Study Finds Preschoolers Are Being Prescribed ADHD Meds Too Soon
Young U.S. children are being prescribed ADHD medication too quickly, a new Stanford-led study found.
Researchers found that many (42%) preschool-aged children diagnosed with attention-deficit/hyperactivity disorder (ADHD) were put on medications — often stimulants like Ritalin — within a month of diagnosis, despite guidelines recommending behavioral therapies as the first step.
We spoke with the lead author of the study, Dr. Yair Bannett, an assistant professor of pediatrics at Stanford, to better understand the implications for parents, pediatricians, and kids.
A LOOK AT THE SCIENCE
Researchers analyzed electronic health records, tracking more than 10,000 kids ages 4 and 5 who are diagnosed with ADHD, which is marked by impulsive behavior and difficulty paying attention or sitting still — beyond the typical “high energy” of young kids.
The American Academy of Pediatrics advises that kids ages 4 and 5 should try at least six months of behavior therapy before starting medication.
This can include tools like visual schedules to help kids stay organized, or parent training programs that reward good behavior and ignore negative behavior.
Stimulant medications cause more side effects in preschoolers than in older children because their bodies don’t yet fully metabolize the drugs, which can lead to stronger side effects.
“Ultimately, for most children with ADHD, we want them to have both types of treatments,” Bannett said. “We know these medications are safe long-term, but for young kids, they are more likely to cause short-term side effects — such as irritability, moodiness, increased crying, or even hitting. When we see those kinds of side effects, we stop the medication immediately.
Dr. Bannett notes research that has shown that children with ADHD who are treated with medication are less likely to develop substance use disorders, be involved in accidents, and experience other long-term negative outcomes.
THE BIGGER ISSUE
While the study does not explore why this is happening, Dr. Bannett says that both a shortage of specialists and a lack of awareness among pediatricians about available resources may be contributing factors.
Luckily, there is hope for parents who want to support their child. Online behavioral therapy programs like Triple P and Incredible Years are easily accessible. Other options include virtual group-based parent trainings.
“It’s not psychotherapy for the child. It’s not play therapy. It’s not CBT. This is different because it focuses on the parents, on the caregivers, and it's teaching them strategies to manage the child's behaviors, changing the environment of the child, putting in place a reward system, and things like that,” Bannett said, noting that there are free and low-cost resources online.
He and other experts are also working to improve training for pediatricians in developmental and behavioral care — especially since many parents turn to them first.
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