Four-year-olds showing debilitating signs of attention-deficit hyperactivity disorder should be evaluated by doctors, revised guidelines say.

Previously, recommendations and diagnosing and managing ADHD started with children aged six to 12. Since 2001, emerging evidence pointed to expanding the age range to include preschool-aged children and adolescents, the American Academy of Pediatrics said.

The revised guidelines suggest doctors first prescribe behaviour therapy for preschoolers, and that methylphenidate or Ritalin may be prescribed if that does not significantly improve “and there is moderate-to-severe continuing disturbance in the child’s function,” the group’s 14-member committee said.

Behaviour therapy includes training parents and teachers on techniques to help children manage their anger, such as using positive reinforcement and punishing when a child fails to meet goals.

Treating children at a young age is important because identifying them earlier and offering treatment increases their chances of succeeding in school, said Dr. Mark Wolraich, the lead author of the report in the November issue of the journal Pediatrics.

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Health.com explains 15 signs that could mean you have adult ADHD:

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• You're restless.

  Children with ADHD can be overly energetic, but adults may just feel edgy or restless. "Adults don't show the more obvious signs such as running and jumping," says Colette de Marneffe, Ph.D., a clinical psychologist in Silver Spring, Md. "Hyperactivity presents more subtly in the form of restlessness." However, you may recall a rambunctious childhood. Dr. Wetzel had a patient who recalled spending a lot of time in the school hallways because "he couldn't sit still." It's a "classic story," he says. <strong>More from Health.com:</strong> <a href="http://www.health.com/health/gallery/0,,20418651,00.html" target="_hplink">10 Things You Should Do If You Have Adult ADHD</a> <a href="http://www.health.com/health/gallery/0,,20480962,00.html" target="_hplink">10 Tricks for Paying Better Attention</a> <a href="http://www.health.com/health/gallery/0,,20307161,00.html" target="_hplink">7 Celebrities With ADHD</a>

• You have a child with ADHD.

  ADHD appears to have a genetic component. When one member of the family has it, there's a 25- to 35-percent chance that someone else in the family does, too, according to the Attention Deficit Disorder Association. When a child is diagnosed with ADHD, some adults, who may have had the same symptoms when they were children, realize that they may have always had the condition without realizing it.

• You have relationship trouble.

  A newly minted relationship is often exhilarating, but the novelty can wear off in time. "Oftentimes adults with ADHD really have a hard time with that transition," notes de Marneffe. "When the relationship becomes more stable and predictable, conflicts tend to emerge." Being easily distracted or inattentive -- symptoms of ADHD -- can also sabotage existing relationships with family, friends, and significant others who view their loved one's behavior as self-centered, Dr. Wetzel adds.

• You smoke.

  About 40 percent of adults with ADHD smoke, versus only 26 percent of the general population. "Nicotine is very effective for a lot of ADHD symptoms and it's not uncommon for me to see someone for the first time after they quit smoking," says Dr. Wetzel. That's because they often start to have more problems with focus and concentration, he explains. Adults with ADHD are also more likely to use alcohol and other drugs, and at earlier ages, than people without ADHD.

• You had academic problems as a child.

  If you suspect you have ADHD as an adult, an early history of ADHD symptoms -- difficulty sitting still, paying attention to the teacher and focusing on your work, for example -- can confirm the diagnosis. "What adult patients will tell you over and over and over again is that they had to work twice as hard as their peers to get half as much done in school," Dr. Wetzel says.

• You're a champion procrastinator.

  Do you live deadline to deadline? "I can't tell you how many times a patient has told me, 'I'm the king of procrastination,' or 'I'm the queen of procrastination,' because they feel like no one else can put things off like they can," says Dr. Wetzel. It makes sense, he adds, because when people with ADHD are under the gun and anxious, that's when they can focus. Constant anxiety, however, can be very stressful.

• You're a thrill seeker.

  People with ADHD are often drawn to activities that are stimulating. They may engage in risky behaviors, like fast driving, gambling and even extramarital affairs. The key is to channel that desire for excitement and novelty into activities that don't jeopardize your work and family life, says de Marneffe. Parasailing or other high-adventure activities may be good outlets.

• You lose things all the time.

  Is losing your cell phone, wallet or keys part of your daily routine? People with ADHD frequently misplace common items. Dr. Wetzel describes ADHD as an "underpowered state of consciousness." If you set down your keys and you're not really paying attention, your brain doesn't lay down a memory of the event. "It's kind of like it never happened," he says.

