QUESTION
My youngest child is three years 10 months old and has always been very active, on the go and into everything. We have to constantly watch him and be on his case and it is exhausting. My wife and I always put it down to him being a boy – he has three older sisters who are generally calmer and organised. However, when he started preschool last September he could not settle and we had to take him out. We tried again two months ago and though he is getting on better, the preschool teacher says he is hard to manage in the group.

She has suggested that we get him assessed and has wondered if he might have attention deficit hyperactivity disorder (ADHD). We were a bit shocked at the teacher’s suggestion, but after we got over that we see that there may be some sense to what she is suggesting. How should we go about getting him assessed and what should we do to help him?

ANSWER
Two- and three-year-old children generally have poor attention spans and are often impulsive and very active, leading this period to get the reputation as the “terrible twos”. Generally, as children get older they become more able to concentrate for longer periods and to begin to pause and think before they act.

However, for some children this improvement is slower in coming and a small number retain impulsive, active and inattentive behaviours as they grow up.

Some of the difficulties these children have are sufficient to gain a diagnosis of attention deficit hyperactivity disorder (ADHD) and they can benefit from specialist assessment and support though this diagnosis is not usually made until children are older.

In addition, there could be other reasons to explain your son’s behaviour such as specific learning, language or hearing difficulties that could be associated with his problems settling in preschool. As a result, it is important to seek an assessment so you can get a clearer picture of his needs.

Seeking an assessment
It can be confusing for parents seeking an assessment for a preschool child. Should they seek an assessment from a psychologist, a speech and language therapist, a paediatrician or a child psychiatrist?

With the implementation of the Disability Act, the process has been streamlined in the HSE. You can now apply to an “assessment of need” officer at your local health centre and they are obliged to reply within 14 days indicating which agency/professional should help you in the first instance.

Depending on your son’s needs, the ideal is to get a multidisciplinary assessment so that you can get a good sense of his development and what is needed to help him. In the meantime, there are lots of specific things you can do to help your son and to continue his progress in preschool.

Establish routines
Clear routines explained on a visual chart can be really helpful to keep children focused and to help them manage what is happening next. Also, active children can really benefit from including in the routine plenty of physical play and exercise as well as periods of downtime and relaxation.

It can be particularly helpful to use pictures on a chart to explain routines to children especially for flashpoint situations. For example, if bedtime is a problem, you can break the steps of the bedtime routine into pictures that can remind and motivate your son to keep on track.

Take time to make sure your child understands what is expected
Children with attention problems can find it harder to process verbal instructions. Parents might have told the child several times to do something and the child appears not to have responded. This is often because the child is distracted and has not processed what the parent has said.

Simple things like getting down to the child’s level, making good eye contact, using very clear instructions and making sure your son has understood can make a real difference in helping him attend to what you are saying.

Equally, reminders and warnings are also very helpful – “Three more goes on the swings, then we are going home”;“When we are in the shop, you stay with Mum.”

Provide lots of encouragement
Children who are active and impulsive frequently get into trouble and, as a result, can receive negative attention from parents and other adults who can resort to cajoling them to behave. Such negative attention is counterproductive and can be damaging to a child’s self-esteem.

It is much more effective to take time to gently guide and show your son to behave and to recognise that he will need lots of encouragement to behave well.

The more specific you make your praise, the more you build his confidence and help give him the skills he needs. For example, you can say, “Good boy, you are sitting on your seat, now we can have a nice lunch;” “Wow, you are holding mum’s hand in the shops, what a safe boy you are.”

Work with the preschool teacher
It is very hopeful that your son is making progress in his current preschool. Indeed, a quality, structured and supportive placement in preschool is one of the most important ways to help him settle and to prepare for the demands of school in the future.

Continue to support and work closely with his preschool teacher next year. Take time to review with her his work in the preschool and what you can do to support her.

If appropriate, involve the preschool teacher in your son’s assessment and ask the relevant professional to create an individual plan for your son that can assist his progress both at home and in preschool.

John Sharry, Irish Times Newspaper, 2013. John writes in The Irish Times Health+ every Tuesday.

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