Question:

I have a 4 year and 8 month old son who has been recently diagnosed, but with ADHD. The diagnosis is not conclusive because he is so young. Medications are making him more hyperactive. Somedays he is too good and some days he is very active. I get calls from the school that he runs out of classroom. He is not harmful to anyone but he is always on the go.

What can I do to change his behavior ? So far I have explained to him a lot that it is dangerous to run out of the classroom but it does not seem to make a difference. Any suggestions ??

Sincerely,
Sonal

My 4 year old son was recently diagnosed by a physician with a mild case of AD/HD – he’s currently in Pre-School at a Center with 30+ kids and every week I receive a call from the school about my son’s disruptive behavior. I understand that he has a hard time focusing and is easily distracted so I want to find a school in my area that has a smaller class size and can accommodate ADHD students. I’ve searched and all a lot of places in my area and class sizes are 30+ kids with 3 teachers at the most – I don’t like that ratio.

The doctors have suggested I give my son Ritalin but I refuse to give him any medications until my husband and I have done all we can to help him. I want to reduce this class size, keep him on a normal routine and help him transition with changes. I’ve never known anyone with AD/HD so the only information I have about it is from doctors or the Internet. If I need to change my routine as a parent to help accommodate my son then I will but I refuse to give him Ritalin. From what I’ve read on the Internet a lot of the parents who are giving their kids this Ritalin are still having the same issues with their child and they see no changes. As a new parent and a young parent – can you tell me where I can go to find a school or resources in my area that help kids with ADHD? Do you think a smaller class will help my son at all? PLEASE HELP.

Thanks!
Alo

Answer:

Hello, Sonal and Alo;

Recently I have received several questions about preschoolers with AD/HD. Coincidently, new findings about best practices with preschoolers with AD/HD have been published within the last year so I thought I would take the opportunity to share this information with you while addressing your questions.

In 2001, the National Institute of Mental Health (NIMH) initiated a study to evaluate the effectiveness of behavioral and medical treatments for preschool AD/HD children. The study, completed in 2004, took place at six university medical clinics nationwide. The children are being followed for five years following the study. Findings indicate that behavioral therapy coupled with parent education was effective in improving the behavior of one third of the 303 three to five year olds who participated. Results also indicated that low doses of methyphenidate (Ritalin) were safe and effective in treating those children who did not respond to behavioral intervention and parent education training.

Results of the study indicate that medication should be a last resort for preschool children, reserved only for moderate and severe cases of AD/HD because, in this age group, side effects seemed to be stronger and the medication was not as effective as with older children. According to the NIMH, medication slowed the children’s growth rate: the children grew about half an inch less in height and weighed about three pounds less than expected throughout the duration of the study. No research has been done tracking the long-term growth rate of preschoolers who take methylphenidate. Other side effects observed were problems sleeping, loss of appetite, and repetitive skin picking behaviors. Despite current concerns about the possibility of an increase in blood pressure, this side effect was not present.

In addition, to the effects of medication, another study funded by NIMH looked at psycho-social and behavioral alternatives. Over the course of 70 months, researchers at Lehigh University’s Project Achieve looked at the progress of 135 preschool students with AD/HD. Dr. George DuPaul, one of the researchers, is known for his studies about the academic implications of AD/HD. According to Dr. DuPaul, “Medication may address the symptoms, but it does not necessarily improve children’s academic and social skills. “

Dr. Du Paul’s non-medical approach was effective in producing a 17% decrease in aggression and a 21% improvement in social skills at home. At school, teachers reported a 28% improvement in those categories. ( Lehigh University News, 8-16-07) These results are considered “significant” by NIMH. Participants were randomly assigned to one of two groups: multicomponent intervention (MCI) or parent education only (PE). Both approaches were equally effective. (NIMH Science Update, 8-15-07)

What was the non-medical magic that produced these results? To start with, I think it’s important to differentiate between poor parenting that may cause problems for children and enhanced parenting that can contribute to resilience and growth for those children with inherent, neurobiologically-based behavioral challenges. The interventions employed in the research studies were targeted at the second group. Parents of children with AD/HD need to remember that they are not the cause of their children’s behavioral difficulties, but they can be key players in improving the outcome for their child.

