Doctors Are Prescribing Preschoolers ADHD Medications Too Soon: Study

Many young children are receiving drugs shortly after they are diagnosed, contravening treatment guidelines.

ADHD drugs, in this file picture. Jenny Kane/AP Photo

Doctors are often prescribing medications to young children for attention-deficit/hyperactivity disorder (ADHD) shortly after the children are diagnosed with the disorder, according to a new study.

That goes against treatment guidelines from the American Academy of Pediatrics, which advise that young children start therapy before being prescribed medication.

“We found that many young children are being prescribed medications very soon after their diagnosis of ADHD is documented,” Dr. Yair Bannett, an assistant professor of pediatrics at Stanford Medicine and lead author of the paper, said in a statement. “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.”

Approximately one in 10 children in the United States has ADHD.

Bannett and other researchers looked at the timing of ADHD diagnosis, medication prescription, and drug treatment among children aged 3 to 5, utilizing records from eight pediatric health systems in the United States.

The data covered Jan. 1, 2016, to Dec. 31, 2023.

Of 712,478 children, 1.4 percent were diagnosed with ADHD when they were 4 or 5, the researchers found, after excluding certain patients, including those without two visits at least 180 days apart.

Doctors prescribed medications within one month of diagnosis to 42 percent of the 9,708 children diagnosed with ADHD, according to the study. The median time from diagnosis to prescription was 28 days for 4-year-olds and zero days for 5-year-olds.

“More than one-third of patients lacked sufficient time for an evidence-based behavioral treatment before starting medications,” the researchers said in the study, which was published on Aug. 29 by JAMA Network Open. “This finding that, to our knowledge, has not been previously reported highlights the need to investigate factors that influence early medication prescriptions.”

The American Academy of Pediatrics guidelines recommend therapy for preschoolers diagnosed with or suspected of having ADHD.

“[Medication] may be considered if these behavioral interventions do not provide significant improvement and there is moderate-to-severe continued disturbance in the 4-through 5-year-old child’s functioning,” the guidelines read.

The academy also says that medication should be considered for preschool children only if they have experienced symptoms for at least nine months.

The new paper was funded in part by the National Institute of Mental Health and the National Heart, Lung, and Blood Institute. Conflict of interest disclosures included one author reporting consulting for Shionogi, which makes a digital therapeutic for children with ADHD. Listed limitations included reliance on diagnostic codes.