Prescribing drugs for preschoolers soon after diagnosis of ADHD conflicts with American Academy of Pediatrics guideline for nondrug approaches first. Research has indicated the ADHD label itself and the stimulant drugs that may be prescribed as treatment can be harmful to children, while evidence of benefit is uncertain.
Nearly half of preschool-age children who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) in primary care settings are prescribed drugs as treatment before changes in managing their behavior are attempted, a new study finds. This is at odds with the American Academy of Pediatrics guideline that nondrug behavioral interventions, such as parent training in behavior management, should be tried first when children 4-5 years old are diagnosed with ADHD because of their overactive or impulsive behavior.
Observing that ADHD is being increasingly diagnosed in children who have not yet entered school, the study investigated the rates of ADHD drug prescriptions and the period of time between diagnosis and the prescribing of drugs to preschoolers by primary care physicians.
An examination of the medical records of over 700,000 U.S. children 4-5 years old revealed that 1.4% of the young children received a diagnosis of ADHD. (Notably, African American children accounted for 31% of the preschoolers diagnosed with ADHD, roughly twice their proportion in the general population. This is an apparent continuation of the disproportionate diagnosing of African Americans with disruptive, defiant and psychotic mental disorders as a result of the systemic racism that the American Psychiatric and American Psychological Associations have admitted is ingrained in their practices.)
Of the preschool-age children diagnosed with ADHD, 42% were prescribed an ADHD drug within 30 days of their diagnosis, indicating that nondrug interventions were not attempted or were not tried for very long. The study’s researchers note that this finding conflicts with the American Academy of Pediatrics guideline to first try behavioral interventions because of the stronger evidence of their effectiveness than drugs for preschoolers. The researchers called for further investigation into why there are such high rates of drug treatment and low rates of nondrug treatment for these young children.
For three-quarters (78%) of the children on ADHD drugs, the first drug prescribed was a stimulant, such as Ritalin, Adderall, or Concerta. Harmful side effects of stimulant-type ADHD drugs include headache, decreased appetite, weight loss, difficulty sleeping, anxiety, depression, upset stomach, nausea, abnormal behavior, increased blood pressure, and increased heart rate, with the risk of heart disease increasing the longer the drugs are taken. Stimulant drugs also carry the potential for dependency and addiction, according to a drug safety warning issued by the U.S. Food and Drug Administration (FDA).
Beyond the risk of side effects, a recent analysis of evidence on ADHD diagnosis and treatment concluded that the diagnosis itself, as well as the stimulant drugs that may be prescribed as treatment, carry the risk of harmful consequences for children, while evidence of benefit is uncertain. The study’s researchers called for a greater focus on appropriate care and support of children with behavioral issues, rather than on diagnosing ADHD.
Even more fundamentally, ADHD is a psychiatric label subjectively applied to a collection of behaviors common to children. The “diagnosis” has no scientific validity, making it a label that is far too easy to pin on children. With roughly one in nine American children labeled with ADHD, researchers in a 2021 study found convincing evidence that ADHD is overdiagnosed in children.
This view was also held by the late psychologist Keith Conners, who conducted the first formal trials on the stimulant-type ADHD drug methylphenidate. He later realized that ADHD diagnoses were out of control, calling ADHD misdiagnoses “an epidemic of tragic proportions.”
The Citizens Commission on Human Rights (CCHR) took concerns about the rampant diagnosing and drugging of children for ADHD to the U.N. Committee on the Rights of the Child, which responded with hearings and a recommendation in 2015 for the establishment of a system for “monitoring of the excessive use of psychostimulants for children.” The U.N. Committee also said that governments should “take the necessary measure to prevent any pressure on children and parents to accept treatment with psychostimulant drugs.”
Many undiagnosed physical conditions – infections, injuries, illnesses, allergies, nutritional deficiencies, reactions to drugs – as well as problems with schoolwork, can result in children’s behavioral problems that may be misdiagnosed and wrongly treated as ADHD, missing the opportunity to address and handle the real underlying cause.
As physician Mary Ann Block, author of No More ADHD, says: “By taking a thorough history and giving these children a complete physical exam as well as doing lab tests and allergy testing, I have consistently found that these children do not have ADHD, but instead have allergies, dietary problems, nutritional deficiencies, thyroid problems and learning difficulties that are causing their symptoms. All of these medical and educational problems can be treated, allowing the child to be successful, without being drugged.”
The content on this site is for informational purposes only and is not intended to substitute for personal medical advice given by a licensed physician. Anyone wishing to discontinue or change the dose of an ADHD drug or any other psychiatric drug is cautioned to do so only under the supervision of a physician because of potentially dangerous withdrawal symptoms or other complications.