Pediatricians are too quick to prescribe medication for young children with attention-deficit/hyperactivity disorder, a new analysis shows.
The American Academy of Pediatrics recommends behavioral therapy for at least six months after an ADHD diagnosis in preschool age children, but doctors often prescribe stimulants as a first-line strategy, according to the study, published Friday in JAMA Network.
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"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," said Dr. Yair Bannett, the study's lead author and an assistant professor of pediatrics at Stanford Medicine.
ADHD stimulant medications are less effective for preschool-aged children. Children under 6 cannot fully metabolize the medications and have an increased chance for side effects, which may include decreased appetite, difficulty sleeping, emotional outbursts, irritability and repetitive behaviors or thoughts, according to the AAP.
"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 said.
The study analyzed data from more than 700,000 children across eight health systems in the United States. More than 9,700 of those children were diagnosed with ADHD when they were 4 or 5.
About two-thirds of those children were prescribed ADHD medication before age 7, with more than 42% of them receiving medication within 30 days of diagnosis, according to the study.
The researchers reported especially high rates of early medication in white children, likely due to the fact that Black, Hispanic and Asian children were less likely to receive an ADHD diagnosis, according to the study.
Children with publicly funded health insurance through Medicaid and the Children's Health Insurance Program were more likely to receive medication earlier than children with private insurance. Systemic barriers to evidence-based behavioral therapies and specialists may explain this finding, the researchers said.
"Behavioral treatment works on the child's surroundings: the parents' actions and the routine the child has," Bannett said.
For young children, the APA recommends giving behavioral interventions six months to see if they are effective before jumping to medication. The APA recommends behavioral interventions in combination with medication in older children.
Approximately 7 million children in the U.S. have ADHD. That is about 1 in every 10 children, ages 3 to 17, according to the Centers for Disease Control and Prevention.
ADHD symptoms include difficulty maintaining focus, hyperactivity and impulsivity, according to the American Psychiatric Association.