monitored, and changes should be made along the way to adapt to the child’s development. It is also important that parents, teachers, and health professionals work together to best support the child.  

Why Is it Important to Diagnose ADHD as Early as Possible? 

Early diagnosis and treatment can make a big difference. This is why, researchers are examining how it could be diagnosed earlier. The latest research is examining the links between ADHD and children having a difficult temperament from birth ⁽⁶⁾. Researchers are also examining links between ADHD and toddlers struggling to achieve motor and language milestones, as well as toddlers being very active ⁽⁷⁾.   

Finally 

Please remember that whatever people may say there is nothing you have done to cause your child’s ADHD. ADHD is a neurodevelopmental disorder.  

If you suspect your toddler may have ADHD, discuss it with your doctor but do not forget that ADHD cannot be diagnosed when children are this young.  

If you have any questions regarding ADHD, please do not hesitate to get in touch with me.  

Love,  

Ana 

Dr Ana Aznar 

References 

⁽¹⁾ Nikkelen, S. W. C., Valkenburg, P. M., Huizinga, M., & Bushman, B. J. (2014). Media use and ADHD-related behaviors in children and adolescents: A meta-analysis. Developmental Psychology, 50(9), 2228-2241. https://doi.org/10.1037/a0037318 

⁽²⁾ Barkley, R. A. (2014). ADHD and injuries: Accidental and self-inflicted. The ADHD Report, 22(2), 1-8. https://doi.org/10.1521/adhd.2014.22.2.1 

⁽³⁾ Polanczyk, G., De Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American journal of psychiatry, 164(6), 942-948. https://doi.org/10.1176/ajp.2007.164.6.942 

⁽⁴⁾ Nigg, J. T., Sibley, M. H., Thapar, A., & Karalunas, S. L. (2020). Development of ADHD: Etiology, heterogeneity, and early life course. Annual review of developmental psychology, 2(1), 559-583. https://doi.org/10.1146/annurev-devpsych-060320-093413 

⁽⁵⁾ McGoey, K. E., Eckert, T. L., & Dupaul, G. J. (2002). Early intervention for preschool-age children with ADHD: A literature review. Journal of Emotional and Behavioral Disorders, 10(1), 14-28. https://doi.org/10.1177/106342660201000103 

⁽⁶⁾ Nigg, J. T., Blaskey, L. G., Stawicki, J. A., & Sachek, J. (2004). Evaluating the endophenotype model of ADHD neuropsychological deficit: results for parents and siblings of children with ADHD combined and inattentive subtypes. Journal of abnormal psychology, 113(4), 614. https://psycnet.apa.org/doi/10.1037/0021-843X.113.4.614 

⁽⁷⁾ Miller, C. J. (2023). Mindfulness Interventions for ADHD. In Clinical Handbook of ADHD Assessment and Treatment Across the Lifespan (pp. 631-647). Cham: Springer International Publishing.