Does My Toddler Have ADHD?

When you watch your toddler going about his frenetic day, his overactive pace may leave you wondering whether his behavior is typical — or if something else is going on. After all, the usual toddler adjectives — fidgety, distracted, impulsive, dramatic, defiant and talkative, to name a few — are also commonly used to describe people with ADHD (attention deficit hyperactivity disorder). 

But try to relax: Just because your toddler can't sit still or focus doesn’t mean you should check in with a specialist. To help you figure out the real deal behind toddlers and ADHD, including the possible symptoms and what doctors say about screening for this condition, read on.

What is ADHD in children?

ADHD is a common mental health disorder defined by episodes of hyperactivity, inattention, or both. The estimated number of children ever diagnosed with ADHD, according to a national 2016 parent survey, is 6.1 million (9.4 percent).

The American Academy of Pediatrics (AAP) advises against assessing a child for ADHD until he’s at least 4 years old. One reason is that toddler brains are developing so quickly that the very behaviors that seem troubling today probably won’t even be an issue in a couple of months.

For another, a child’s behavior has to be inappropriate for his age and development. So, while it’s possible for a toddler to have ADHD and may even be noticeable as early as age 3, it’s rarely diagnosed this young. ADHD in children can be broken down into three different subtypes:

• Inattentive type. Once known as ADD, this type describes those who can sit still and get along with others, but actually aren’t paying attention. Concentrating on homework or other activities is difficult.
• Hyperactive/impulsive type. Tots with this type of ADHD seem to be constantly running, jumping and wriggling around. They’ll also interrupt others and have trouble taking turns with other kids.
• Combined hyper and inattentive. A combination of both hyperactive-impulsive and inattentive behaviors is the most common type of ADHD.

ADHD can affect all ages of children and adults, though it’s seen more often in boys than girls and the different types can follow gender lines, with boys being more hyperactive and girls falling into the more inattentive group. This behavioral condition presents symptoms that may be mild or moderate, though they can also be severe in some cases.

ADHD symptoms in toddlers

The AAP says it’s difficult to diagnose ADHD in children younger than 4 years old because many of the common signs and symptoms for this condition are actually normal, everyday toddler behaviors.

But while most doctors agree that it’s hard to decipher whether or not a young child has this condition, there are some early signs of ADHD that you can watch for:

• Frequent and intense tantrums. Angry outbursts and the inability to control emotions.
• Aggressive behavior. You might hear about rough play with friends or removal from social situations because of aggressive or willful actions.
• Distracted and overwhelmed. Daydreaming, a habit of not listening, disorganization with personal items, and frequent distraction are common signs of inattentive ADHD. 
• Overly fearless. Impulsive behavior such as leaping off the top of the jungle gym, injuries due to recklessness, and even engaging too much with strangers are signs of impulsivity. 
• Always in motion. Constant running, climbing, jumping, squirming, fidgeting and an inability to stay seated are common hyperactivity clues.
• Disruptive. Frequent talking, interrupting, blurting answers and finishing others’ sentences.

ADHD causes and risk factors in toddlers

There’s no test that can be given to diagnose ADHD (it’s more of a process that involves gathering intel from many sources), and there don’t seem to be specific causes that can be pinned to this condition. That said, there are some risk factors that may contribute to it, such as:

• Genetics. Many studies suggest that a person’s family history and genes are the root of ADHD. In fact, 3 out of 4 kids with ADHD also have a relative with the same disorder.
• Premature birth. Being born premature can contribute to the development of ADHD, as well as a brain injury in the baby and extreme stress for the mother during pregnancy.
• Environmental factors. More research is being conducted on possible outside factors for ADHD, such as a child’s nutrition and social environments.
• Smoking, drinking alcohol and/or using drugs during pregnancy. These habits may also be connected to ADHD.
• Artificial colorings and preservatives. While it’s not definitive that additives and/or sugar are behind ADHD, there’s some research that indicates food colorings, such as FD&C Yellow No. 5, may up the incidence of hyperactivity in some kids.

Should I have my toddler screened for ADHD?

You can always bring up any concerns you have about your child’s emotional development with your pediatrician. And it’s wise to be in close contact with your tot’s day care provider or preschool teacher for clues too.

Still, know that while the diagnosis and treatment of ADHD in young kids has expanded its age range to between 4 to 18 years old, doing so any earlier is difficult.

But if an ADHD screening were to take place, gathering all the information from those who have daily contact with your child (babysitters, teachers, family members) is the first step. Next, any alternative causes or underlying conditions should be considered, such as anxiety or depression (both also very rare in toddlers and young kids), language delays, learning disorders, or physical issues like sleep apnea or ear infections. Also be sure that your little one is getting enough sleep at night, as overtired children also sometimes can appear to have ADHD.

ADHD treatments and medication for kids

If the above conditions have been ruled out and a diagnosis is given, the most successful ADHD treatment often includes a combination of behavioral-management therapy and medication, though it depends on the child and the specific situation. Experts generally recommend starting with behavior therapy, which teaches kids management techniques for self-control and better focus. 

If these strategies don’t seem to be making a difference over time, moving to medication may be the next step. Talk to your regular pediatrician, child psychiatrist or developmental pediatrician, but know that finding the right drug may take a while. The AAP points out that “a child’s response to stimulants is variable and unpredictable,” but that in general, research suggests 90 percent of children treated with medications benefit from them.

As for additives and diet, the AAP recommends that all children eat meals full of fruits and vegetables, rather than those that are packaged or processed. Whenever possible, stick to whole foods — while a definitive connection between food additives and colorings and prevalence of ADHD hasn’t been fully proven, an increasing number of studies suggest that some food additives can interfere with a child's hormones, growth and development. The AAP reports that some may also increase the risk of childhood obesity rates, which have tripled since the 1970s.

What’s the difference between ADHD and autism spectrum disorders (ASDs)?

ADHD and autism may have similar symptoms, but there are several key differences between the two. While a child with ADHD has trouble focusing, one with an autism spectrum disorder tends to be overly focused on things, such as placing toy trucks in neat lines. And kids with ADHD often love interacting with other kids, whereas ASD children may be at least somewhat withdrawn.

Kids with autism have trouble understanding emotional and physical boundaries and may not realize how their behavior or speech may be coming across. Children with ADHD, however, know right from wrong but don't always think about the consequences of their actions when they don’t want to do what they’re told. 

Autism can be detected and officially diagnosed much sooner in life than ADHD — even as early as 18 months or younger. But as mentioned, a child who may have ADHD can’t be reliably diagnosed with this condition until he’s 4 years old.

As you parent your super busy toddler, take heart and know that the fast-paced, impulsive behavior you’re seeing is very often just that — normal toddlerisms that are to be expected at this age. But if you’re concerned that your little guy isn’t developing along the same lines as his peers, have a conversation with the pediatrician for some reassurance and guidance.