ADHD in a 3 year old girl

[Mhhhuyu]

DD recently started primary school preschool in September and the teacher has now raised that they have concerns and voiced the potential of ADHD.
This is as she is not following instructions - appearing as if she hasn't heard- and struggles to sit still. If she sits still she has to hum or sing.
She has always struggled with structured activities - would rather run around and pretend to be an animal than listen to a library storytime or make up her own moves at a dance class. I would say on the whole I've not found her especially hard to parent. We can go out to soft play, tea and cake, baby cinema (she has actually sat in a full length film before there). She loves interactive child friendly museums and play cafes. She will sit down in restaurants although we know we are on a timer until she gets bored- she will do drawing. She sat through a whole PTA meeting when we gave her a new open ended toy. She is very verbal, could recite books she liked from heart from age 2, does large jigsaws, draws her family and animals. No devices but does often have cbeebies on in the background at home- plays happily if it's on, and comments on what's happening.

She has her moments sure, generally when hungry or tired, but we almost never have to resort to any sort of discipline or changing activity. I just can't get the girl to sit down and tolerate something she finds boring for more than a few minutes.

I'm really not sure what to do with this. I've been very worried and spiralling but then when I look at SEN forums I'm just not having those same difficulties. I've rang HV but don't know what to expect really. School are involving SENCO and I'm worried she is now being pigeon holed before she's started her school career. I want to support her but also want her to thrive and be happy.

Is it school nursery? I can't see why she's in school at 3. What I would say is that schools very rarely bring these things up if there isn't a genuine concern. More often it's parents trying to create issues with a perfectly normal child. However, school or nursery have years and years of experience between the staff. We recognise when a child is potentially outside the bounds of 'typical' and when they are not. It's difficult for parents to see this as they will have limited fields of children they are comparing to. They're it's nothing wrong with getting things looked at at it will take ages for anything to happen and it will probably only be helpful if they have' pigeonholed'get as they will be lining for ways to help her manage rather than telling her off. Best in mind, ADHD is also hyper focus (on things you want to focus on) not just a lack of attention.

Sorry for all the errors, was in a rush for school run!

Thee is nothing wrong with getting things looked at as it will take ages for anything to happen and it will probably only be helpful for her if they have 'pigeonholed' her, as they will be looking for ways to help her manage rather than telling her off. Bear in mind, ADHD is also hyper focus (on things you want to focus on) not just a lack of attention.

Thanks for replying - yes it's school nursery. I understand what you mean in terms of them knowing what is typical. I had thought if she hadn't improved by year 1 then we could pay privately for assessment and support, I just didn't think we would be getting wheels turning at 3. The more SEN stuff I read the more I feel bewildered as whilst I can see how she could fit inattentive ADHD, the problems faced by others are nothing like our experience.

I think the earlier the better, and actually it's one area where private isn't always better. You can always supplement privately if you need to later on. The sooner school have support in place, the better off she will be, so she is not starting on the backfoot. By Y1 she could be really behind (not good for confidence, plus takes extra to catch up). ADHD manifests differently but I would trust school to recognise it. Anything which is irrelevant or not working can get dropped.

My DD got her diagnosis early. I didn’t think she had ADHD but turns out I thought she was typical because I have it too Oops.

Don’t worry about pigeonholing. DD’s diagnosis was helpful to get her support when she was young. We worked extremely hard to support her and get her behaviourally where she needed to be. The older she gets, the less relevant it is. She’s learned to manage herself, and is mostly great at school. Now, at parents’ evening, when the teachers mention something and I say, “well that’s probably the ADHD” they say “oh <look at notes> she has ADHD…”. I doubt she’d get a diagnosis now, although her brain is still doing its ADHD thing.

It’s all information. And the wonderful thing about ADHD is that parenting that works for ADHD kids works for NT kids. The converse isn’t true. So you might as well do what she might need.

They won’t diagnose adhd until at least the age of 5 as per Nice guidelines

My DD was flagged at around this age - like you, we were so worried about pigeon holing etc.

