Medicate My 4-Year-Old?!

Revised guidelines give doctors the go-ahead to diagnose and treat ADHD in younger kids, but are parents comfortable evaluating preschoolers for attention deficit?

Why Parents Worry About Early Diagnosis

While some experts and parents welcome the news of earlier diagnoses and treatment, others are concerned. Many parents believe that children are already overdiagnosed and overmedicated. Won’t expanding the guidelines only exacerbate the problem?

“The goal of the new guidelines is not more diagnoses, it is more accurate diagnoses,” says Ari Tuckman, Ph.D., a psychologist and author of Understand Your Brain Get More Done: The ADHD Executive Functions Workbook (Specialty Press). Still, some parents hesitate to have their children evaluated before they are school-age. Here are four common reasons why they wait:

“I’m afraid to medicate my four-year-old”

The new AAP guidelines say that when a preschool-aged child has been diagnosed, the first line of treatment should not be medication but behavior therapy. The guidelines do not mandate using medication. They merely inform families and clinicians that using medication in younger groups has been shown to be helpful and safe. If behavior therapy has been tried (usually in an eight- to 12-week program) and found not to work, only then should a doctor consider putting a four- or five-year-old on medication.

“Medication, at any age, is never a magic bullet,” says Reiff. “However, if your child exhibits dangerous behaviors that significantly impair his daily living, it seems reasonable to consider the possibility of medication management.”

“Parents should ask, ‘Would it be helpful to my child to explore what medications have to offer?’” says William Dodson, M.D., head of the ADHD Treatment Center, in Denver, Colorado. “As one pediatrician said, ‘We’re not talking about a tattoo on your child’s face. We are going to see what medication has to offer and then decide, based on knowledge rather than fear.’”

“Behavior therapy doesn’t work”

“Behavior therapy won’t change the wiring of a child’s brain,” says Tuckman. “It can, however, minimize distractions and change the tone of the interactions between a child and parents or teachers. Behavior therapy enables a child with ADHD to function better, as changing the way a diabetic’s diet can help him feel and function better without changing his ability to process sugar.”

“I don’t want my child to be labeled”

Your child will be less likely to be labeled a “troublemaker,” a “bad kid,” or a “daydreamer” if you address his ADHD early. “One study showed that a child with untreated ADHD received 20,000 negative messages in the first 10 years of life,” says Dodson. “If a child mostly hears, ‘You’re a little monster, you’re impossible to deal with,’ it affects how the child thinks about himself. Treating ADHD can help your child function and behave better, and will most likely build his self-esteem .”

“It’s normal for preschoolers to be hyperactive and have short attention spans.”

Preschoolers are naturally active and usually can’t focus as long as older children can, but there are differences between kids with ADHD and those without it. “Preschoolers with ADHD run out into the street without thinking,” says Patricia Quinn, M.D., a developmental pediatrician in Washington, D.C., and the director of the National Center for Girls and Women with ADHD. “Very young children with ADHD have more broken bones, more stitches, and more emergency room visits than children who don’t have the condition.”

Another difference is something Quinn calls “up and away activity.” “Say the preschool teacher asks the students to glue cotton balls to paper to create clouds. The non-ADHD child may glue on 10 cotton balls. Children with ADHD may glue on two and get up and walk away. Or they’ll pull out a toy, touch it, and walk away. There is a lack of purpose to their activity. They’re the kids who spin around in a chair incessantly or jump up and down on a sofa. Having your child diagnosed and treated in preschool will help her manage symptoms and will likely keep her safe and sound.”

Next: Try Behavior Therapy First

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