9 24 20-Toddlers

How to Distinguish ADHD
Warning Signs
from Typical Toddler and
Preschooler Behavior
adhd expert webinars

ADDitudemag.com/webinar
Copyright © 2020 by ADDitude
meet today’s expert speaker:
Caroline Buzanko, Ph.D.

Dr. Caroline Buzanko is a licensed psychologist and
clinical director of Koru Family Psychology. Dr. Buzanko
has worked with children with neurodevelopmental
disorders and their families for more than 20 years and
focuses on maximizing connection, confidence, and
resilience. She facilitates ADHD-related groups and
workshops across North America and is an adjunct
assistant professor at the University of Calgary.

Early Signs of ADHD

Inattention

Hyperactivity/
Impulsivity
• Constantly moving and
fidgeting
• Extreme squirminess
• Talk nonstop
• Constant noises
• Less rest
• Trouble feeding
• Unable to wait
• Loud
• Danger!
Emotional Dysregulation

Early Signs
 Negative emotionality
 Constant crying
 Cannot self-soothe
effectively
 Angry
 Fussy
 Hard to manage
 Low frustration
tolerance
 Trouble transitioning

Early Signs
 More frequent, intense, and severe
tantrums
 Controlling
 More (over) reactive and greater
emotional intensity (excited or
sad)
 More anger, aggression, and
hostility
 Low frustration tolerance
 Limited perseverance
 More avoidance
 Brood longer
 Moodier & irritable
 Cannot tolerate feedback

Early Signs of ADHD
Behavior Neurotypical Possible ADHD
3+/week for more than 15

2-3 times/week for less than 15
minutes at a time; frequency and
Tantrums minutes; frequency and
intensity persist for 6 or more
intensity lessens over 6 months
months
Aggressive 36+ months, occurring more than

behaviors 1-2 times/month (between 12-
once or twice (i.e., often during
36 months)
(e.g., biting) tantrums)
Self-injury
(e.g., head- n/a Occurs at any time

banging)

Peer Rejection

Diagnosing ADHD
• Complex!
– Heterogeneous nature
of ADHD
– Other diagnoses
– No clear
developmental or
neuropsychological
markers
– Other variables can
get in the way
– Normal behaviour?

Diagnosing ADHD
• Behavioral deficits
– Impairments to meet
societal expectations

Diagnosing ADHD
• Use a practical definition of ADHD
• Greater understanding of the child
• Translates data into functional behavior

Diagnosing ADHD: Practical Definitions
Inattention Hyperactivity Impulsivity Emotional Dysregulation
Trouble staying on and finishing Excessive restlessness Doesn’t think before acting Overreactive
tasks
Easily distracted and sidetracked Constantly on the go Limited self-control Reacts quickly and intensely
Better in new situations Plays loudly Repeat offenders & rewards don’t Emotional roller coaster
work
Forgets instructions & needs them Class clown Poor planning Easily frustrated
repeated
Messy & disorganized Extreme squirminess, fidgeting Trouble waiting for their turn or Gives up easily
for things they want
Forgetful, loses things Excessive talking Interrupts/blurts out Avoids things
Shy & quiet Constant noises Blames others Aggressive
Misses details, careless mistakes Leaves seat Mis-hears instructions or jumps Easily excitable
ahead without listening
Daydreams Runs or climbs when not Unaware of how they affect others Trouble calming themselves
supposed to (and remorseful later)
Doesn’t pay attention when Easily bored and looking for fun Sensitive to corrective feedback
someone talks directly to them

More Severe and Frequent

ACROSS
CONTEXTS

Comprehensive
• Thorough emotional, behavioral, and developmental

assessment
• Multiple sources across settings
• Multiple measures
• Decisions based on accepted standard
• Differential diagnosis
• Clinician skill
Diagnosing • Developmental stages
• Other psychiatric disorders
ADHD Descriptions of behavior
History & course
Knowledge of differential diagnosis

Identify all presenting problems
Identify areas of impairment
Conditions affecting functioning

