Updated 13 June 2017

30% of American kids diagnosed with ADHD before the age of 6

Close to 30% of children with ADHD are diagnosed before they are 6 years old even though there aren't many tests aimed at diagnosing children that young, a new federal government report shows.

It's difficult to determine whether the results show over-diagnosis of ADHD or not, said Joel Nigg, director of the division of psychology at Oregon Health & Science University in Portland.

"Although guidelines and instrumentation for diagnosing preschool children, for example, are weaker, the condition itself is developmental and expected to exist in preschool," said Nigg, who was not involved in the study. "So, many of those young diagnoses may be valid."

Symptoms of ADHD include inattention, hyperactivity and impulsive behaviour, which can affect a child's ability to learn.

The study was done by Susanna Visser, a researcher at the U.S. National Centre on Birth Defects and Developmental Disabilities, and published in a Sept. 3 report from the U.S. Centers for Disease Control and Prevention.

The researchers interviewed nearly 3,000 parents of children ever diagnosed with ADHD and 115 parents of children diagnosed with Tourette's syndrome. About half the children with ADHD had been diagnosed before age 7, and 31 percent had been diagnosed before age 6.

Family members play an important role

Among the children diagnosed before age 6, a parent or other family member was the first one to become concerned about the child's attention or behaviour in three of every four cases, the researchers found.

Just over half the children with ADHD received their diagnosis from a general paediatrician or family doctor. Only a quarter of the children diagnosed before age 6 had seen a psychiatrist for their diagnosis, but children were even less likely to get their diagnosis from a psychiatrist as they grew older.

"One of the most striking things is that most providers are, in fact, trying to follow the guidelines - trying to use rating scales and get information from multiple informants, like teachers, in addition to parents," Nigg said.

If doctors are using information from teachers in making a diagnosis, that suggests doctors are not making quick decisions in 15 or 30 minutes based only on a parent's description of their child's behaviour, Nigg added.

Yet over-diagnosis may still be occurring, based on the report, said Dr. Danelle Fisher, vice chair of paediatrics at Providence Saint John's Health Centre in Santa Monica, Calif.

"Over-diagnosis presents a number of problems, including being improperly labelled as ADHD if, in fact, another behavioural or psychiatric problem is the cause of the symptom," Fisher said. "This could also lead to over-medication of such children."

Both Fisher and Nigg suggested it is unwise to rush to a judgement of ADHD if a preschool child seems particularly boisterous or difficult to manage.

"Children are developing rapidly at that age, and many 4-year-olds who seem excessively hyperactive tend to stabilize during the major development shift from 4 to 6 years old," Nigg said. But he added that the situation can become too severe to wait it out sometimes.

"In cases where the child is unable to learn, unable to participate in group or preschool activities, or where a negative relationship is developing between parent and child, then a professional evaluation and intervention are likely indicated," Nigg added.

Several options may be available for parents, Fisher said.

"Firstly, parents should look into parenting classes in order to help them manage difficult or unruly behaviour," Fisher said. "Secondly, if there is a family history of ADHD or other childhood behaviour disorders, neuropsychological testing should be performed by a qualified professional, including a psychologist, psychiatrist or neurologist."

A key aspect of an ADHD diagnosis, she added, is that the symptoms occur across multiple settings, such as at home and at school.

"Parents should be wary of an ADHD diagnosis made on the observation of symptoms in only one setting," Fisher said.

Read more:

Does ADHD really affect 7% of kids worldwide?

Positive reinforcement helps kids with ADHD perform better


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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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