A new study shows that about 90 percent of ADHD medical specialists do not follow guidelines for treating very young children with attention-deficit/hyperactivity disorder.
For example, some doctors started preschoolers on medication too soon before trying any non-drug treatment, such as counseling parents on how to deal with their child’s behavior.
The results are concerning because doctors should recommend behavioral treatments first, the researchers said.
“At a time when there are public and professional concerns about overmedication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children,” said study researcher Dr. Jaeah Chung, of Cohen Children’s Medical Center in New York.
For the study, researchers surveyed 560 doctors who specialize in diagnosing and managing children ages 4 to 6 with ADHD.
The findings revealed that only 8 percent of doctors followed all guidelines from the American Academy of Pediatrics.
The rest prescribed medications too soon, prescribed medications without first checking to see if behaviora; therapy was working, or did not use the drug methylphenidate as the first drug treatment.
One in five doctors said they often prescribe medications to preschoolers with ADHD as their first line of treatment. The AAP said in 2011 that doctors should attempt to treat ADHD in preschoolers with behavioral therapies before prescribing medications.
Furthermore, about 40 percent of doctors said that when they did prescribe drugs, they initially used a medication other than the ADHD drug methylphenidate (Ritalin).
According to the AAP, methylphenidate should be used first in preschoolers because it has been more rigorously studied in young children than other medications such as amphetamines.
Approximately 20 percent of doctors said they expected the number of children they treated with medications would increase in the future.
Study researcher Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s, noted that the AAP guidelines are written for general pediatricians, and it’s possible that specialists see children with more severe ADHD (who are more likely to need medications).
However, “Doctors collectively should recommend their patients pursue behavior therapies first,” Adesman said.
Adesman noted that there may be obstacles to behavioral therapy: The treatment is not always covered by insurance, and families may live in an area without a behavior therapy specialist. In this case, the AAP recommends that doctors weigh the risks of starting drugs at an early age against the risks of delaying treatment.