Many preschoolers with attention deficit hyperactivity disorder (ADHD) — or symptoms of it — are much less likely than their peers to be ready for school, a study in Pediatrics found.
Experts say, though, that’s no reason to stop the child from entering kindergarten.
A team led by Dr. Irene Loe, an assistant professor of pediatrics at Stanford University, found 79 percent of children with ADHD weren’t at full readiness compared to 13 percent of children without the disorder.
“A lot of these kids are not identified until they’re really having a lot of trouble in the school setting,” Loe said in a statement.
She studied 93 children ages 4 and 5 — most who attended or had attended preschool, some who were enrolled in kindergarten. Of them, 45 were diagnosed with ADHD or identified by parents as having symptoms, 48 of the children didn’t have ADHD.
The researchers confirmed they were properly classified. They looked at five areas of functioning: physical well-being and motor development; social and emotional development; approaches to learning; language development; and cognition and general knowledge.
Children were deemed to be impaired if scores in one area were more than one standard deviation worse than the mean score for their age. They were considered unready for school if they were impaired in two or more of the five areas.
Where some children fall short
Kids who had ADHD were no more likely than their peers to struggle with cognition and general knowledge. They were more likely than children without the disorder to have difficulty in the other four areas.
- 73 times more likely to struggle in approaches to learning
- more than 7 times as likely to have impaired social and emotional development
- 6 times as likely to have trouble with language development
- 3 times as likely to have impaired physical well-being and motor development
Families need access to behavioral therapy for preschoolers with ADHD — something recommended for the age group but not always covered by insurance.
“If a child has solid preacademic skills (they don’t need to be reading and writing yet) and plays with same-age friends, they are going to be more engaged in kindergarten than preschool. That’s true even if they have ADHD,” said Dr. Mark Bertin, a developmental pediatrician from New York.
Parents whose children aren’t yet in school can seek help from a psychologist, pediatrician, or developmental pediatrician, Bertin said.
Preparing children for school usually starts prior to entering kindergarten, as some children have speech delays or autistic spectrum disorders, added Dr. Marc Lerner, a clinical professor of pediatrics at the University of California, Irvine School of Medicine.
Part B special services, which provides services for toddlers, can start at age 3.
What parents can do
Many children with ADHD may also experience high levels of worry, so being able to get comfortable on campus or with peers before school starts can be helpful.
Another way to prepare children is to ensure regular schedules and good sleep habits. Parents can also mimic a child’s upcoming school schedule the month before school begins in order to help prepare the child.
Growing their social-emotional competence is critical to learning for all children headed to school. It can be quite valuable for children with ADHD symptoms, Lerner said.
Parents should encourage developmental skills that can aid in school success such as physical health, sensory development, behavioral management, being able to focus, sharing, communicating emotions, coping with emotions, and early academic skills.
Holding children back
Some parents consider waiting a year to let a child with ADHD enter kindergarten, but there’s not much evidence that it’s useful for most students, Bertin said.
The American Academy of Pediatrics (AAP) suggests only doing so around kindergarten or first grade, or at a time of a natural transition such as family relocation.
Bertin said holding a child back doesn’t help in the short run. When their disorder is manageable, the child may then be less academically engaged.
“Holding someone back also can disrupt educational services, and can affect self-esteem,” he said.
“Parents… may believe they are giving them a better chance to succeed in academics, athletics, or social settings… this isn’t necessarily the case,” Lerner said. “Labeling children as ‘not ready’ for kindergarten and delaying the start of school can prevent them from being in a more appropriate learning environment.”
Some evidence suggests that being among the youngest in a class can cause academic problems, but most issues seem to disappear by the third or fourth grade, Lerner explained.
Other research indicates that children who are old for their grade are at a greater risk for behavioral problems during adolescence, possibly because they aren’t challenged and become bored.
School readiness a problem
The AAP released a report this month calling for kindergarten screening, rather than a gatekeeping test, for age-eligible children to enter school.
School readiness skills in most young children have improved, but achievement gaps based on poverty, race, and early trauma still exist.
The AAP found that 48 percent of low-income children are ready for school at 5 years old, compared to 75 percent of children of the same age who came from moderate- or high-income households.
Kids who’ve experienced two or more key traumatic events (abuse, neglect, seeing violence, or being separated from a parent due to death, incarceration, or divorce) are 2.67 times more likely to repeat a grade than peers who didn’t have adverse experiences.
“It’s not just about preacademic skills,” said Dr. P. Gail Williams, lead author. “It’s a combination of physical well-being, social emotional abilities, being able to self-regulate, as well as language skills and cognitive skills. And that starts right from birth.”