What to know about ADHD in toddlers

Toddlers (children ages 1–3 years) go through different developmental phases and milestones. During this development, toddlers may exhibit behaviors similar to Attention deficit hyperactivity disorder (ADHD), including symptoms such as hyperactivity, impulsivity, and difficulty paying attention. 

However, as this behavior is typically part of a toddler’s development, it can be difficult to receive a diagnosis.

In the United States, about 5.3 million children are diagnosed with ADHD, 2% of which are ages 3–5 years. However, the percentage of children not receiving the diagnosis could be higher as ADHD is often underdiagnosed, especially in girls.

How do I know if my toddler has ADHD? 

Between the ages of 1 and 3 years, you cannot distinguish between ADHD and typical toddler behavior. However, there may be some symptoms that point to an increased risk of ADHD later on in life. According to the National Institute of Mental Health, children may experience the following symptoms of ADHD:

• hyperactivity
• inattention
• impulsivity

Let’s look at these symptoms in detail and how they may manifest in children between the ages of 1 and 3.

Inattention

Toddlers typically have a short attention span, as their brains and ability to focus are still developing. So, it can be usual for them to experience and exhibit inattention.

However, in some instances, inattention in a 3–4 year old child can be a symptom of increased risk of ADHD.

Examples can include:

• disliking or frequently avoiding activities that require paying attention for a few minutes
• losing interest in an activity quickly and beginning another instead

Hyperactivity

Toddlers are always on the move as their newly developed and discovered motor skills help them explore the world. They want to get into everything — and they do. Exploring things around them is a huge part of their development. 

Some symptoms of hyperactivity may point to the possibility of having ADHD. These include:

• constantly squirming and fidgeting
• talking and making noise in excess or more than other children their age
• not being able to sit still, kicking and jiggling their feet, or twisting around on their seat
• climbing and running around when instructed not to

Impulsivity

A toddler’s brain is developing the ability to regulate and manage their impulses. So, it’s usual to see toddlers get into an unsafe situation every now and then as they often give in to their impulses. 

However, some symptoms of impulsivity may indicate ADHD. These include:

• getting regularly into situations that are not safe
• frequently interrupting when other people are talking
• having a high level of impatience
• warming up too quickly with strangers

Other symptoms

Toddlers with ADHD may also present other symptoms, such as:

• displaying frequent aggression toward playmates and classmates
• having more anger and frustration when compared with other children their age
• experiencing frequent injuries from running, climbing, and moving too fast when asked not to 
• experiencing sleep difficulties, such as getting little sleep

Diagnosis

Diagnosis of ADHD in toddlers is usually tricky. As some of the core behaviors typical in toddler development are similar to symptoms of ADHD, it can be difficult to distinguish one from the other.

The American Academy of Pediatrics (AAP) has guidelines for ADHD diagnosis for children as young as 4 years. There are no official guidelines for ADHD diagnosis in children younger than 4 years, which constitutes the toddler age group. 

This is because as children grow older, they usually grow out of the core behaviors similar to ADHD symptoms. After the age of 4, it becomes easier to distinguish whether they have ADHD.

While some children younger than 4 years do receive a diagnosis of ADHD, this is extremely rare. The AAP recommends that pediatricians analyze the child’s behavior in at least two major settings (at home and day care) to determine an ADHD diagnosis. 

Treatment

If your toddler has behaviors indicating ADHD, the first line of treatment is therapy. The AAP recommends behavioral treatment first and medications only when needed. 

Therapies that can help treat ADHD symptoms in toddlers include:

• Behavior therapy: This therapy can teach parents, caregivers, and teachers how to identify, monitor, and manage behaviors. It can also help children to learn new behaviors.
• Parent behavioral training: This training encourages parents to learn more about childhood development. It can also give them the tools and strategies to help their child manage negative behavior with positive discipline.

When it comes to medications to treat ADHD in young children, the AAP recommends the drug methylphenidate for children ages 4–5 years on a low dose.

Examples of brand name methylphenidate include Ritalin and Methylin.

It is important to know that methylphenidate can have side effects like slowing your child’s growth and weight gain. It also has a high risk of dependence (with dependence, your body needs a drug to function like usual). So, it’s important to work closely with a healthcare professional when using this medication for your child.

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How can you manage ADHD symptoms in toddlers? 

As a parent and caregiver, it can be challenging to manage ADHD symptoms in small children, but there are some things you can do to feel better equipped. It’s also important that you, as a parent and caregiver, practice self-care and find support.

Examples of ways you can manage ADHD in young children include:

• taking parenting skills training that can not only help you understand your child’s behavior but also teach you techniques and strategies to manage and correct their behaviors
• behavior therapy, which can teach you positive ways to interact with your child as well as how to work together with a therapist in the treatment of your child’s ADHD
• practicing self-care and methods to reduce stress, such as meditation, yoga, and exercise

Summary

It can be difficult to receive a reliable diagnosis of ADHD in children between the ages of 1 and 3 years. Core behaviors of toddlerhood coincide with some of the symptoms of ADHD, such as inattention, hyperactivity, and impulsiveness.

The AAP has clinical guidelines to diagnose ADHD in children over the age of 4, as children with these traits tend to grow out of these behaviors by this age. If these traits persist, it may indicate that a child has ADHD.

Some early symptoms can identify if your child’s behavior is due to typical toddler characteristics or if it is because of ADHD. These symptoms include:

• extreme impatience
• more aggression compared with peers
• frequently and quickly losing interest in activities

Treatment for toddlers diagnosed with ADHD includes behavior therapy and medication. Doctors also recommend parents and caregivers take parenting skills and behavioral therapy classes to understand and better interact with their children. 

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