Attention-deficit hyperactivity disorder (ADHD) receives widespread, serious consideration among clinicians, researchers, parents, educators, and policy makers who share concerns for the condition’s seemingly pervasive occurrence and challenging consequences. Families, schools, and pediatricians across the United States grapple with questions concerning causal influences, diagnostic criteria, prevention, and intervention strategies. Indeed, much good science has enabled the professions to organize a set of rational clinical guidelines for the diagnosis and treatment of ADHD in school-aged children.
At the same time, a rising tide of younger children appear to be manifesting behavioral analogs of the inattentiveness, impulsivity, and hyperactivity that define the classical condition. Although it is tempting to label and treat ADHD in 2 to 4 year olds as one would in older children, several distinctions demand a fresh exploration and orientation to the issues present in the very young child.
Compared with older children, the developing brain and nervous system of toddlers and preschoolers are structurally and functionally less organized. The range of normal variation in neurologically based behavioral maturation and self-regulation among very young children is greater than among older children. The primary social influences and expectations of family systems foster behavioral diversity across the population that grows more standardized as children move into the culture of schools later in childhood. Therapeutic modalities, including pharmacological regimens, may also have differential effects on the developing nervous system of young children.
This special supplement presents the latest evidence-based thinking on controversies in the assessment, interpretation, and treatment of ADHD in early childhood. Nine papers by professionals steeped in clinical practice, research, and health policy contribute a timely deliberation upon current knowledge of ADHD in early childhood. Taken together, the collected papers offer a sound approach to sorting fact from fiction, theory from theology, and reasonable practice from rank prejudice. I hope this contribution inspires colleagues to pursue further inquiry and insights in developing our young science and in supporting the functional health of children.