Doc Group Recommends ADHD Drugs for Kids as Young as 4

By Douglas Main | October 18, 2011 12:40 pm

Yesterday the American Academy of Pediatrics issued new guidelines for treating attention deficit hyperactivity disorder, or ADHD, expanding the age range at which the condition can be diagnosed to include kids as young as 4 years old all the way up to young adults aged 18. The previous guidelines, made a decade ago, limited diagnoses to kids ages 6 to 12. The physician group decided to make the change due to new evidence that ADHD symptoms can surface in preschool-aged children and persist later into adolescence and adulthood than previously recognized. The report says methylphenidate (Ritalin) may help control ADHD symptoms in children ages 4 and 5, though only one large study has been done to support this conclusion. The authors stress, however, that medication should only be given after behavioral modifications are attempted—and that Ritalin may have some serious possible side effects like irreversibly slowing growth.

While some doctors welcome the report, others say the new recommendations only encourage excessive diagnoses of ADHD and use of medications by children. As pediatrician Claudia Gold writes, children under the age of 6 are still developing, and a wide variety of interventions by parents and therapists may change the child’s behavior—and associated brain chemistry—without medication. Gold suggests that concerns about the serious adverse effects of medication, as well as the likelihood of conditioning children to desire (or think they “need”) drugs from a young age, should make any parent think twice before agreeing to a drug regimen for their preschooler. Labeling  issues as a “disorder” at such a young age is mistaken, she says, stifling deeper examination of the reasons for the child’s behavior or what it means. She says that years of research have shown that children can “develop the capacity for empathy, flexible thinking and emotional regulation when parents respond to the meaning of behavior rather than simply the behavior itself.”

It’s worth noting that the chair of the committee, physician Mark Wolraich, is a periodic consultant to Eli Lilly, Shire Plc, and other pharmaceutical companies. Eli Lilly and Shire hold exclusive U.S. patents for atomoxetine (brand name Strattera) and guanfacine (brand name INTUNIV), respectively, both of which the report recommends for treating ADHD in adolescents.

Reference: Subcommittee on AHDH, Steering Committee on Quality Improvement and Management, the American Academy of Pediatrics. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. Published online October 16, 2011; DOI: 10.1542/peds.2011-2654

Image: Kinoz / Flickr

CATEGORIZED UNDER: Health & Medicine
  • Cathy

    When did we as a society start to think that it was abnormal for a four year old to have a short attention span and boundless energy?

  • lindsay

    couldn’t agree more, Cathy…….

  • Lauren

    Mainly because hyperactivity and innattention are only some of the symptoms of ADHD. Many parents would say “normal” levels of hyperactivity are not reasons for checking to see if a diagnosis is possible. Everyone forgets things sometimes, or doesn’t listen, or has trouble communicating, or interrupts other people, or can’t sit still, but when an individual is doing these things consistently, constantly, and continues to do so after behavioral changes have been attempted, then you start to consider if ADHD and treatments for it, are worth looking into. Especially if the individual affected is feeling less capable, confident, and comfortable with themselves because they struggle with things that others clearly don’t have to. I’ll admit I’m biased, as I was diagnosed towards the end of my childhood. Being aware of your differences means you can learn from them, and get the specialized treatment that may help you overcome them, with or without medication. Personally, I think medication should come after specialized behavoral counselling for the child and the family, but extreme cases will always happen, and I don’t want to make a blanket statement about all ADHD kids and adults. Everyone’s just trying to figure out what’s right for them, and to be happy and healthy sometimes means being identified as different.

  • Wendy

    I think that the main reason that the age of evaluation was lowered was simply because there’s so much more information now than there was ten years ago. Earlier evaluation means earlier intervention – if necessary. That does not mean earlier prescriptions for medications.

  • Chrysoprace

    Growing up, half of my friends were on ADHD meds, but only two of them really needed them. The others just had parents who in one way or another were failing their children in ways apparent to even a 13 year old. Also, the potential for abuse of ADHD meds is rarely mentioned in articles like this, a child can get as much as 2$ per pill if the dosage is high, and that is a whole lot of money when one is 13 years old. Theres a reason it’s called “kiddy coke,” grinding 20-30mg and snorting it gives a high quite like crystal meth. I even knew one teen who would regularly steal entire bottles of ADHD meds from neighborhood kids and sell them to others. Burglary, drug trafficing, and drug abuse in young teens caused by the ready availability of pharmaceutical grade speeders.

