ADHD Treatment for Kids: Why Are Young Children Getting It Wrong?
- Young children with attention deficit/hyperactivity disorder often receive medication just after being diagnosed, which contravenes treatment guidelines endorsed by the American Academy of Pediatrics, a Stanford Medicine-led study...
- The finding, published on August 29 in JAMA Network Open, highlights a gap in medical care for 4- and 5-year-olds with ADHD.
- But pediatricians often prescribe medication immediately upon diagnosis, according to an analysis of medical records from nearly 10,000 young children with ADHD who received care in eight pediatric...
Early ADHD Medication in Young Children contradicts Guidelines, Stanford Study Finds
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Young children with attention deficit/hyperactivity disorder often receive medication just after being diagnosed, which contravenes treatment guidelines endorsed by the American Academy of Pediatrics, a Stanford Medicine-led study has found.
The finding, published on August 29 in JAMA Network Open, highlights a gap in medical care for 4- and 5-year-olds with ADHD. Treatment guidelines recommend that these young children and their families try six months of behavior therapy before starting ADHD medication.
But pediatricians often prescribe medication immediately upon diagnosis, according to an analysis of medical records from nearly 10,000 young children with ADHD who received care in eight pediatric health networks in the United States.
concerning Trends in Early ADHD Treatment
“We found that many young children are being prescribed medications very soon after their diagnosis of ADHD is documented,” said the study’s lead author, Yair Bannett, MD, assistant professor of pediatrics. “That’s concerning, as we certainly 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.”
Stimulant medications, commonly prescribed for ADHD, can cause more side effects in young patients than in older children. Before age 6, children’s bodies don’t fully metabolize the drugs. These side effects can lead to treatment failure as families may discontinue medication due to irritability, emotional lability, and increased aggression.
“We don’t have concerns about the toxicity of the medications for 4- and 5-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,” Bannett explained.
The Importance of Early Identification and thorough Treatment
ADHD is a developmental disorder characterized by hyperactivity, difficulty paying attention, and impulsive behavior. Early identification is crucial, as children with ADHD are at higher risk for academic problems and school dropout. Effective treatment improves academic performance and prepares individuals for success in adulthood – maintaining employment, building relationships, and avoiding legal issues.
However, treatment isn’t one-size-fits-all.Behavioral therapy and medication serve different purposes.Behavioral treatment focuses on modifying the child’s environment – parental actions and routines – to build skills and establish habits that align with the child’s brain function. Medication primarily addresses ADHD symptoms like hyperactivity and inattentiveness, offering temporary relief.
The American Academy of Pediatrics recommends parent training in behavior management as the first-line treatment for preschoolers with ADHD. This training equips parents with strategies to foster positive relationships, reward good behaviors, manage negative behaviors, and utilize organizational tools like visual schedules.
Study Details: A Deep Dive into the Data
The researchers analyzed data from electronic health records of children seen at primary care practices affiliated with eight U.S. academic medical centers. The initial sample comprised 712,478 records of children aged 3, 4, or 5 who had at least two visits with their primary care physician over a six-month period between 2016 and 2023.
From this, 9,708 children with an ADHD diagnosis where identified (1.4% of the initial sample). A significant 42.2% – over 4,000 children – received a medication prescription within one month of their diagnosis. Only 14.1% received medication more than six months after diagnosis, indicating a deviation from recommended guidelines.
| Time to Medication After Diagnosis | Percentage of Children |
|---|---|
| Within 1 Month | 42.2% |
| 1-6 Months | 33.8% |
| More Than 6 Months | 14.1% |
| No Medication | 9.9% |
Children with a formal ADHD diagnosis were more likely to receive medication quickly compared to those with initial notes of ADHD symptoms leading to a later diagnosis. However, even among preschoolers who didn’t initially meet full diagnostic criteria, 22.9% received medication within 30 days.
Barriers to behavioral Therapy and Potential solutions
The study, based on electronic health records, couldn’t determine the reasons behind physicians’ treatment decisions.However, informal conversations with doctors revealed a significant barrier: limited access to behavioral therapy. Many areas lack qualified therapists, and insurance coverage can be inadequate.
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.’
Bannett emphasizes the need to educate pediatricians on bridging this gap.He highlights the availability of free or low-cost online resources for parents seeking to learn behavioral management principles.
He also stresses that behavioral management therapy is beneficial for older children with ADHD. “For kids 6 and above, the suggestion is both treatments, because behavioral therapy teaches the child and family long-term skills that will help them in life. Medication will not do that, so we never think of medication as the only solution for ADHD.”
Study Contributors and Funding
Researchers contributed to the study from the Children’s Hospital of Philadelphia, the Perelman School of Medicine at the University of Pennsylvania, Nationwide Children’s hospital, The Ohio State University College of Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of medicine, Texas Children’s Hospital, Baylor College of Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Children’s Hospital of Philadelphia, the University of Colorado, and Nemours Children’s Hospital.
This work was supported by the Stanford Medicine Maternal and Child Health Research Institute; the National Institute of Mental Health (grant K23MH128455); and the National Heart,Lung,and Blood Institute (grant K23HL157615). The study was conducted using PEDSnet,A Pediatric Clinical Research Network,developed with funding from the Patient-Centered Outcomes Research Institute.