Attention-Deficit Disorders

In Preschool Children

by Bracha Sacks, Psy.D.

Attention-Deficit Disorder is characterized by impulsivity, hyperactivity, and inattention, but this may describe most two-year-olds. Toddlers typically act without thinking, climbing onto furniture or running into the street without fear of consequence. Small children may flit from toy to toy and "tune out" anything they do not want to hear, such as, "time for bed!" or "put your blocks away." Parents thus ask, "Can a two or three year old actually have ADD?"

ADD is not diagnosed until the key symptoms have been present for six months to one year. However, experienced adults can often spot the precursors of ADD in babies and toddlers. Infants who will develop ADD frequently are "difficult" babies who seem to sleep very little, cry a lot, and are sensitive to changes in the en vironment. Transitions are problematic; these babies refuse to sleep in an unfamiliar place, like to stick with favorite foods, toys, and activities, and reject new situations until they become accustomed to them. Later, parents notice a high level of activity. These are the infants who never seem to be where they were left. Crawling, they climb out of cribs and playpens. Later, they climb onto the highest shelves and cabinets and open childproof locks with ease.

When a parent is driven to distraction by such an active and hard-to-please child, he or she may seek help from professionals. The symptoms a clinician will look for at age two or three are simply exaggerations of normal behavior. Is this child MORE impulsive than average? Less able to focus attention? More restless, to the point of being motor- driven? Parents are asked to complete checklists describing various behaviors and their frequency. The child is compared to a normative sample, and if he is well above average in these behaviors, an ADD diagnosis is likely.

   The easiest symptoms to spot are those relating to hyperactivity. Hyperactive toddlers never seem to sit still; while a typical youngster can sit through a storybook, a hyperactive child cannot. She may listen, hear, and understand the story while running around the room, o she may tune out and become involved in her own activities. Such children run, climb, and move every muscle until exhausted. Because of impulsivity, the child's constant movement often lacks restraint. He will run or climb to achieve his goal, knocking aside obstacles in the way by banging into them. He cannot plan and organize his movements because he acts on the impulse of the moment. He does not think, "If I climb on this chair to get the cookie, I might fall, so I'll ask Mommy instead." Rather, an urge says "get cookie" and his mind and body immediately follow. Some children have a very short attention span, even without impulsivity and overactivity. Unlike their peers, they are unable to listen to and concentrate on a story. They lose focus extremely quickly and may even seem to "space out." Many of these children have a problem screening the various stimuli they encounter. That is, they hear the teacher reading Goldilocks with the same urgency that they hear the child next to them coughing slightly, the door squeaking, and everything else that is happening. Background sounds, sights, and smells are perceived as equally important as the primary ones. While being fed, the child may get up, look out the window, and say "what's that?" because he heard a truck go by. He cannot tell that this truck is irrelevant and his dinner is relevant.

Inattentive children are often perceived as stubborn or defiant. A parent says "pick up your toys!" and nothing happens. Adults often say that such a child is disobedient or deliberately not listening; however, the ADD child simply never heard the instruction. She was tuned into her own thoughts and Mom's words came through, if at all, only as background noise.

A competent professional diagnosis followed by remediation can help the ADD child make the most of his or her strengths and overcome weaknesses to achieve and succeed in life.

Dr. Bracha Sacks is in clinical practice at The Center for Attention-Deficit and Behavior Disorders, 1801 Avenue M, Suite 10, Brooklyn, NY 11230 (718) 421-4200).