Beyond Family history and functioning
Symptoms: Peer relationships
Whole Child Academic performance
Approach Comorbidity and associated difficulty
Targeted behaviors

• Strengths and interests
– Potential reinforcers

Linking to Intervention
Reduce Develop
symptom relevant life
severity factors

Multimodal Intervention
Behavior
Management
Psychological
Support
Education
(individual/
family)
Accommodations
Effective Medical
& Environmental
Intervention Management
Manipulation

Behavior
Education
Management
Psychological
Support Medical
(parent & Management
child)
Accommodations
& Environmental
Effective
Intervention
Exercise
Manipulation

Play!
Imagination crucial
for problem-solving,
loving life, and
excelling.

Behavior Modification
Behaviour Family therapy/ Parent/Teacher

support plans parent-child training
interactions
Consequences Interacting in Education/
depending on positive ways understanding
behaviors • No bad/lazy
kids!
Learning based on
consequences
Key Skills for Adults
Understand ADHD Effective Positive Create opportunities

communication reinforcement for success
Consistent Positive interactions Stress management

consequences

Critical difference in outcomes for kids with ADHD
Greatest predictor of long-term happiness

Protector from:
• Violent behavior
• School failure
• Substance abuse
• Depression
• Suicidal ideation
• Unwanted pregnancy
28
Invite. Ensure everyone’s in a talking mood
Listen, collaborate, and coach (vs. tell)
Give them first shot before giving advice/solutions
Share ideas without judgment

EFFECTIVE
COMMUNICATION
Let them set and follow own goals
Establish reasonable rules and expectations
Let them try (no “I told you so’s”)

Understanding the Brain
• Executive Functions
delayed
– In early development,
imperfect and inconsistent
• Direct
• Structure
– Long-term treatment
– Effective treatments within
NATURAL environment

Interventions: Level of Environment

When things are going well =
conditions are met to support EF

• Picture of phone booth

Helpful Not So Helpful
• Engaging (interests) • Boring

• Immediate consequences • Delayed consequences
• Frequent feedback • Infrequent feedback
• Personally important • Low importance
• Early • Late in the day
• Supervised • Unsupervised
• 1:1 • Group situations
• Structured • Unstructured
• Clear expectations • Uncertainty
• Close to needed materials • Need to search for
• Quiet/low arousal materials
• Loud/high arousal

Important to
match
expectations
to what they
can do

Never take away
recess.
Give more!
Movement increases
blood flow to the brain.
Improves performance,
creativity, attention,
and focus.

Level of Person: Motivate

Important!
Kids with ADHD release dopamine at low rates = unable to apply
themselves to tasks that are not intrinsically interesting
Work cut short

Low incentive = Forget rules
mind wandering Caught up in
emotion

Task
Incentive

Important!
Kids with ADHD

release dopamine at BUT, when
low rates = unable to motivation is high,
apply themselves to
tasks that are not brain activity is the
intrinsically same as other kids
interesting

Incentive
Task

Be Explicit!!!!!!!!!!!!
(Don’t Assume Anything)

Self-Regulation

Self-Regulation Building Blocks
Sensory Emotional
Behavior
processing development
Executive Planning and

Attention
functions sequencing
Receptive Working
Social skills
language memory

Kids need to:
Effortful coping Remember rules + anticipate consequences…
…to make positive choices about what to do next

Lend me your brain, please!
Co-Regulation

Misbehavior vs.
Stress Behavior

• Aware of behaviour
and rules
• Within their capacity
to act differently

• None of these capacities

Recognize Stress: Play Detective
• What is going on for

ME?
– Am I being patient? Warm?
Responsive?
– CO-REGULATION critical!!!

