Drugs to treat attention deficit hyperactivity disorder are being prescribed too quickly to preschool children in the United States, according to experts.
Millions of American children have been diagnosed with the lifelong neurodevelopmental disorder, one of the most common in childhood. The condition affects the brain, leaving kids unable to focus or control impulsive behaviors, and making them overly active.
Doctors recommend treating ADHD in children, between the ages of three and five, with six months of behavioral therapy before prescribing medication. But Stanford Medicine researchers warned Friday that the treatment guidelines, endorsed by the American Academy of Pediatrics, aren’t being followed.
Instead, young children are often getting medication – including stimulants and non-stimulants – just after being diagnosed.
“We found that many young children are being prescribed medications very soon after their diagnosis of ADHD is documented,” Dr. Yair Bannett, an assistant professor of pediatrics at Stanford Medicine, said in a statement. “That’s concerning, because we know starting ADHD treatment with a behavioral approach is beneficial; it has a big positive effect on the child as well as on the family.”
Daily medication relieves symptoms but effects wane over the course of the day. However with therapy, families can build skills and habits that are compatible with how the child’s brain works.
Both approaches are needed for most kids with ADHD to do well. But previous studies of preschoolers, diagnosed at age four or five, show that it’s best to start with six months of behavioral treatment before prescribing any medication.
“For kids six and above, the recommendation is both treatments, because behavioral therapy teaches the child and family long-term skills that will help them in life,” Bannett said. “Medication will not do that, so we never think of medication as the only solution for ADHD.”
That’s not Bannett’s only concern. Medications prescribed for ADHD cause more side effects in young patients because their small bodies don’t fully process the drugs. They can also make young children more emotional and aggressive.
“We don’t have concerns about the toxicity of the medications for four- and five-year-olds, but we do know that there is a high likelihood of treatment failure, because many families decide the side effects outweigh the benefits,” he added.
The new findings are based on analysis of electronic medical records of young children with ADHD who received care in eight pediatric health networks across the U.S.
Looking at records of more than 712,000 children, seen by doctors between 2016 and 2023, the researchers identified more than 9,700 children who received an ADHD diagnosis. Of those diagnosed, 42.2 percent were prescribed medication within a month of their diagnosis.
Even among preschoolers who did not initially meet the full criteria for the condition, 22.9 percent received medication within 30 days.
Although the researchers could not ask why the children’s physicians made the treatment decisions, Bannett said access to therapy was an issue that came up in informal conversations.
“Doctors tell us, ‘We don’t have anywhere to send these families for behavioral management training, so, weighing the benefits and risks, we think it’s better to give medication than not to offer any treatment at all,’” he explained.
An estimated 7 million children, between the ages of three and 17, have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. There is no single test to diagnose ADHD and symptoms can change over time.
ADHD typically manifests in one of three ways before the age of 12. With “inattentive presentation”, it is hard for children to organize or finish a task, pay attention to details, follow instructions or conversations. With “hyperactive-impulsive presentation”, the child fidgets, talks a lot and has trouble sitting still. The third presentation includes all of these symptoms.
The cause of ADHD remains unknown but scientists say genetics, environment, head injuries, the mother’s mental health and alcohol and tobacco use during pregnancy are all possible risk factors.