• You have trouble on the job.

  Everyone encounters some task he doesn't particularly enjoy, but most people are able to find a way to complete the boring aspects of their job, says de Marneffe. People with ADHD, however, have a hard time doing that. Jobs with a lot of repetition tend to be a poor fit, she observes. Choose work that engages you and fulfills your need for novelty and variability.

• You have a quick temper.

  If you fly off the handle in a fit of anger or frustration one moment but are completely over it in the next, it might be a sign of ADHD. Because this type of irritability can also be a symptom of bipolar disorder, some people with ADHD can be misdiagnosed, says Dr. Wetzel. (However, you can also have both.) It's important to get a thorough evaluation and diagnosis.

• You have problems completing tasks.

  Is your house cluttered with piles of laundry? Is your expense account still a work in progress? Failing to finish tasks can be a symptom of ADHD in adults. Dr. Wetzel, author of the e-book "<a href="http://www.amazon.com/Handbook-Patients-Family-Friends-ebook/dp/B004S3I8Z4/ref=sr_1_1?ie=UTF8&m=AG56TWVU5XWC2&s=books&qid=1305231560&sr=1-1" target="_hplink">The Adult ADHD Handbook for Patients, Family & Friends</a>," finds the most successful ADHD patients tend to be entrepreneurs who recognize this shortcoming and surround themselves with people who will focus on the details, finish the paperwork and handle the mundane portions of a task.

• You're impulsive.

  If you blurt out whatever's on your mind without weighing the consequences, it might be a symptom of ADHD. And acting on an impulse, rather than thinking things through, can cause trouble with family and colleagues. Examples would include abruptly quitting a job, having unprotected sex or impulse buying with little thought about the repercussions.

• You can't relax.

  Your spouse wants to catch a movie, but unless it's the thriller you've been dying to see, you may get up several times or have random thoughts that distract you from the plot. Being calm requires a quiet mind, and that's tough for people with ADHD because "so many other things can take over their consciousness," Dr. Wetzel says. "People with ADHD will tell you it's almost impossible for them to meditate."

• You're easily distracted.

  You're on a conference call, but your mind keeps wandering. Next thing you know, you've lost chunks of conversation. With ADHD, sustaining focus is a real problem and a core feature of the disorder. Unimportant things -- from external noises and movement to daydreams -- grab your attention. Move to a work space with fewer distractions or use white noise to block out other sounds in the surrounding environment.

• You're disorganized.

  Here's the tip off: Your desk is a mountain of paper and you just wasted a half hour searching for an important legal document. Or maybe you failed to make appointments for your children to see the pediatrician, and the school wants their immunization reports -- pronto. If you have ADHD, getting and staying organized is a challenge for you. Breaking organizational tasks into smaller steps may help, according to the National Resource Center on ADHD, in Landover, Md. <strong>More from Health.com:</strong> <a href="http://www.health.com/health/gallery/0,,20418651,00.html" target="_hplink">10 Things You Should Do If You Have Adult ADHD</a> <a href="http://www.health.com/health/gallery/0,,20480962,00.html" target="_hplink">10 Tricks for Paying Better Attention</a> <a href="http://www.health.com/health/gallery/0,,20307161,00.html" target="_hplink">7 Celebrities With ADHD</a>

ADHD is the most common neurobehavioral disorder in children, occurring in about eight percent of children and youth, according to the report.

To be diagnosed with ADHD, a child must show key symptoms in multiple environments such as at home, at school and in relationships with their peers that are tracked over time and persist.

For elementary school children and adolescents, the group recommended both approved medications and behaviour therapy.

Side-effects of stimulant medications include slowing of growth in children, appetite loss, sleep problems and stomach pain.

"As pediatricians, we're very concerned about growth in young children," said Dr. Diane Sacks, a pediatrician in Toronto. "If they're on a medication that decreases appetite, we are concerned that the growth may be impacted."

For teens diagnosed with ADHD, the guidelines recommended that doctors watch out for any signs of drug of alcohol abuse.

The pediatric group also released an updated toolkit to help health-care professionals to diagnose and treat ADHD, and a consumer resource book for parents.

Some of the guideline authors said they have consulting relationships with companies that sell ADHD medications.

About half of kids with ADHD also continue on to have it in adulthood.