You can’t really say whether or not a child has Attention deficit hyperactivity disorder (ADHD) before the age of 4 years as many children are very hyperactive at that age! However, that doesn’t mean that there aren’t kids under the age of 4 years who don’t have severe hyperactive behaviour or disruptive moods, but they may end up having other diagnoses in the long run.
When are kids diagnosed with ADHD?
The majority of children are diagnosed because of behavioural, social or developmental issues at, or, around 5 years of age, and another group due to educational difficulties at about a grade 3 level.
How is a child diagnosed?
As far as the diagnosis is concerned, consensus criteria for the diagnosis of ADHD are defined in the Diagnostic and Statistical Manual of Mental Disorders V (DSM V). I know this sounds rather off-putting, but this manual is just a guide for all health professional in the field to have some sort of consensus as to which criteria constitute a specific diagnosis.
In these guidelines the symptoms of ADHD are divided in two categories:
- The first are the criteria that suggest inattentiveness and distractibility. There are 9 criteria of which more than 6 would be suggestive of a diagnosis.
- The second group are symptoms and signs of hyperactivity and impulsivity, again 9 criteria. If more than 6 are present it suggests a diagnosis on this axis.
So, it’s evident that some children may qualify for a diagnosis on one set of criteria but not another. Yet, we refer to all children that satisfy the criteria as ADHD and we do not subdivide diagnoses into ADHD and ADD.
Who should make the diagnosis, and decide if medication should be prescribed?
The most practical answer is anyone in your community who is either an expert in the field or has a great deal of experience with children with ADHD. In an ideal world the diagnosis should be made by child psychiatrists, developmental paediatricians and trained psychologists.
Unfortunately, those resources are quite scarce. The next level of professionals that may be able to help are paediatricians, psychiatrists and some general practitioners.
Teachers are not allowed to make a diagnosis, but many of them are very experienced and may ask you to have your child assessed. That would not be an unreasonable request, but they cannot insist that medication be prescribed. Therapists also have experience in the field of ADHD, and although they cannot make definitive diagnoses, they could suggest an assessment for a diagnosis and medical intervention, and be part of the therapeutic team.
When should my child with ADHD be medicated?
The indication to start a trial of medication is when, despite your child being in the correct school placement, the ADHD symptoms interfere with learning or social development to a significant degree. If it does not, there is no harm to take a wait-and-see approach (preferably together with a professional that can give you guidance). But when it does, it is better too trial medication sooner rather than later.
Professor Andre Venter’s speciality is in developmental paediatrics. His passion is helping all children, and especially those with cognitive, physical, emotional, psychological and educational barriers grow, develop and reach, not only their potential, but to flourish and become accepted and useful members of our society. He is one of the founders and also the director of the Maternal and Child Academic Hospital Foundation (MACAH F) which was established in 2017.