Does More Preschool = More (Wrong) ADHD Diagnoses?
In principle, no. But if a preschool environment is not designed with developmental principles in mind, and ADHD criteria are tossed around without regard to developmental level, then we could see artificial diagnoses made – maybe a lot of them.
Drs. Stephen P. Hinshaw and Richard M. Scheffler predict (in an Op-Ed in the New York Times) that such a scenario can lead to an epidemic of incorrect diagnoses of ADHD in preschoolers. What are the key factors parents should thing about? Here’s a few tips:
MAKE SURE A PRESCHOOL IS JUST THAT: PRE-SCHOOL
There are tremendous developmental benefits to attending preschool. These are achieved when they are designed with developmental principles in mind. That means, simply, that kids should be playing a lot of the time.
Play includes all kinds of activities, including: arts & crafts, music, using blocks to build things, pretend play, running around, and engaging in playground types of activities. Wait, what about learning letters and numbers and developing advanced reading skills and mathematical proficiency? That will come … when they get older (the idea is to promote academic readiness, not academics). For decades, we’ve known that early learning – the academic readiness that we are shooting for in preschool – operates very much through the body. Both gross motor and fine motor skills are primary for brain development and provide the sensory mechanisms underlying cognitive exploration and innovation. All that exploration sets the stage for fundamental cognitive skills that will be used later to master reading and math and writing. Consider this: the simple act of learning to copy figures in toddlerhood is a significant predictor of later academic performance in kindergarten (even after controlling for “cognitive” skills). So while some “academics” can be introduced in the preschool years, the savvy educators know how to do this in measure, and focus on the ways that preschoolers should be spending their time.
Keep in mind that interaction with adults and other kids is also critical for both social and cognitive development. It’s more important that they are being read to, than “reading” on their own. Their vocabularies are expanding tremendously but so much of this happens naturally in conversation and via planned reading group activities (rather than drills to master letters and words). Kids need to express themselves socially, and begin to learn some age-appropriate rudiments of self-control and emotion regulation. They also need to mix it up a little with other kids and learn how to get along with each other (with a little guidance here and there).
ONLY SEEK OUT ASSESSMENT FOR ADHD IF IT’S REALLY A SUBSTANTIAL CONCERN TO EVERYONE
We are now diagnosing toddlers with ADHD. Some toddlers are getting prescribed medication for ADHD. The rationale for this is to help kids as early as possible before the consequences of ADHD take hold on their development.
While this strategy has been controversial, the fact is that some toddlers show very extreme levels of behavior that are different than what you see at that age. But keep in mind that this is a very low percentage of toddlers, and that it’s very challenging to determine this clinically. Hinshaw and Scheffler point out that inappropriate diagnoses of ADHD often come about because the diagnostic process is not comprehensive, and in fact way too short. The result is then a sloppy (and typically wrong) diagnosis of ADHD, and a potentially inappropriate prescription.
Parents need to be appropriately cautious (but not dismissive) of concerns that their toddlers are showing signs of ADHD, particularly if they are in a preschool that is expecting them to behave like “school kids.” One of the hallmarks of ADHD is that it is pervasive – it should be a big problem at home, at school, almost everywhere. Maybe not all the time, but you shouldn’t see “symptoms” in just one context, like a preschool classroom. And you should see the “symptoms” occurring much more frequently than you see them in other toddlers. Often times (not always) a hallmark is very impulsive behavior that can put a youngster at risk for injury. Being distracted now and then and not wanting to sit still is what we call … being a toddler.
BE A SAVVY PARENT
The reality is that parents need to be savvy, both about the type of preschool environment that’s right for toddlers, and how ADHD gets wrongly diagnosed, especially in very young children. A preschool should look and feel like a preschool when you go in there. Kids should be acting like kids, having fun, but have some structure and purpose in mind. They should be playing a lot more than they should be doing “schoolwork.” Educators know how to nurture their developing brains and bodies to promote the very real and necessary social, emotional and cognitive development that takes place in those critical years that provide a foundation for academic readiness (a term which, by the way, shouldn’t go away in the early school years either). And if your preschool is concerned about ADHD, take the concern seriously, but be discriminate. Here’s an interview with an ADHD expert that provides a good feel for knowing when to be concerned about ADHD, and what to do about it.
Help your child organize her homework assignments with our helpful worksheet.
Tags: ADHD, ADHD overdiagnosis, Health, Kids Health, NY Times Op-Ed, preschool, stimulants for ADHD, toddlers, toddlers with ADHD | Categories: Behavior, Health, Intervention, Must Read, Parenting, Red-Hot Parenting