Recently, a family came to see me with a very active, on-the-go tot in hand. I say ‘in hand’ and mean it quite literally. Jack’s father was concerned that if he let the boy go, the result would be mayhem.
Jack’s parents explained to me all of the symptoms their little guy had – he’d rarely sit still, would race from activity to activity and couldn’t focus long enough to finish anything. This was a pattern of behaviour occurring both at home and at preschool. Jack was only four years old and was reportedly putting himself in danger and never seeming to learn from any mistakes that he made.
Interestingly, Jack’s older brother, Charlie, was exceptionally bright and also a very active kid. However, Charlie could sit and concentrate on puzzles until they were complete – provided Jack didn’t run through and ruin them. After a thorough investigation, Jack was eventually diagnosed with attention deficit hyperactivity disorder (ADHD) and broad treatment began.
A common problem?
The identification of Jack’s condition placed him among the five to six per cent of Australian children who are diagnosed with ADHD. This figure might sound quite high – and indeed, the media is often quick to report on the ‘meteoric’ rise of the disorder and the apparent ‘over-medication’ of our children.
However, the fact is that there has not been a substantial increase of ADHD in Australia. The more accurate way to think about things is that there has been an evening out of the figures.
In Western Australia, for example, diagnosis rates have moderated. In Victoria, diagnosis rates have risen slightly. This is due largely to updated guidelines, which have led to better analysis of diagnosis rates and treatment methods. Interestingly, only about one-third of all children diagnosed with ADHD take specific medication.
Jack’s case was unusual, considering that he had been diagnosed with ADHD prior to beginning big school.
The majority of children are only diagnosed as their behaviour begins to impact on their schooling and it is confirmed that their issues are not confined to the home.
Young boys are two to three times more likely to be diagnosed with ADHD than girls and are also more likely to be treated using medication. This is largely due to the fact that girls more often present with ADHD of a predominantly inattentive type (which used to be called ADD), characterised by daydreamy, distracted behaviour, without the severe hyperactivity that ADHD usually includes.
Making a diagnosis
The diagnosis of ADHD is one that is difficult to make, as many toddlers – especially boys – are simply naturally boisterous and energetic and may meet the diagnostic criteria as a result. A critical element of diagnosis, though, is that symptoms are constant and intense – far beyond the normal spectrum of behaviour.
Diagnosis is made even more difficult by a wide variety of disorders that can be mistaken for ADHD, especially in toddlers. These include defiant behaviour disorders, auditory processing problems, autism spectrum disorders and sensory processing problems. It’s regrettable, but many kids are wrongly diagnosed with ADHD when they are suffering from a completely different and unrelated condition.
This is why obtaining a thorough, professional diagnosis is critical. Jack’s parents were wise enough to request a second opinion after the first ‘expert’ they saw spent less than 15 minutes with Jack before declaring he had ADHD and prescribing medication.
Jack’s story is a good example of how problems and symptoms become more evident as a toddler develops. Jack’s condition was initially managed without medication, using a series of different strategies including staff training for his preschool carers, parent management and behaviour modification strategies, as well as beginning social skills work.
However, Jack presented with other problems once he started at big school. Typical of children with ADHD, his learning difficulties became much clearer in the classroom, and this impacted on his self-esteem.
By the time he was in year one, Jack had developed a terrible reputation and he was, sadly, being socially excluded. At this point, Jack was prescribed specific medication which helped with his other interventions such as occupational therapy and specialised help for reading, spelling and comprehension difficulties.
Following the correct course of treatment has changed the lives of many of the kids I’ve seen with ADHD, including Jack. I share his parents’ optimism that Jack will prosper wonderfully over the coming years.
Early signs of ADHD
- Constant hyperactivity and always being ‘on the go’
- Constant fidgeting and rarely sitting still
- Being distracted, racing from activity to activity
- Not focusing and very rarely completing activities
- Being impulsive and making the same mistakes repeatedly
- Not listening and not understanding consequences
- Being disorganised and always losing things
- Regularly interrupting the play of other children
- Constantly interrupting and talking incessantly
This is a simplified list only. If your tot is displaying similar symptoms, go and see a paediatrician or child psychologist.