Treating Young Children with ADHD
Doctors and psychiatrists can diagnose attention deficit disorder in children as young as four. But most ADHD medications aren’t FDA approved for preschoolers. So how can parents treat symptoms in the very youngest kids with ADHD?
Your five-year-old child has just been diagnosed with attention deficit hyperactivity disorder (ADHD). Ritalin and Concerta — the most common methylphenidates prescribed to treat ADHD in children — aren’t FDA-approved for use in children younger than six. So what do you do?
Both the American Psychological Association and the American Academy of Child and Adolescent Psychiatry advise that customization is key — any treatment plan for young children must reflect the severity of symptoms.
For children with ADHD who play well with others and who have healthy self-esteem, Carol Brady, Ph.D., a child psychologist in Houston, says that environmental changes can help. “A smaller classroom, with less stimulation, and a strong routine often make a tremendous difference in improving ADHD symptoms in preschoolers.”
According to a recent study sponsored by the National Institute of Mental Health, parent-led behavior therapy can have dramatic results for about one-third of children with ADHD. The study, which included more than 300 three- to five-year-olds with severe ADHD, showed that 114 were treated effectively with behavior modification — techniques such as offering consistent praise, ignoring negative behavior, and using time-outs that their parents learned in a 10-week parenting class.
Medication is often the last resort for parents of children with ADHD. As mentioned, most common attention deficit drugs are not available for preschoolers, however the NIMH study did find that young children treated with low doses of Ritalin did experience significant reductions in ADHD symptoms, as measured by standard rating forms and observations at home and at school.
These medication-induced gains were not without drawbacks, though. The NIMH study found that:
- Preschoolers may suffer more side effects from ADHD medications than do older children. Eleven percent of the children in the NIMH study ultimately stopped treatment, despite improvements in ADHD symptoms, due to moderate to severe side effects, such as appetite reduction, insomnia, and anxiety.
- Medication appeared to slow preschooler growth rates. Children in the study grew half an inch less and weighed three pounds less than expected. A five-year follow-up study, due out this year, is looking at long-term growth rate changes.
Preschoolers with severe ADHD experience marked reduction in symptoms when treated with behavior modification only (one third of those in the study) or a combination of behavior modification and low doses of methylphenidate (two thirds of those in the study). Although medication was found to be generally effective and safe, close monitoring for side effects is recommended.
For more information on the Preschool ADHD Treatment Study: Journal of the American Academy of Child and Adolescent Psychiatry, November 2006. (jaacap.com), National Institute of Mental Health, (nimh.nih.org).