  • ADHD mom

    Somehow I get the feeling that most 6 year olds aren’t going to be dealing their meds on the playground.;P

    Some kids really really need this stuff. My son was unable to learn how to talk because he was so hyperactive that he just could not be still for the kinds of things most other kids can hang out for.. and the lack of self esteem that goes with having a body you cannot control is rampant. The meds help him to concentrate, to learn how to talk and socialize, to learn basics. We started medicating him a little earlier than 4, and though I worry about the effects, if we didn’t.. well, we would have a big mess here.

    I think what people who don’t have kids with ADHD don’t realize is that it is more than just ‘boundless energy’. It is a fundamental lack of bodily control. The urge to move, or talk incessantly, is so powerful that they are helpless against it. There is literally NO WAY that someone with ADHD or ADD can stop themselves. Medication can give them a way to settle themselves (with varying degrees of success), to gain control back. It isn’t about squashing a delicate flower’s imagination and childhood, it’s about helping a kid get their childhood BACK.

  • Bob

    I wonder if these doc are under the influence of the drug companies…oh wait most are

  • JD

    ADHD is caused by all the sugars kids consume now days. If everyone had as much sugar as some kids these days everyone would be bouncing off the walls. That is also why so many kids at young ages have diabetes. Control the sugar overdose and you take control of many kids problems at once including obesity.

  • Joe

    just another way for drug companies to profit off the suffering of our children its past time people do something about these greedy corporate conglomerates who care nothing for the people they say they are trying to help.

  • torres

    It’s my humble conviction that ADHD is a made up problem caused by too much fast-moving and unfocused television coupled with our modern society’s unrealistic demands that kids sit in a chair all day and not move, rather than being outside and active, curious and imaginative: Think back to human children in nature, living a natural life, thats what these kids need, less boundaries. : )

  • dewsy

    torres….if you were to look at a scan of a brain with ADHD, you would see that ADHD is not a “made up problem”…but rather, a very real neurological condition where portions of the brain are actually different from those without ADHD. It’s a real condition and, JD, it’s not simply “too much sugar”. My son was on the feinggold diet (which included ABSOLUTELY no processed sugars for the first 8 years of his life, yet his focus and hyperactivity was off the charts. (this is not to say that diet may not play a part for some kids….but it is not a catch-all solution). As someone who taught elementary school for 15 years and a parent of a 15 year old ADHD child, it bothers me to read uninformed statements.

  • torres

    Sorry that you feel me uninformed, though my point greater point, Dewsy, is this; if you changed the societal norms and structure, (and they are ever-changing, i.e. homosexuality) give your child a sword and shield and your child may now be blessed with the boundless energy to be praised as a reincarnate Alexander the Great. Being better informed than I, tell me, what is “normal”? What is “abnormal”? My understanding is that “experts” can’t specifically agree on these terms.
    Life rewards diversity; I could see how many psychological problems would be boons to other societies, past, present or future. Your child, and the millions of kids who will be pushed these pills, I would say, IS, normal. As “normal” and “abnormal” as any, just born in the wrong age, with the wrong expectations. But drug ’em if you’d like. All beautiful and wild spirits need to be dulled and caged to do what we expect of them.

  • lyllyth

    Dewsy makes a good point, but until such brains scans substantiating structural changes to patients’ brains are a standard part of the diagnosis before medications are handed out, I think we have a society problem more than we have a behavioral problem.

    There always will be a small portion of patients who truly do benefit from these prescriptions.
    But for every one of these patients, there are probably seven more who do not need them being overmedicated simply because it’s the easiest way to deal with them.

    I personally feel it is unethical to medicate a child, altering their brain chemistry, possibly permanently. If standard medical practice will not include substantiating brain scans, they shouldn’t be handing out ADHD medications or anti-depressants to kids, period.


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