My advice. Go with it. Take the input and run with it. If it transpires she doesn't actually need the intervention then fantastic - school won't provide it if it ends up it isn't necessary . If, a couple of years down the line, it turns out that they're correct then fantastic, you're a step further along getting her support if it's needed and in a timely manner.

They are not in a position to diagnose, just remember that. They can only comment on the behaviour. It's often the parents who push preschool staff to label what SEN their concern is when they are simply addressing behaviour. For all you know she may not ever be diagnosed but will benefit from support starting school until her behaviour settles a bit. I work in this area and I've come across children who are often over stimulated and may have some sensory issues in a classroom environment that resolve with age and don't end up with diagnosis. (Although statistically it's much more likely she will have ADHD.) It's new territory for you but it's not terrible news, it's extremely common and there is loads of support out there. I'm not in UK so don't know the system well but I would think early intervention is important and it's only for DDs benefit.

I also agree with what PP said, preschool staff are with this age group all day often with many years experience, they know very well what typical behaviour in a social setting looks like, and I should say the spectrum of 'typical' is very wide. They would not have raised concerns unless they had a genuine issue and its probably been discussed by a team of staff, not based on one person's whim. Their concerns are valid, regardless of what your experience is at home, because you cannot truly know how she behaves in a social setting without you.

IMO (I have ADHD and 2/3 DC diagnosed) it's inappropriate for preschool staff to be suggesting ADHD at age 3 - it's basically impossible to tease it out from the active/intense side of normal at that age.

They could say things like "she has a lot of energy" or "she seems to display some sensory seeking behaviours" or "she's extremely curious" but I don't think it's unusual for a 3yo to struggle to pay attention to something they aren't interested in - is it?

I appreciate my views may be skewed because the majority of my experience of small children is clearly ADHD-focused. But I did also used to run classes for children and 3yos' attention span in general is like trying to herd cats. They're all like that. Luckily it's fairly predictable what will interest the vast majority of them so it's not that difficult to herd them (I suppose they are more like puppies in this sense.) I wonder if she has unusually intense interests and this is why they are finding it hard to interest her in the tasks they are trying to?

IME the biggest issues at the preschool age for children with ADHD are emotional regulation and the sensory issues because some have a really huge, insatiable need to either move constantly, be making constant noise or sometimes it's touching things/chewing things/trying to constantly lie on people or burrow their head/feet into you (which is usually a sign they are seeking deep pressure). You can address these all directly - there are loads of great emotional regulation programs for preschool aged children which typically benefit all the children, not only those who struggle with emotional regulation, sensory seeking can be addressed by providing appropriate outlets for those needs. Following instructions can also be an issue - I would suggest that they give her some "jobs" to do - I would also do this at home as it is hugely helpful if you can get them used to it early on. This can help her to feel useful/responsible/grown up and get praise and recognition for the tasks that they want her to do anyway, and it helps explain why those rules are in place. Oh and potty training/eating can often be issues, related to sensory sensitivities.

If it is ADHD then none of that will prevent it from continuing to be apparent into later ages/stages, but it can help strengthen areas of skill which are often difficult, and if it's more an "intense end of normal" thing then it will help that phase to pass a bit more smoothly.

But it could be any number of things at this age. She could be highly intelligent and bored. She could just have some sensory issues which will sort themselves out as she gets a bit older. She could be struggling to hear.

I think it's unlikely that she will be pigeonholed simply because I think it is incredibly unlikely that you will get an NHS paediatrician to diagnose ADHD at age 3 unless it is one of the absolutely extreme cases which you hear of very rarely for example a child of this age (which I have heard although online, so take with a pinch of salt) who is routinely escaping the house and taking walks down a country lane in the middle of the night, or taking the car keys and trying to drive the family car.

But OTOH the waiting lists are years long - the cynic in me says join it if it's offered, because if you are having horrendous problems at age 5/6 (which, touch wood, I hope you won't!) you don't want to be at the beginning of a 3 year wait then for answers. And OTOH if you get past this point and she does better with a bit more maturity and patience then you can always cancel the appointment.

