ADHD in preschoolers? Be cautious.

More than 10% of school-age American children have been diagnosed and treated for Attention Deficit Disorder.  Many are helped by medication; treatment can truly be life-changing for them and their families.

But some children younger than school-age are being prescribed ADHD medications, and it may not be appropriate.

An article in the Washington Post this past May 3 points to data from the CDC, suggesting that too many children under 6 may be prescribed medication, although behavioral therapy may be more appropriate.

The cardinal symptoms of ADHD include easy distractibility, short attention span, and impulsive behavior.  In school-age children, these symptoms can cause poor academic progress, because the child finds it hard to learn, and even harder to demonstrate what you’ve learned and do classwork, if your learning style is impulsive and disorganized.  In addition, children with ADHD find it hard to cooperate with adult routines. And the social life may suffer because other children find it difficult to be friends with a kid who is distractible and impulsive.

But with pre-school children, I am impressed that distractibility, short attention span, and impulsiveness is normal behavior!  Most kids this age have some difficulty managing their impulses; their task in “growing up” is to learn self-restraint.  As with any other skill, some kids learn self-restraint faster than others.  We should be cautious about “medicalizing” such normal behavior.

I agree with the American Academy of Pediatrics that kids under 6 who have behavior problems should generally be evaluated by a psychologist or other behavior health professional, before starting medication.  Frequently, such behavioral therapy can teach a child (and their parents) techniques to alter behavior, so that their behavior becomes more socially acceptable and they can integrate with their peers.  If behavioral therapy is not successful in orienting the child towards more acceptable behavior, then medication might be more appropriately considered.

Why does this not happen?  Why are young children being treated more often with stimulants and other neurologically active medications?  Behavioral therapy may not be easy to arrange, or to follow through with, especially if trained therapists in the area are in short supply.  And the dramatic (and apparently easy) success of medical treatments in older children can be seductive.

We are fortunate in our area to have seen the number of well-trained child therapists increase recently, and I am pleased that I have such resources available to my patients.

If your preschool children are acting out, don’t assume that they have ADHD – seek a professional evaluation first!

To see the Washington Post article, click here:
https://www.washingtonpost.com/news/to-your-health/wp/2016/05/03/cdc-warns-that-americans-may-be-overmedicating-two-to-five-year-olds-with-adhd/

To read an essay about “responsibility and cooperation” on my website, click here:
http://www.dmpkids.com/index.cfm?fuseaction=trees.pageDetails&p=28-2-33

For a list of some local pediatric psychologists that I have had good experience with, click here:
http://www.dmpkids.com/index.cfm?fuseaction=trees.pageDetails&p=48-2-53

—  David Epstein MD