In addition, it would be very difficult, Sonal, for you to prevent your child from running out of the classroom unless you were actually at the school. Preschool children benefit from behavioral strategies that are concrete and readily available at the time the behavior occurs.

There are no easy answers. Understanding and parenting the child with AD/HD is a challenging job. Some general suggestions include:

• Choose a preschool or daycare that is highly structured. Consistent routines are critical for children with AD/HD.
• Provide a choice of activities throughout the day. Choice tends to diffuse conflict.
• Give your child advance notice when it’s time to change activities. Timers can be helpful.
• Use drama and other role-playing activities to teach social skills.
• Catch your child “being good.” Give him or her plenty of praise for appropriate behavior.
• Prevent escalation of an inappropriate behavior by using calm reminders when the behavior begins to surface.
• Be sure to safety-proof all areas of the home and school. Children with AD/HD are accident-prone.
• Establish communication with your public school district early. Early intervention may be available.
• Communicate frequently with your childcare provider or preschool about your child’s needs. Whenever possible, provide consistent expectations and routines between home and school.

Many commercial programs are available that can help parents and school personnel develop specialized behavior management skills to support preschool children with AD/HD. These programs generally take place over at least several weeks and many of them require homework. The Project Achieve study used a “pre-packaged” parent education program called “Community Parent Education” ( Cunningham et al.) The support organization Children and Adults with Attention Deficit Disorder (CHADD) recommends several approaches for parent training. The CHADD organization offers the Parent to Parent education program that is extremely informative. For information about Parent to Parent in your area, visit the CHADD website. Another program mentioned in Attention! Magazine is Parent Child Interaction Training (PCIT), a short term program for any preschool child experiencing behavioral challenges. People have reported success in supporting behavior at home with the “1-2-3 Magic” program by Thomas Phelan. This behavior management program is widely offered, sometimes through school districts and also published as a book.

Finally, I would strongly suggest that you obtain a copy of the CHADD Educator’s Manual (Zeigler-Dendy, Durheim, & Teeter Ellison) and share this with your child’s preschool. Chapter 6 is devoted to interventions for preschool children. One of our jobs as parents is to help educators become more aware of the challenges our children face.

Resources

Books

Phelan, T.W. 1-2-3 Magic, Third Edition. 1-2-3 Magic for Teachers. Available at: www.parentmagic.com

Zeigler-Dendy, C., Durheim, M, & Ellison, AT (2006). CHADD Educator’s Manual. Landover, MD: CHADD. Available at: www.chadd.org

Parent Education

Cunningham, C.E, Bremner, R.& Secord M. (1998) Community Parent Education Program. Ontario, Canada: Hamilton Heath Sciences Corp.

Parent Child Interaction Therapy (PCIT). University of Florida, Gainesville, FL. Information available at: http://pcit.phhp.ufl.edu/

Parent to Parent: A Family Training on AD/HD. Information available at: www.chadd.org When you get to the homepage, click on “Especially for: Parents.” You will be able to follow the links to find a teacher near you.

Triple P-Positive Parenting Program. Small changes, big differences, the University of Queensland, Australia. Information available at: : http://www1.triplep.net/

Articles

Lehigh University. Preschool ADHD: The Next Critical Public Health Concern.UR New Stories: 2295

Kern, L. DuPaul, J. Volpe, R.J., Sokol, N.G., Lutz, G, Arbolino, L, Pipan, M, VanBrakle, J.D. Multisetting Assessment-Based Intervention for Young Children at Risk for Attention Deficit Hyperactivity Disorder. Initial Effects on Academic and Behavioral Functioning. The School Psychology Review 36. no.2. 237-55. June, 2007

National Institute of Mental Health. Preschoolers with ADHD Improve with Low Doses of Medication. Press Release. October 16, 2006. Available at www.nimh.nih.gov

Neergaard, Lauren. Simpler, Nondrug Way to Treat Children with ADHD. Marin Independent Journal. Tuesday, September 4, 2007.

Wolraich, M. AD/HD: Can the Disorder be Diagnosed Before Children Enter Elementary School? Attention!. August, 2007