"He goes, I think, right here," declared six year old Kieran Faas. He was working on a puzzle with his mom, a task that takes focus. It's something the kindergartner couldn't accomplish before.
"After perhaps 30 seconds, or 90 seconds we just moved on," said Sherry Dwyer, explaining her son's lack of ability to stay engaged in any activity.
His preschool teachers called him active, and easily frustrated. At home he was a handful.
"He would wake up at 5 o'clock in the morning and he's the Energizer Bunny until 11 o'clock at night," said Dwyer.
By the time he was four he was being turned down for play dates.
"Kids get labeled right?" said Dwyer. "You know it's like, "You're going to destroy my house,"" she said of the reaction she often experienced from parents of his peers.
Confused and frustrated, Dwyer and her husband turned to Kieran's pediatrician.
"We needed to rule out autism and Asperger's. And we went down that path. After a period of time, she felt he should be evaluated for ADHD," she said.
The previously accepted age for screening kids for attention deficit hyperactivity disorder was six. Now new guidelines from the American Academy of Pediatrics drop that age down to four.
"Those of us who have been dealing with ADD have known for a long time that there is a percentage of children with ADHD who need to have the issues addressed before they get much older," said Physician Dr. Theodore Mandelkorn.
Dr. Mandelkorn, who diagnosed Kieran, specializes in treatment of ADHD in children and adults at his practice, Puget Sound Behavioral Medicine on Mercer Island. He said the new American Academy of Pediatric guidelines stress behavior therapy first, and it can work. But it's not effective for all kids with the disorder.
"This is the bind these children are in, which is, they're expected to improve. They're expected to make a difference in this, and they can't," Dr. Mandelkorn explained.
The new guidelines say doctors may consider medications even for kids as young as four when ADHD symptoms are so severe that behavior techniques fail. Dr. Mandelkorn said the benefits from the drugs outweigh the risks.
"There is no evidence at this point of long term side effects that we need to worry about. How do we know? Because we've been treating millions of people for sixty and seventy years," he said.
In the end, choosing behavioral or medication treatment or a combination, is up to parents. Sherry Dwyer said for Kieran, the solution, so far, includes medication.
"The medication has helped him be able to focus at school, be able to focus at home and be able to build very good relationships with his peer group," she said.
The new guidelines also raise the upper age of treating ADHD in kids, from the current age of twelve, to eighteen. According to the National Institutes of Mental Health, ADD and ADHD often run in families. Researchers are looking at several genes that make children more likely to develop the disorder. Government estimates show slightly over 8% of children may have ADHD. Because other conditions can mimic the symptoms, it's important to get a thorough assessment by a health care professional.