Dr. Greene, how long should a toddler be expected to pay attention to one thing? My 3-year-old just can't sit still. Could he have ADHD?

After a long day in the office, when I would be ready to wind down with a quiet evening, my youngest son, almost 3, is switching on his turbo jets! Together, as Batman and Robin, we race around the house chasing imaginary villains. We catch up with them, tie them up, untie them, and sprint again more times than I can count. Sometimes we get tied up, and Mommy rescues us. In between we jump on Casper, his broomstick Bat Horse, and gallop around the town to say "Hi!" to the pirates. When we pass the basketball hoop, we pause ever so briefly to play a game of basketball, before zipping outside to hit some baseballs and run. A dash to the front yard to throw rocks and play hockey, then back inside for Batman and Robin to make a tunnel and hide, vibrating with excitement, for Mommy to find.

Where does he get that boundless energy?

When a toddler enters that stage of zest and fascination, it's almost a parental rite of passage to discover this force of nature, as if for the first time, and remark, "If only we could bottle that energy and sell it, we would be rich!" or "I could sure use a transfusion of his energy (and he could stand a little less)," or "Youth is wasted on the young!"

A three-year-old's normal fountain of energy delights and exhausts, and sometimes frustrates and worries, modern-day parents. Perhaps our world doesn't accommodate this explosion of energy as well as the pioneer or farming days of old might have. Today, we hear about the medical condition called Attention Deficit Hyperactivity Disorder (ADD or ADHD), and wonder if our children might be hyperactive. By age 4, about 40 percent of children act in a way that makes their parents and teachers concerned about ADD (Developmental and Behavioral Pediatrics, 6, 339-348, 1985).

Some people are very tall, some are short, but most are of average height or close to it. As with most things in life, something of a bell-shaped curve also applies when it comes to toddler energy levels. There is a normal, average period of extreme energy that lasts about a year and often includes the 3rd birthday. This phase in normal children actually fits the official definition of ADHD.

There are several good, "official" definitions of ADHD, but I find the definition in the DSM-IV the most useful (Diagnostic and Statistical Manual of Mental Disorders, 4th edition). This definition differentiates symptoms into two categories: "Inattention" and "Hyperactivity-Impulsivity." Children with a diagnosis of ADHD should meet A-E of the criteria below:

A. Either 1 or 2:

1. Six or more of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

• a. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• b. Often has difficulty sustaining attention in tasks or play activities
• c. Often does not seem to listen when spoken to directly
• d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• e. Often has difficulty organizing tasks and activities
• f.
  • 1
  • 2
  • 3
  • next ›
  • last »
  Show full page