Behavior

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Hyperactivity—Behavioral Issues in Child Care and Schools

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ICD10

  • R45.87

  • R41.840

  • Z55

How can children with hyperactivity be identified?

Hyperactivity is typically thought of as one part of attention-deficit/hyperactivity disorder (ADHD), which can be diagnosed in children as early as age 4 years. However, because most preschoolers can be active and inattentive and have difficulty staying engaged at times, only medical and/or mental health professionals should establish the diagnosis after carefully receiving input from parents or guardians and teachers.

How common is it?

It is estimated that about 11% of children aged 4 to 17 years meet the criteria for ADHD. There are many more very active young children who do not meet the criteria for the full diagnosis.

What are the behaviors usually seen?

While most young children are active, a child who is “always on the go” and has trouble sleeping, waiting for his or her turn in games, and settling down for quiet activities, naps, or bedtime may have early signs of hyperactivity. Children with a diagnosis of ADHD will also demonstrate impulsive behaviors, such as pushing a friend out of the way when they are rushing through the classroom or climbing on a high ledge to get a better view. They may also appear dreamy or “in their own world” at times.

When should a more concerning issue be suspected?

It is important to understand that in young children, symptoms of hyperactivity may be confused with signs of having experienced a traumatic event or anxiety. Therefore, when children's behavior changes and they begin to demonstrate increased activity, there are many factors to consider, and the family’s pediatrician and/or a mental health professional should be consulted.

What are typical management strategies in the behavioral support plan?

Children who demonstrate hyperactive behavior should have environments with clear and consistent rules and routines. These rules, along with a class schedule, should be visually posted, and adults should refer children to these posted supports to help them stay on task. There should be a sufficient variety of adult-led versus child-led activities during the day, and teachers should work to ensure that children are not participating in too many teacher-led activities in a row. Active imaginary and self-directed play supports children’s self-regulation abilities and should be considered an important part of children’s education.

Children should be given sufficient time to exercise and “get the wiggles out” throughout the day, with thought being given to how children will have time for gross- motor play on inclement weather days. Parents should be encouraged to bring appropriate gear (eg, a warm coat, raincoat, boots) so that children can play outside, regardless of typical weather fluctuations. (Students should stay inside if weather is dangerous.) Finally, teachers should actively teach social-emotional skills, such as sharing or taking turns, which are things very active children may struggle with throughout the day. Specific, direct teaching of these skills at circle time is important, along with incidental support of the skills throughout the children’s day.

When should I ask for additional support?

A mental health or medical professional should be consulted if a child’s hyperactivity is extreme and/or if the child is also showing signs of impulsivity and inattention. If the child is 4 years or older and receives a diagnosis of ADHD, the school should seek to partner with the treating professional about supports needed in the classroom.

What training and/or policies may be needed?

Teachers should learn about how to create and appropriately use visual schedules, visual rules, and other visual supports (eg, guides on taking turns and prompts for visual activity centers, such as timers and names or photos that can moved to indicate in which activity center a child is participating). These supports are also useful for children with other special needs, such as autism spectrum disorder. Additionally, teachers should be made aware of how to structure their daily routines to support the activity needs of the children in the classroom. This intervention can be useful for all children in the room, but it is particularly helpful when there are overactive children in the classroom.

Where can I find additional resources?

  • Center on the Social and Emotional Foundations for Early Learning (http://csefel.vanderbilt.edu)

  • Children and Adults with Attention-Deficit/Hyperactivity Disorder (https://chadd.org)

Adapted from Managing Behavioral Issues in Child Care and Schools: A Quick Reference Guide.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.