NEW DELHI, Sept 1: Despite clear clinical guidelines recommending six months of behavioral therapy before initiating medication for young children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), a significant number of pre-schoolers are being prescribed medication almost immediately after diagnosis, a new Stanford Medicine-led study has revealed.
Published in JAMA Network Open, the study highlights a troubling trend: many children aged four and five years are starting pharmacological treatment far earlier than advised, in direct contradiction to guidelines issued by the American Academy of Pediatrics (AAP).
Researchers analysed the medical records of nearly 10,000 preschool-aged children across eight pediatric health networks in the US. The findings were stark: 42.2% of these children received ADHD medication within just one month of diagnosis. Alarmingly, only 14.1% began medication after completing the recommended six-month period of behavioral therapy.
Dr Yair Bannett, assistant professor of paediatrics and the study s lead author, expressed serious concerns about this practice. Starting ADHD treatment with a behavioural approach is beneficial; it has a big positive effect on the child as well as on the family, he said.
Behaviour therapy focuses on modifying the child s environment and routines, training parents to manage behaviours effectively through positive reinforcement and structured schedules.
Moreover, stimulant medications, commonly prescribed for ADHD, tend to cause more side effects in younger children. Children under six years metabolize these drugs less efficiently, resulting in irritability, emotional instability, and aggression. Dr Bannett noted, While toxicity is not a major concern, treatment failure is high because families often discontinue medication due to these side effects.
ADHD is characterised by hyperactivity, impulsivity, and difficulty maintaining attention. Early diagnosis and effective treatment are crucial, as children with ADHD face higher risks of academic struggles and school dropout. Research confirms that appropriate management improves long-term outcomes in education, employment, relationships, and legal behaviour.
The American Academy of Pediatrics endorses parent training in behaviour management as the first-line treatment for preschool children with ADHD. This evidence-based therapy equips parents with skills to nurture positive behaviours and ignore negative ones, providing tools such as visual schedules to help children organise daily tasks.
Medication serves a complementary role, alleviating core ADHD symptoms. Its effects are temporary and dependent on consistent dosing. Most children with ADHD benefit from a combination of behavioural therapy and medication, but behavioural intervention should precede pharmacological treatment, especially in young children.
The study s analysis could not determine why doctors frequently prescribed medication early. However, informal conversations with physicians revealed that limited access to behavioural therapy is a major factor. In many regions, therapists trained in behavioural management are scarce, and insurance coverage is often inadequate.
Dr Bannett stressed the importance of educating paediatricians on available resources, including free or low-cost online behavioural training for parents. If behavioural therapy is unavailable, doctors sometimes feel compelled to prescribe medication rather than offer no treatment at all.
While this study focused on 4- and 5-year-olds, behavioural therapy remains vital for older children with ADHD. For those aged six and above, guidelines recommend combined behavioural and medication treatment to provide both symptom relief and long-term coping skills.
Dr Bannett concluded, Medication is never the sole solution for ADHD. Behavioural therapy teaches the child and family long-term skills that will help them in life. In other words, behavioural therapy builds lifelong skills that medication alone cannot provide. (UNI)
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