By now, if you’ve been following my blog posts for any length of time, you are well aware that I specialize in working with ittybitty children. Often. get referrals something along the lines of this….

“Little Johnny– 3 years old, hyperactive, impulsive, problems with peers in daycare setting, very aggressive, won’t listen to adults, (mom, dad, or otherwise), runs around daycare class, short attention span.

Cue intake appointment with the parent – Typically, one of the first questions they ask me is “Does my child have ADHD”? My answer?  “Maybe, maybe not!”   (Pretty sure it’s not the answer they wanted right at that moment in time…BUT) Here is my explanation as to why:

Very young children are not programmed to sit still, listen perfectly, follow all directions the very first time they are asked, etc. etc.   

There are MANY reasons why children in this age bracket may exhibit several of these symptoms! Anxiety in young children can look a lot like ADHD. So can lack of sleep, abuse/trauma , boredom, sensory processing disorders, lack of limits and boundariesas well as a mismatch in parent /child temperament. (Essentially, the child may not be exhibiting any clinically significant symptoms, it’s just that their temperament does not sync up with their parent’s temperament causing disconnect in how parent and child relate and communicate with one another!)

As frustrating as it is to go through the process with your doctor or therapist answering their 10,000 questions please be patient with the process. As a parent, you want an answer as to why your child is behaving the way he/she is but it is very important to ensure your child receives an accurate diagnosis prior to moving forward with various treatment options. Your pediatrician, psychiatrist or therapist may refer to the DSM 5 Diagnostic Manual for more specific guidance in determining an accurate diagnosis for your child. Below are the most current guidelines for ADHD criteria:

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for the child’s developmental level:

  • Often fails to give 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 on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked)
  • 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 (such as schoolwork or homework
  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
  • Is often easily distracted
  • Is often forgetful in daily activities

2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

  • Often fidgets with or taps 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 (adolescents or adults may be limited to feeling restless)
  • 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 his/her turn
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years
  • Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities)
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functionin
  • The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Should you feel that any of the above mentioned symptoms could be describing your child, bring it to your pediatrician’s attention first in order to determine if further referrals are necessary to identify the source of your concern.

Katerie Breuer, MSW, LCSW, LISP-CP 


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