Julia S. Feldman, Ph.D., on debunking a common ADHD myth

Young children who are constantly "on the go" or who frequently interrupt or intrude on others face substantially higher odds of receiving an ADHD diagnosis than their peers, according to a new analysis of data from the National Institutes of Health's Environmental Influences on Child Health Outcomes (ECHO) Program. Julia S. Feldman, Ph.D., a postdoctoral fellow in the Department of Psychiatry at the University of Pittsburgh, led the study, published in the Journal of Attention Disorders, which examined caregiver-reported symptoms in more than 3,600 children ages three to five.

Across the sample, all 10 ADHD symptoms assessed were significantly linked to a diagnosis, but hyperactive and impulsive symptoms outperformed inattentive ones. Children reported as "on the go" or as interrupting or intruding on others were more than six times as likely to be diagnosed with ADHD as children without those symptoms, a stronger association than symptoms like fidgeting or difficulty waiting one's turn. "On the go" was also the most commonly reported symptom, endorsed for roughly two-thirds of four-year-olds and one-third of five-year-olds, a frequency Feldman and her coauthors said points to the need for more context-specific measures of hyperactivity in young children. ADHD diagnoses in the sample rose with age, from 6% at age three to 12% at age five.

In this interview with Managed Healthcare Executive, Feldman pushes back on the idea that preschoolers are simply too young, or too naturally active, for ADHD to be diagnosed or meaningfully monitored. She argues that when symptoms are inconsistent with a child's developmental stage, providers and parents should treat that as worth taking seriously rather than dismissing it as ordinary childhood behavior.

Feldman also points to the transition from preschool to kindergarten as a critical window. "As adults, we don't give kids enough credit for how hard that transition is," she said, noting that the shift brings new demands, like sitting still for lessons and navigating peer relationships, that can be especially difficult for a child developing ADHD. Identifying symptoms earlier, she said, allows caregivers to build support strategies before a child starts accumulating negative feedback at school, protecting both the child's self-esteem and their transition into formal schooling.