I think it would be helpful if there was a category where they could say there are some flags here which might later point to ADHD but it's too soon to really say, but in this group of children who have this sort of "possible ADHD" profile, these are the things which help. (Sensory supports, emotional regulation support, age-appropriate responsibilities, visual timetables for routines or to show what's happening next, specific directed praise, etc)

The behaviours you are describing (and which school are assuming to be ADHD) could be because of so many different factors, and it is definitely way too early to even look at inattentive ADHD. No clinic will assess a 3 year old for ADHD as it's too young to exclude any learning/ language/sensory needs, autism as well as normal 3 year old behaviour - school are making quite far reached assumptions. The supports your DS may require are needs based, not diagnosis based - you can insist they offer supports based on DS needs.

I think age 3 is very young to be discussing ADHD. Plus she only started nursery in September!

My dc was diagnosed aged 8 and started showing signs of ‘bad’ behaviour at school at about 4-5. They didn’t have the running around kind, more defiance and doing the exact opposite of what they were asked.

I would keep an open mind I think if I were you but I do agree with you overall.

My dc has had a difficult time at school all round and the behaviour got worse with them being worse at school than at home right into their teenage years and till they finished school.

Thanks that's really reassuring - could you share more about what support she needed?

Don't get me wrong, I want to work with school, and we totally took what they've said on board.

It's just a bit bewildering as to what to do or expect- we weren't expecting such concrete concerns so quickly.

I think that they’re probably raising concerns at this stage, when she is still too young for diagnosis, because the waiting lists are horrendously long.

As a pp suggested, accept any referral offered, and make a decision when you finally get an appointment. It is hard to get nhs adhd medication with a private diagnosis so the referral is useful even if you can afford private.

Things which you can try to see if they help (which also work well for fidgety nt children) are fidget tools, wobble cushions and therabands.

Thank you for this insight and lots of food for thought.

We took her dummy away at age 2 but she still uses a chew toy sometimes at bed time - I would say it's very infrequent but when she's upset she does like biting something and wrapping herself in a blanket. She is excellent at naming emotions- frustration, disappointment etc.
She potty trained with no issue but another problem at nursery is she won't go if they ask her to- she will completely refuse. She will say she is scared- nursery have said this is very unusual. However she will use the toilet independently when she needs it. She had one accident and that was in the first week.

Thanks for the tips.

We will 100% jump any hoops, take any referrals, I'm definitely not that skeptical.

It's just hard to square a lot of the experiences of parents I'm reading about with my girl who got fussed over by an elderly couple for her excellent behaviour in a tea room last week 😅

There may never be a diagnosis for your child OP, definitely address the challenges flagged. If you do this from a younger age, it should result in better outcomes for your DD (who is still only little, so don't worry too much!).

There are 3 different children in my family where the preschool/care-provider suggested that perhaps the child wasn't acting 'typically', but the parents ignored concerns. Years later, despite being happy, intelligent children, there are definite, more obvious ND challenges with all 3. Only one of them engages with SEN support, and, unsurprisingly, that child struggles less with daily expectations and is thriving in and out of school. One of the 3 is a saint a school, but is the absolute opposite at home, so will likely be forced to engage with a health professional at some point. I can only think 'if only he got proper support earlier'.

With my DC who later got diagnosed with ADHD, they definitely had moments where their behaviour would be praised by strangers etc - it was the frequency of the harder moments which was notable. Fears have definitely been a theme though, particularly of things like toilets.

Overall she sounds closer to my DC who is not diagnosed, but he is only 4, so I can't rule it out for him completely.

I'd put the ball back in their court - what can they offer to support your daughter? Tbh a lot of what you write about sounds developmentally appropriate, especially if there are no concerns at home, and I am starting to wonder about whether staffs' have unrealistic expectations of childrens' behaviour at this age.