Differential Diagnoses of ADHD in Early Childhood

ADHD in early childhood presents a slightly different and unique differential diagnosis. The conditions to be considered are the following:

1. A deviation from the norm (difficult temperament), involving difficulty in regulation, much crying, difficulty in calming down, hyperactivity, etc.

2. Children who have been given no clear limits.

3. Behavioural disorder or rebellious opposition disorder. Rarer at these ages, although they exist.

4. Deviations in IQ (talented/retarded).

5. Spasms of petit mal type. This condition causes staring into space and dissociation. It appears mostly at ages 5-6 years, but might appear even earlier. The disease is relatively easy to diagnose, since a characteristic pattern can be detected on electroencephalogram.

6. Chronic inflammation of the middle ear, antihistaminic medications.

7. Undiagnosed sight and hearing problems.

8. Other physical and/or chronic conditions, such as hyperthyroidism, hypothyroidism and severe anaemia.

9. Genetic syndromes: fragile X syndrome, William's syndrome, neuro-developmental pervasive disorder.

11. Psychosis.

12. Infancy affective disorders, including anxiety disorder, infantile depression and mixed disorder of emotional expressiveness. In these children, the inappropriateness of affect stands out more than attention difficulties, although these certainly exist.

13. Child-parent attachment disorder with self-endangerment [64]. In this case, the tendency for self-endangerment, aggressiveness and impulsiveness displayed by the small child are aimed at capturing the attention of an unavailable or incapable parent, and for this reason they will appear mainly when the child is interacting with the parent. In severe and prolonged cases, these behaviours will appear in the presence of any adult whom the child sees as a potential psychological parent.

14. Regulatory disorders, motorically disorganized/impulsive type: although the concept of regulatory disorders in affect, attention and processing sensory information is well known to clinicians, much work is still needed in order to determine the validity of these diagnoses.

15. PTSD of infancy. Irritability and attention difficulties are very common in young children who have experienced trauma, yet the origins of PTSD and ADHD are entirely different, so in most cases it is easy to distinguish between the two. At the same time, in complex cases where the young child is chronically exposed to difficult experiences, diagnosis is harder.

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