Children as young as age 4 can now be officially diagnosed with Attention-Deficit/ Hyperactivity Disorder (ADHD), according to new guidelines released by The American Academy of Pediatrics. The new report recommends behavior modification therapy as the first line of defense for preschoolers diagnosed with ADHD, with prescription medications like Ritalin to be tried at a low dose only if therapy is not effective on its own.
Up until now, the AAP only provided guidelines for ADHD diagnosis starting at age 6, when most children begin first grade. What's behind the change in thinking? Emerging evidence now makes it possible to diagnose and manage ADHD sooner. “Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school,” said Mark Wolraich, MD, FAAP, and chairperson of the committee that authored the report. “An earlier diagnosis will help decrease stress on the family, and prevent affected children from getting the message from an early age that they’re 'bad' kids.”
ADHD, previously known as ADD, is the U.S.’s most common childhood mental disorder; currently 8 percent of all U.S. kids, which translates to about 5 million, have been diagnosed. It is a neurological condition that causes a child to lose focus and behave in ways that may make it difficult to successfully participate in school, social and family life. Children with ADHD can be inattentive, hyperactive or impulsive, and many have a combination of these behaviors. The new guidelines are an attempt to give evidence-based, specific recommendations for what some pediatricians are already doing unofficially: using Ritalin and other stimulants off-label to treat small kids with problems severe enough to get them expelled from preschool and wreak havoc on their families.
ADHD or Just Being a Kid?
How can parents tell the difference between a child with true ADHD, and one who’s just a little immature or going through a difficult phase? Often they can't without the help of a medical professional. In order for a child to be diagnosed for ADHD, he or she must demonstrate symptoms outlined by American Psychiatric Association’s Diagnostic and Statistical Manual IV, known as DSM IV. These symptoms include an inability to focus, a tendency to lose things, trouble listening, and more behaviors that pretty much sound like your typical preschooler on a bad day. “We are not talking about one-off incidents, or just a tough time of day when kids are tired,” says Dr. Wolraich. “Parents should see these behaviors consistently in multiple settings. It’s the extent and frequency of the problem that helps us make the diagnosis.” Pediatricians should also first rule out other causes of problem behavior, like poor vision, hearing, traumatic life events or other learning disabilities.
What about kids who seem to be borderline, able to squeak by in school but having a tougher time managing hyperactivity and impulsiveness than their peers? Talk to your pediatrician. Behavior modification therapy, which includes group or private parent training, may help even without an official ADHD diagnosis. “Behavior modification provides techniques to help you to parent better,” says Dr. Wolraich, which might be enough to help you keep your challenging child on track.
Long-term Effects of Medication
Dr. Wolraich stresses that behavior modification without medication should be tried first for preschoolers (for grade school children and adolescents, the AAP recommends medication andbehavior therapy in tandem, if possible). Most programs last around 8 to 12 weeks. Dr. Wolraich stresses that ADHD meds are only for preschoolers with moderate to severe behavior problems. “We want to be more conservative in treating the littlest kids, because there’s still not a lot of data on the long-term effect of medication,” says Dr. Wolraich. Since kids with ADHD stays on meds for an average of three years, there’s a dearth of studies on how ADHD medications like Ritalin, Adderall, Dexedrine, or Vyvanse can effect development when you start at a young age and continue it.
Preschoolers on stimulants like Ritalin tend to experience the same side effects as older kids, like insomnia or loss of appetite. However, due to a slower metabolism, smaller doses may be effective for preschoolers, making side effects less of a problem.