Too Young for Attention Deficit Disorder? Views from Preschool

Abstract

A review of public-school administrative records and interviews with early-childhood directors from special and regular programs were used to collect information about factors associated with outcomes for young children with attention-deficit disorder with or without hyperactivity (AD/HD) in preschool. Special-education preschool administrators and community-based child care and preschool directors differed in their fundamental view of "what works" with preschool AD/HD children, but they agreed in principle on other issues (e.g., public-school providers attested to faith in adult-directed programming; community providers cited child-centered approaches as effective with AD/HD). The records review and interviews indicate that intrinsic program structure, gentle and constant adult help, acceptance of the child, family integrity, gross motor facilities, and attention to comorbidities were seen as positively related to child success. Multiple caregivers, poor understanding of development, failure to foster self-soothing and other personal mastery skills, expectations of perfection, and delegated parenting were identified as negatively related to good outcomes over time for children with AD/HD or similar profiles.

The Prevalence of Attention-Deficit/ Hyperactivity Disorder Among Persons With Albinism

“…9,21 Diagnosing ADHD in the school-aged child by DSM-IV criteria has been well studied; however, making a diagnosis in a preschool-aged child or adult is less well defined. [22][23][24][25] Making a diagnosis of ADHD in a young child with decreased visual acuity is particularly problematic. Because of their early-onset visual impairment, children with albinism often receive early intervention and increased attention by parents and the school system, which may mitigate some of their ADHD symptoms.…”

“…July [20][21][22][23]2006, and from the University of Minnesota International Albinism Center. Informed consent and assent was obtained from parents or from participants 8 years and older.…”

What Is Attention-Deficit Hyperactivity Disorder (ADHD)?

“…110 The diagnostic uncertainties of extending a criterion-based diagnosis for school-aged children to preschoolers have been reviewed. 4,[111][112][113][114] The American Academy of Child and Adolescent Psychiatry practice parameter states that preschoolers are "best identified when the child is asked to do sedentary tasks requiring sustained attention in a structured classroom setting, a situation not often experienced by preschoolers." 4 In fact, many 3-year-olds have not had previous preschool experience, and the ability to behave acceptably and pay attention is influenced by many factors, including separation reactions, the nature of the tasks, the expertise of the preschool staff, and the quality of the preschool setting.…”

Rethinking the AAP Attention Deficit/Hyperactivity Disorder Guidelines

“…17,18 One early childhood specialist working in a public school setting notes that fully half of the preschoolers in her and five other centers' experience who were diagnosed as having AD/HD were "found to be living in families with serious adult problems" (domestic violence, maternal depression, sexual abuse, terminal illness in a parent). 19 She, in collaboration with colleagues, identifies several worrisome trends for the under-fives, including (1) "multiple caregivers and interruptions in care during the first 30 months of life," (2) "limited understanding of "developmental appropriateness" by parents and caregivers," and (3) "failure to foster self-soothing, adaptive mastery, and the ability to delay gratification in mainstream child-rearing." 19 There is evidence that "experiential factors" in the first 4 years may play a role in the pathogenesis of difficulty sustaining attention and learning.…”

“…19 She, in collaboration with colleagues, identifies several worrisome trends for the under-fives, including (1) "multiple caregivers and interruptions in care during the first 30 months of life," (2) "limited understanding of "developmental appropriateness" by parents and caregivers," and (3) "failure to foster self-soothing, adaptive mastery, and the ability to delay gratification in mainstream child-rearing." 19 There is evidence that "experiential factors" in the first 4 years may play a role in the pathogenesis of difficulty sustaining attention and learning. [19][20][21] This hypothesis, though fraught with confounders, bears investigation.…”