With the added emphasis on preschool education and the number of preschools that are available to children, the diagnosis and consideration of ADHD is not just in school-aged children. ADHD has become the most common mental health diagnosis for children ages 3 to 5. According to the September 2007 issue of the Harvard Mental Health Letter, researchers have begun to explore the use of drugs and other treatments for preschoolers.

When children are such a young age, it is quite difficult to determine whether the behavior is a problems or is just ''kids being kids.'' How does one tell? Behaviorists are specialists who study children of similar age and determine a range of normal behaviors. For example, a child who is so hyperactive that he consistently squirms while belted in the car seat and always ends up with the belt around his neck is obviously deviating from the norm. Comparing this child with others the same age would assist in determining whether the symptoms are inconsistent with the developmental level.

Such behaviors in preschoolers with ADHD indicate they are not just inattentive and overactive; they are a real danger to themselves and others. In spite of instruction and warnings, they may play with matches or rush into traffic. They are noisier than other children and appear to have no concern when corrected. Obviously, they cause havoc in both home and school. Although the Food and Drug Administration (FDA) has not approved stimulant drugs for children under age 6, a large controlled trial of methylphenidate (Ritalin) and other drugs in children ages 3 to 5 found that giving the medication is not as effective as in school-age children.

Parent training is the most popular alternative. This training is based on the belief that assisting parents to develop positive skills is important. If a parent is negligent or intrusive, it might trigger hyperactive behavior in a child who has such a tendency. If cruel or harsh discipline is used, it may evoke stubbornness and unusual resistance. Parents are shown how to set appropriate limits and use moderate rewards and punishment. The researchers encourage parents and physicians to be slow to make the diagnosis and to consider parent training and even specialized day dare before resorting to stimulant drugs.

Limited research is also a major problem in dealing with preschool children. Clinical practice guidelines are lacking. Child mental health professionals from the Bradley Hasbro Children's Research Center, one of the first psychiatric hospitals exclusively for children, and eleven other institutions have developed recommendations for clinicians who are considering medications for children ages 3 to 6.

Programs to assist preschool children with ADHD are being developed and researched. One such innovative curriculum program called Tools of the Mind hopes to improved academic performance, reduce diagnoses of ADHD, and close the achievement gap between children from poor families and those from wealthier homes. Dr. Adele Diamond, University of British Columbia, led the first evaluation of Tools program (2007). This program focuses on executive functions (EFs) or the ability to put things together, which is located in the prefrontal cortex area of the brain. Functions include resisting distraction, considering responses before speaking, mentally holding and issuing information, and mental flexibility to think outside the box. Diamond noted how these skills are rarely taught to the preschooler, but can provide a huge advantage, especially for disadvantaged children. Diamond attributes part of the recent explosion in ADHD in preschoolers to some children's never learning to exercise control, attention, and self-discipline. She believes that some of the children are simply deficient in these skills because they have never been taught. Tools encourage out-loud instruction and dramatic play. In today's school climate of highstakes testing, children in preschool are pushed into areas, such as reading and writing, before many are physically able. This puts pressure on teachers and gives little time for the child to learn these important EF skills. Diamond believes that preschool teachers must limit play and spend more time on instruction; however, ''social-pretend'' play may be more critical to academic success.

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