ADHD News & Research

Treating Preschoolers: Many Doctors Don’t Follow ADHD Guidelines

Too many specialists are prescribing medication first instead of behavior therapy to treat preschoolers with ADHD, which goes against the recommendations laid out by the American Academy of Pediatrics.

May 9, 2013

A recent study reveals that more than 90 percent of pediatric specialists who diagnose ADHD in children are not following clinical guidelines developed in 2011 by the American Academy of Pediatrics (AAP).

The study, conducted by the Cohen Children’s Medical Center of New York, surveyed 3,000 physicians specializing in neurobehavioral conditions on how they treated ADHD in children aged four to six, as well as which drugs they prescribe most often.

Researchers found that among 560 respondents, more than one in five specialists who diagnose and treat ADHD in preschoolers recommend drugs as a first-line treatment, either alone or accompanied by behavioral therapy.

That contravenes AAP recommendations, which call for behavioral therapy first, followed by ADHD medication only if the non-drug treatment fails.

Further, for situations where pharmacotherapy is appropriate, the AAP recommends that doctors prescribe methylphenidate (Ritalin). But the more than one in three specialists surveyed reported they “often” or “very often” prescribe a different drug first.

Why do physicians first prescribe medication to children diagnosed with ADHD, instead of behavioral therapy? The study’s authors suggest that this may be because families don’t have access to behavioral therapy resources, or find them cost-prohibitive. It may also be the case that parents find it difficult to make the long-term time commitment behavioral therapy entails.

The study’s lead author contends that these reasons don’t justify prescribing ADHD meds to preschoolers immediately upon diagnosis. “Pediatricians, specialists, and parents should increasingly look to behavioral treatments as a first-line treatment,” says Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center, “and medication should be reserved for cases where either behavioral therapy is not effective or where it is not available.”