Attention deficit disorder in the preschool years: its characteristics and course from infancy to toddlerhood

Diagnosis of Attention Deficit Disorder with/without hyperactivity in school-age children is based on the presence of the three main symptoms: lack of attention, impulsivity and hyperactivity. In infants and toddlers, these symptoms may very well be contingent to their development stage, but may also signify early signs of attention deficit disorder. Diagnosis in the age group of 2-5 years is very challenging, because reliable criteria are still lacking. The cutpoint between normal developmentally-based lack of attention and impulsivity and "true" attention deficit, is often not clear enough. Also, the very young child's condition often reflects the quality of the early parent-child relationship. Diagnostic criteria, differential diagnoses and treatment relevant to this age group, are presented. An 18 month old boy with signs of irritability, sleep problems, and poor attention span, shows the course of these symptoms, from infancy to toddlerhood under treatment, with modalities that changed over time. We suggest adopting an integrative standpoint of the young child and his/her family in the diagnostic as well as the therapeutic process, while keeping in mind the dynamic and development-dependent nature of the clinical presentation.