Querying ADHD in the under 5’s

During my time as a Trainee Parent Infant Psychotherapist in a local CAMHS service, I have noticed an increase in referrals querying ADHD in children under the age of 5.

Parents report that their children are ‘impulsive’, ‘struggle to sleep’, become easily frustrated, will act out physically and are hyperactive, and are unable to calm down.

So what is ADHD and why is it rarely diagnosed in the Under 5’s

The Diagnostic Criteria for the under 5’s (DC 0-5 2016:25) states:

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder of developmentally inappropriate levels of inattention or hyperactivity-impulsivity that interferes with the functioning of a young child and his or her family, workers etc.

Professionals are usually hesitant to diagnose children so young. Behaviour in the under 5’s, tends to be unstable and can change weekly; due to children learning how to regulate and recognise their emotions in different environments and different social settings. A large part of the ADHD assessment is a school and home observation, as children with ADHD illustrate inattentive and or hyperactive behaviours depending upon the environment. Therefore, observing children at this age for an ADHD assessment may not give professionals an accurate picture of the child’s behaviour.

Furthermore, some of the areas of concern regarding ADHD children are areas that are still developing when the child is under the age of 5. These concerns may include the lack of object permanence (knowing someone is still there when not physically there), the struggle to regulate their own emotions, and the lack of Executive Functioning Skills (such as the ability to plan). For example, the infant may struggle with their Executive Functioning Skills at age 3, but may have further developed these skills by age 5.

So how can professionals and parents support children, under the age of 5, where ADHD is being queried.

Ultimately, practitioners and parents can support children in developing these skills For example:

  1. Classic ‘peek a boo’ games, support children in learning that people, in particular caregivers, are there, when they cannot be physically seen (object permanence); this allows the child to learn that they are still thought about. This allows the child to learn to feel more secure when their caregiver is not physically around.
  2. With regards to impulsivity, parenting strategies such as ‘time out’, allow children to develop the ability to reflect, pause and process their feelings, similar to ‘mindfulness’; which is also a recognised treatment method for ADHD. By allowing the child to ‘pause’, neurologically, it supports the development of the frontal lobes; which support in the development of emotional regulation. However, if a time out or a ‘mindfulness moment’ is being used, the infant is encouraged to see the adults. The incident can then be discussed after the time out has finished.
  3. Teaching children to recognise emotions through photos or facial expressions allows the child to learn how to recognise these emotions in themselves and others. This allows them to learn how to express these emotions in different ways, e.g., by telling their parent that they are sad.

If you have concerns about your child, then do contact the Parent Infant Clinic.

References:

Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: DC: 0-5 (2016). New York: Zero to Three the Natl Center