Attention deficit hyperactivity disorder (ADHD) is usually not diagnosed in children under age 4. That’s because ADHD behaviors, like inattention and impulsivity, can be considered normal for toddlers.

ADHD is more than just typical toddler behavior. According to the National Institutes of Health (NIH), the condition must occur over a long period and impair functioning. This is part of the reason ADHD is not typically diagnosed in toddlerhood.

Professionals can diagnose ADHD in school-aged children 12 or younger, but according to the American Academy of Pediatrics, doctors and healthcare professionals should not diagnose the condition in children before age 4.

While toddlers may show some signs of ADHD, it does not necessarily mean that they have the condition. At this age, they may have difficulty paying attention or be hyperactive or impulsive.

However, some toddler behaviors may lead some parents to wonder whether their child has ADHD or has a chance of developing it.

Read on for a checklist of symptoms to watch out for.

What is ADHD?

ADHD is a neurodevelopmental disorder that may cause hyperactivity (constantly active behavior) and impulsive behaviors. People with ADHD, including children, typically have trouble focusing on one task. They may also have difficulty sitting still for long periods.

According to a 2019 study, some behaviors noted in toddlerhood could be related to the development of ADHD. However, considerably more research is needed.

According to the NIH, these are the three main signs of the condition in kids over age 3:

These behaviors also occur in children without ADHD. A child won’t receive an ADHD diagnosis unless they have several symptoms that have been present for at least 6 months and that affect their functioning. These symptoms may affect their ability to participate in age-appropriate activities.

Research shows that even in the preschool years, children with ADHD can present with cognitive difficulties around abstract thinking, language, critical reasoning, visual perception, and visual motor skills.

According to the study, children with ADHD were found to be five times more likely to have problems with organization.

Great care must be taken in diagnosing ADHD in children, particularly when considering medication. A mental health professional or pediatrician will be the best at making a diagnosis at this young age.

ADHD vs. ADD

In the past, ADHD could also be referred to as attention deficit disorder (ADD) if the symptoms were primarily inattentiveness. Now, what was once ADD is referred to as inattentive type ADHD.

No matter whether someone is mainly hyperactive-impulsive, inattentive, or both, they’ll be diagnosed generally as having ADHD. ADHD is now an umbrella term encompassing both hyperactivity and impulsivity, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Several behaviors can indicate your child has difficulty with attention, a key sign of ADHD. In school-aged children, symptoms of inattention may look like this:

  • difficulty with sustaining attention, in play or completing work
  • difficulty listening and following directions
  • difficulty paying attention to detail and making seemingly small mistakes
  • challenges staying organized
  • avoiding tasks at home or school that require more sustained attention

Note, however, that these behaviors can also be typical in a toddler and expected for their developmental phase.

Signs of hyperactivity that your toddler may display include:

  • being overly fidgety and squirmy when seated
  • being unable to sit still for calm activities like eating and having books read to them
  • talking and making noise excessively
  • running from toy to toy, or constantly being in motion
  • running around or climbing at inappropriate times

Another symptom of ADHD is impulsivity. Signs that your child has overly impulsive behaviors can include:

  • displaying extreme impatience with others
  • having difficulty waiting for their turn when playing with other children
  • interrupting when others are talking
  • speaking at inappropriate times
  • answering questions before they are fully asked or finishing other people’s sentences

Again, these can be expected behaviors in toddlers. They’re only a reason for concern if they’re extreme when compared to those of children of a similar age or if they’re affecting your toddler’s functioning.

A school-aged child with ADHD may show other symptoms as well. These may include:

  • more frustration, anger, and outbursts than their peers
  • endangering oneself or others due to fearlessness
  • difficulty calming down
  • aggressive behaviors (toward self or others)
  • little need for sleep

While mental health professionals should not diagnose ADHD in toddlers, you may want to discuss your concerns with a pediatrician or mental health professional.

This may help determine a diagnosis when your child reaches school age. These healthcare professionals may also offer suggestions to help with hyperactivity, impulsivity, and inattention.

Children can only receive an ADHD diagnosis when they have reached school age. That said, diagnosing ADHD in children can be difficult because normal developmental behaviors can be mistaken for symptoms.

For example, toddlers sitting quietly and behaving in preschool may not be paying attention. Children with hyperactivity may have challenges listening to, understanding, or carrying out instructions.

Most toddlers may show hyperactivity, impulsivity, and inattention at times. This may look like excessive energy or trouble following directions.

The medical professional will typically fill out a clinical checklist while observing the child and have them take a test such as the Test of Variables of Attention (TOVA). Teachers are also often asked to fill out forms. All of this data is compiled and used to make a diagnosis.

If you’re concerned about your child’s behavior, you may want to speak with a pediatrician or mental health professional.

The NIH notes that ADHD can be very common among children. The CDC estimates that 2% of children ages 3 to 5 have ADHD.

If you think your toddler may be showing signs of ADHD, consider sharing your concerns with a pediatrician. They may be able to help you and your child manage the condition.

They may also point out other signs to look for and guide the diagnosis process when your child is old enough. In addition, while environmental factors could still be triggers for ADHD, if a child has a parent or relative with the condition, there’s a higher likelihood they have it as well.

Can ADHD be diagnosed in a 3-year-old?

Many mental health professionals will not make a diagnosis before age 4, and sometimes not until the child has been in school.

This is because a key criterion for ADHD is that the symptoms are present in two or more settings. For example, a child shows symptoms at home and school or with a parent and with friends or relatives.

How do you treat ADHD in toddlers?

While there’s no cure for ADHD, treatment can help improve your child’s symptoms. This may include:

  • medication
  • psychotherapy, including family therapy, behavioral therapy, and cognitive behavioral therapy
  • lifestyle measures

For success at school, certain classroom management tactics may also help improve your child’s attention.

Can ADHD in toddlers present with a speech delay?

Speech delay isn’t specifically associated with ADHD in toddlers and can be related to other neurodiversity or learning disabilities. Some children just start speaking later than the average.

That said, unlike with ADHD, it’s possible to diagnose a child with autism spectrum disorder (ASD) at age 2, and speech delay can be a sign of this condition. If your child also presents with symptoms of ADHD, this can be noted for a future diagnosis.

If your child’s speech is delayed and they’re presenting with other ADHD symptoms, consider consulting with your pediatrician.

Doctors and healthcare professionals do not diagnose ADHD in toddlers. They may diagnose the condition in school-aged children.

Many behaviors associated with hyperactivity, impulsivity, and inattention in school-aged children may be typical behaviors in toddlers.

If you have concerns about your toddler’s behavior, you may want to discuss them with a pediatrician or mental health professional.