Parent Emotion-Related behaviors
Adaptive child emotion outcomes
Safe environment Criticizing

Supports Minimizing
Child emotion dysregulation

Validates Punishing
Perspective taking Own emotion
dysregulation
Own emotion
regulation

Social
Connections!
Keys for
success Maintain balance
to help them cope
effectively

Behavior Management

Establishing Behavior Expectations/
Strategies
INVOLVE CHILD START SMALL! FEW STATE RULES TEACH & PRACTICE USE ROLE PLAY TO
RULES AND BUILD POSITIVELY TO SUCCESS KEEP KIDS ACTIVELY
ON SUCCESSES ENGAGED
USE POSITIVE MAKE REWARDS PRAISE KIDS FOR REVIEW RULES PROVIDE ONGOING
MOTIVATORS VS. APPEALING AND FOLLOWING RULES REGULARLY AND AT STRUCTURE AND
PUNISHMENT IMMEDIATE POINT OF SUPPORT FOR
PERFORMANCE SUCCESS

Externalize Behaviors

Find the
Antidotes

Practice!
Structured teaching trials
where we set up the stressor
and teach kids the skills they
need to tolerate and cope with
the stress

Role of
Medications

Role of
Medications

 Reduces key symptoms and
improves daily functioning
 Normalizes brain development
 Can help with productivity and

attention in the class

Don’t Teach Skills

ADHD Parent Masterclass
http://drcarolinebuzanko.com/adhd-masterclass/
Dr. Caroline Buzanko, R. Psych.

caroline@korupsychology.ca
drcarolinebuzanko.com

Please enter your questions in
the box to your left.
Please note: Live webinar attendance and all questions submitted via GoToWebcast are
confidential. None of today's webinar attendees can see the names of other attendees, nor can
they see the questions submitted via GoToWebcast. Usernames are associated with questions
posted in the ADDitude forums.
ADDitude does not provide medical advice, diagnosis, or treatment. The material in this webinar
is provided for educational purposes only. Copyright © 2020 by New Hope Media. All rights
reserved.

Upcoming Webinars
• Tuesday, September 29th at 1pm ET
Bridging the Distance: Accommodations and Technology for Overcoming
Remote Learning Challenges for Students with ADHD with Brian Friedlander,
Ph.D.
https://www.additudemag.com/webinar/distance-learning-tech/
• Thursday, October 8th at 1pm ET
How CBT and ADHD Coaching Help Adults Manage Their Symptoms Naturally
with J. Russell Ramsay, Ph.D., and David Giwerc
https://www.additudemag.com/webinar/cbt-adhd-coaching/
Visit http://additu.de/webinars to view the webinar replay library.

Thank You!
If you missed any part of today’s webinar, a recording is available for replay at
http://additu.de/webinars.
To continue the conversation, we invite you to join us on
ADDitude Forums
ADDitude’s online community for attention deficit support and solutions where you can join
our ongoing ADHD discussion groups: https://www.additudemag.com/forums/


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How to Distinguish ADHD

adhd expert webinars

Caroline Buzanko, Ph.D.

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

3+/week for more than 15

Aggressive 36+ months, occurring more than

(e.g., head- n/a Occurs at any time

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

Forgetful, loses things Excessive talking Interrupts/blurts out Avoids things

Shy & quiet Constant noises Blames others Aggressive

adhd expert webinars

adhd expert webinars

adhd expert webinars

• Thorough emotional, behavioral, and developmental

History & course

Knowledge of differential diagnosis

adhd expert webinars

Identify areas of impairment

Conditions affecting functioning

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

Behaviour Family therapy/ Parent/Teacher

Understand ADHD Effective Positive Create opportunities

Consistent Positive interactions Stress management

adhd expert webinars

adhd expert webinars

Listen, collaborate, and coach (vs. tell)

Give them first shot before giving advice/solutions

Share ideas without judgment

Establish reasonable rules and expectations

Let them try (no “I told you so’s”)

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

• Engaging (interests) • Boring

adhd expert webinars

adhd expert webinars

adhd expert webinars

adhd expert webinars

Work cut short

adhd expert webinars

adhd expert webinars

Kids with ADHD

Dr. Caroline Buzanko, R. Psych.