One of the striking things we learned in the very first Head Start Study (see earlier post on Head Start) was that teachers who placed emphasis on an orderly classroom and its materials by commands to an individual, in contrast to teachers who emphasised verbal directives to the class as a whole, showed little gains in IQ. Teachers who used a warm and supportive style while addressing the whole class produced an average gain of 10 points of IQ in the six-week class. Verbal activity for the whole class rather than reprimands to an individual appeared to be the stimulus to cognitive growth.
Ages 3 to 4 in children is a period of key advances in brain growth and neuronal connectivity. With the expansion of pre-kindergarten programs throughout the country, as Steve Hinshaw and colleagues have recently emphasised, we can expect more diagnoses of ADHD, and it is essential that these lessons of the past be remembered. Cognitive growth is a form of resilience that protects against ADHD.
Evidence shows that much of the faulty diagnoses of ADHD stems from the school setting where pressures to sit still, or to perform highly cause teachers and parents to leap quickly to ADHD as an explanation. Preschool is a period when the basic rules of good diagnosis applies: detailed and cautious clinical history, with multi-observers and multimodal interventions. At the same time, REAL ADHD does exist early and correct detection is also crucial.