The American Academy of Pediatrics’ (AAP) recommendations for managing attention-deficit hyperactivity disorder do not include diagnosis in children age 3 and younger, but a recent Centers for Disease Control and Prevention report revealed more than 10,000 2- to 3-year-olds are given ADHD drugs.
“The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of ADHD in children below age 4,” The New York Times
reported about data presented at the Georgia Mental Health Forum
We talked with Children’s National psychiatrist Adelaide S. Robb, MD
, to get more insight and information about the recent report.
What do you think of the recent findings?
Dr. Robb cautions that the findings from the survey do not show a direct diagnostic evaluation for ADHD and there is no tracking of other therapies that may have been done before medication. The findings also don’t take into account other diagnoses, such as anxiety.
She said that when people hear about findings such as this, they may “immediately conclude we are over diagnosing ADHD and overmedicating young children.”
She said that specific studies, such as the National Institutes of Health’s Preschool ADHD Treatment Study
, offered a very specific evaluation, intensive therapy, and then medication trial.
What should parents do if they suspect their child has ADHD?
“Any child presenting at a young age with ADHD-like symptoms needs a comprehensive evaluation including a physical examination, intellectual and language testing, and examination for other disorders,” Dr. Robb said.
If parents, caregivers or teachers have a concern, the first step is to talk to your child’s pediatrician.
Are there guidelines for medicating young children with ADHD?
AAP’s standard recommendations and guidelines for ADHD
do not include diagnosis in 2- to 3-year-olds.
Dr. Robb explains that the reason the AAP does not include diagnosis in this young age group is because sometimes these behaviors may resolve by age 4, as the child develops increased attention and concentration, along with decreased impulsivity. Additionally, the American Academy of Child and Adolescent Psychiatry
“has practice parameters on ADHD and information about the evaluation of preschoolers for psychotropic medication,” Dr. Robb said.
Are there other treatment options available that don’t include medication?
Yes. In fact, Dr. Robb recommends therapy as a first step. Her advice for parents is to first consult your pediatrician for an evaluation for cognitive ability, language, and hearing. She also suggested therapy before considering a trial of stimulant medication.
Other alternatives include parent management training and placement in a special education classroom, according to Dr. Robb.
What else should parents know?
Dr. Robb says medications carry risks. Common side effects for medications in young children include poor growth, loss of appetite, and irritability. However, some children may benefit from medication, she says.
Parents should consult their child’s pediatrician and ask for a thorough evaluation if they have concerns.
Learn more about Children’s National’s Infant and Toddler Mental Health Program.