ADHD at Each Stage of Childhood – Preschool through High School
by Kathleen Nadeau, PhD
by Kathleen Nadeau, PhD
ADHD can be identified at a very early age in some children, particularly those that are notably hyperactive, have intense emotional reactions, are difficult to soothe. Such children may sleep little, and can’t be left alone for a minute due to dangerous impulsive behaviors. Some parents report that their young toddler seems to have no sense of fear and endless energy. While such children may grow up to be dynamos of entrepreneurial activity, they can be exhausting to parent and can seem to turn a family “upside down” due to their constant need for supervision and limit-setting.
In most infants and toddlers with ADHD, the picture is less dramatic. They may have a history of ear infections and colic; they may have difficulty with toilet training as early as their peers; and in some, developmental milestones may be a bit delayed. The variety of patterns seen in infants and toddlers that are later diagnosed with ADHD is great — some are quiet and dreamy; some are charming and talkative; many are highly imaginative and engaging. In toddlerhood, an ADHD diagnosis is most likely made because the toddler is so disruptive, so explosively reactive or so dangerously hyperactive that treatment with medication may be highly recommended to slow down the toddler tornado.
Some children are fairly easily managed at home, but demonstrate emerging problems when they enter preschool when the developmental expectations increase. Children that are impulsive may annoy classmates and teachers because they grab toys, interrupt interactions of others, and dart off toward an item or activity that catches their eye rather than remaining in the group activity. These children may have difficulty sitting in circle time to listen to a story; they may hug other children inappropriately or be inappropriately aggressive towards others; they may have a noticeable difficulty paying attention to and following directions.
Being asked to leave a preschool, although unusual even among children later diagnosed with ADHD, is considered a clear marker that an ADHD diagnosis should be considered and that early behavioral interventions are called for.
A good match between the child and the preschool is critical. Sometimes a child that seems to be a behavioral problem in one preschool may fit in very well in another. One little boy who was doing very well in a relatively unstructured Montessori preschool experienced a great deal of difficulty in the kindergarten he transferred to. As he put it, “I don’t like that school. You have to do what the teacher says every minute all day long!” It is critical to work to find an environment that will be a good match for the preschooler rather than focusing efforts on making the child conform to the demands of a preschool environment that is a poor match for his needs and temperament.
Elementary school places ever increasing demands on children to sit still, pay attention to the teacher, and engage in cognitively demanding tasks that may be of little or no interest to the child. Fine motor control is required to master the art of writing — a task that most children with ADHD find very challenging. Attentional problems that may not have been evident in preschool, when a child has more opportunity to select activities that are interesting to her, may rapidly emerge in the early elementary school grades as a child has little choice of activities to engage in. Difficulty completing in-seat assignments and difficulty initiating and completing homework are hallmark signs of emerging ADHD. Patterns of forgetfulness and disorganization begin to emerge. A child with ADHD often forgets to bring home or tell a parent about required permission slips; he may often forget to copy homework assignments; she may often leave her jacket at school or forget to bring home a book needed for homework.
It is important to realize that children of above average intelligence may continue to do very well in elementary school. Although they may have difficulty staying tuned in to the teacher, the academic demands may be so unchallenging to them that little attention is required.
Social interaction problems may become more evident in elementary school, especially among girls for whom there are more stringent expectations that they will read social cues, and be able to listen and interact appropriately during extended interactions with other girls. Looking back, many women with ADHD report that they began to “feel different” than other girls in elementary school.
Middle school is often a time for ADHD struggles to emerge that may have remained hidden during elementary school years. Suddenly, a student with ADHD has multiple teachers and multiple homework assignments to record and complete. While hyperactivity may decrease at puberty, many girls with ADHD experience an increase of symptoms as they pass through puberty and experience fluctuating hormone levels that impact the severity of ADHD symptoms.
Social immaturity is often seen in these young pre-teens with ADHD. Often, social immaturity continues so that there is a gap of several years between the social maturity of teens with ADHD compared to their peers without ADHD by the time they have moved through adolescence.
The natural awkwardness and self-consciousness of early adolescence can be magnified in students with ADHD. They may seem more comfortable with children several years younger, or may withdraw more socially as they are unable to keep up with the more competitive, challenging rapid-fire give and take of social interaction with other young teens. Others, feeling badly about declining grades, try to compensate by becoming the class clown or by seeking attention through risk-taking behaviors.
More academically motivated middle-schoolers with ADHD may demonstrate increasing anxiety as they struggle to maintain good grades as academic demands increase. These students may have great difficulty planning papers and projects; they may be prone to stay up late at night, anxiously trying to complete assignments that they had difficulty getting started on earlier in the evening.
High school years are among the most ADHD-unfriendly educational years. Later, in college, there is much greater flexibility about what classes to take, about class schedules, and how many courses to take each term. Support services for students with ADHD in college tend to be much more accessible than for high school students.
The high school environment is inherently ADHD-unfriendly. The school day starts too early, with the result that most students with ADHD, who have difficulty falling asleep at a reasonable hour, are chronically sleep deprived. The school day requires extended concentration, however the high school environment is inherently distracting. High school is a time when study skills and paper-writing skills are an increasing necessity, and even bright students with ADHD may start to fall behind academically as they experience difficulty with time management, with getting started on assignments, with getting adequate sleep, and with simultaneously managing the all-important social demands of high school years.
Conflicts with parents increase as teens resent feeling micro-managed by parents who may fear that they will never accomplish anything without constant parental involvement. Conflicts emerge over cigarette smoking (a much greater risk for students with ADHD), drugs, alcohol and sexual activity. Students with ADHD demand the same freedoms as their non-ADHD peers, but may be much less prepared to handle them. For example, the driving risks for students with ADHD is much higher, forcing parents to grapple with difficult decisions.
And as college years loom, parents must decide whether their teen with ADHD is truly ready to move away from home and manage the greater independence and reduced structure of college.
Diagnosing and treating your child’s ADHD
Although ADHD is a lifelong condition, with some degree of ADHD-related challenges persisting throughout adulthood, it is a highly treatable condition. Medication should be carefully considered as it has the potential to assist a child in focusing their attention so that they can learn the essential life management skills so critical for a successful adult life after high school.
Treatment needs to focus on helping parents understand out to create and maintain an ADHD-friendly home environment for their child with ADHD, preparing their child to build an ADHD-friendly living environment for himself when he matures and leaves home.
Organizational skills, study skills, problem-solving skills and healthy daily habits all contribute to reducing the negative impact of ADHD.
For a careful diagnosis and solution-focused treatment for you and your child, contact us at the Chesapeake ADHD Center at (301) 562-8448 .