How can you determine if a toddler has ADHD or is just being a toddler?

[HeatherO1014]

My son is 3 and a half and is an only child.  He is constantly doing things to "push my buttons."  I make it a point to praise him for his positive actions (such as following direction, using his manners, toileting, etc.)  Yet, he still seems to always be acting up, not listening and/ or being openly defiant.  I do time outs and try not to spank.  The only time he gets spanked is if he does something potentially harmful.  It seems as though he spends the majority of the day in time out.  He is also the kind of child that will sit there and scream at the top of his lungs for at least 30 minutes...I have timed it severeal times.  He also has, while in time out, gotten off of his time out spot to go over and kick the door and returned to the time out spot.  I feel like I am at the end of my rope.  I know that he acts up just to get a reaction from me (which I am working on) I just don't understand why he continually does it.  I have taken time to just sit and watch him play either by himself or with other kids and there are a few things that I have noticed that really concern me.  First, he gets very aggressive.  Not like hitting or bitting, but like coloring or playing with toys as if he is angry.  He is to the point where he is just flat out destructive.  He grinds his teeth and kind of growls.  I have actually had to remove several toys and books from his room because he has gotten so frustrated that he destroys them.  Second, he has a very hard time keeping focus.  When I talk to him, I like for him to make eye contact so I know he is listening.  He can not hold eye contact for longer than a few seconds.  Even when it is with something that he wants.  I have a very hard time keeping him focused on one thing at a time.  Last, when he gets to be hyperactive, he does not calm down.  It's like he goes up and up and up until he is in trouble.  I limit his sugar intake and he doesn't ever have sodas or caffeine.  He is a very smart kid.  I don't ever underestimate his memory or intellect.  We play word games a lot, and he remembers words that we went over the previous week without myself or my husband reminding him.  He also has watched me do things and picked up on them very quickly.  For example, he watched me work the DVD player and he knows how to put in a movie and start it.  He also knows where each of them go and which movie goes in which case.  I have talked to several people about this and they have all asked me if he has been diagnosed with ADHD.  My question is, how do you diagnose a toddler with ADHD?  Is all that I just described just regular 3-year-old behavior?  I really need some guidance.  Thank you for your time.          

[Agiesmom]

Great advice from tiredbuthappy!

Over the years, both a pediatrician and a psychologist told me (independently) that an ADHD diagnosis should not even be attempted to be made before the age of 7.

Like TBH suggested, try natural consequences and keep him really, really busy.  My son was very much like yours at that age and the bathtub was used often--and he had lots of tub toys to play with including funnels, squirty things, etc.  Sandbox, bubbles, sidewalk chalk, playdoh, paint (he preferred messy paint to drawing or coloring), bake with him (let him play with some of the dough), go to the stream and let him throw rocks in it, feed ducks at the lake, take him to a gym when there is "open gym" time--where he can jump on a trampoline, climb, etc. while supervised.  Montessori-like activities like sorting (get a bag of mixed beans, pour them into a big bowl and then set up several little bowls and have him put the same type of bean in each of the bowls or have him sort coins or different size bells, etc.) and life skills activities (sweeping, wiping tables, washing dishes, vacuuming, etc.) are things he also loved.  I found that keeping my son very busy with sensory-stimulating things was helpful.

Best of luck to you!

[tiredbuthappy]

obviously only your pediatrician is the only one who can truly help you find the answer to your question about ADHD, but i do have a few thoughts. First, my understanding based on my experiences is that they do not diagnose toddlers as ADHD. So I suspect those people you are speaking to do not really know what they are speaking about. I have been working with young children for over a decade, many of those years in daycares and preschools, and I have never heard of a child that age who actually had a diagnosis of ADHD.

I would start by eliminating time-out. obviously it's not working. When a child is spending all day in time-out, one needs to look at what's going on. what is he doing to get in trouble? time-out isolates children from the problem and does not teach problem-solving skills or empathy. i find logical consequences to be much more effective. you spill it, you clean it. you break it, you try to fix it. you hurt someone, you try to find a way to help them feel better. And simply saying "sorry" is pretty much meaningless at this age.

to help him gain a better understand of his feelings you can try role playing with puppets. for some children it is very difficult to talk about what frustrates them. create a scenario where a puppet is angry. have your son try to help him find solutions.

you say he destroys toys because he gets frustrated with them. how are they frustrating him? are they age-appropriate? when you see him start to get frustrated do you model problem-solving for him? for example, if he is getting upset that his tower keeps falling you could say "hmm... it looks like you tower keeps falling. I wonder what we could do to help it be stronger? I wonder why it is falling. Do you have any ideas of how we could build it differently?" Guide him through the process. Don't give him the answers but rather make observations that would help him come up with the solution. For example, "it looks like that block on the bottom might be too small to hold up the rest. I wonder what we could do about that?" Guiding him like this while he plays will not only help him learn to approach problems flexibly, it will also give him confidence as he succeeds.  

Are the 2 of you home all day? He sounds very bright. Make sure you engage him and provide stimulation. Go out and explore. Find some bugs and observe and draw them. Do some simple science experiements. Make oobleck or homemade playdough. children like you describe often benefit from sensory activities as they can be soothing. gak, oobleck, and playdough are great for him. fill up a dish pan with water and give him measuring spoons, cups, and funnels. take a small cup, put an 1/2 inch of water and a few drops of dish soap in it and give him a straw. watch him blow mountains of bubbles! make rainbow rice and put it in a bin for him to play with.  see if you notice a difference. if you do you may learn that he needs more open-ended, creative activities. (many toys and games these days are not open-ended and tell you how to think and play. this may be what is frustrating him) you may see that sensory experiences calm and engage him. or you may just find that he was bored and needed new activities. all of these outcomes are desirable, so it's worth a try!