Treating Toddlers with ADHD: Lacking Guidance

CDC estimates thousands of toddlers being treated for ADHD

(RxWiki News) There are guidelines for treating children 4 years of age and older for ADHD, but no such guidelines exist for younger children. That lack of guidance hasn’t prevented the treatment of thousands of toddlers for ADHD.

Children with attention deficit hyperactivity disorder (ADHD) might seem to daydream, be distracted, fidgety, talk too much or be in constant motion.

At a mental health forum in Georgia, a scientist from the Centers for Disease Control and Prevention (CDC) presented a report on ADHD in children.

The report concluded that children under the age of 4 were being treated for ADHD even though there are no medical guidelines that doctors can use when treating these young ones.

The toddlers were being treated with behavior therapy and medication, and the percentage of toddlers being treated for ADHD represented a very large number of children.

"Talk to your pediatrician about concerns with your child’s behavior."

Susanna N. Visser, DrPH, MS, from the Division of Human Development and Disability at the CDC, presented a report in May titled, “The State of ADHD Care in Georgia: From Data to Action.”

This report was compiled from Medicaid claims in Georgia and nationwide claims from families with private insurance.

According to the American Academy of Pediatrics (AAP), the first treatment of children who show ADHD symptoms should be behavior therapy. Only if that doesn’t work should medication, usually with methylphenidate (brand name Ritalin), be considered.

Nicole Richardson, LPC, a licensed mental health professional in Austin, TX, told dailyRx News, "It would be advantageous to start a minor on a medication protocol at the same time as a behavioral modification protocol. After a predetermined amount of time, take the minor off of the medication while continuing the behavioral modification in order to re-evaluate the need for the medication."

The guidelines, however, apply to children ages 4 to 18. The AAP does not have guidelines for treating children with ADHD under the age of 4. 

Dr. Visser reported that over 6 million youth aged 4 to 17 were diagnosed with ADHD in 2011-2012. These numbers represent about a 30 percent increase from the 2003 numbers. It is estimated that 11 percent of children aged 4 to 17 will eventually be diagnosed with ADHD.

Over 5 percent of the 4- to 5-year-olds in the Medicaid program in Georgia were getting medical treatment for ADHD. Of those children, 44 percent were getting behavioral therapy and 74 percent were receiving medication.

Dr. Visser concluded that if only 44 percent of the preschool children with ADHD were being treated with therapy to modify their behavior, 56 percent of them were not receiving care that is recommended by AAP. 

According to the report, in 2012, about 1,600 toddlers in Georgia were being treated for ADHD, and 760 of them were receiving medication. The rates in Georgia were comparable to the national average.

If those percentages were applied to all toddlers in the US, it was estimated that about 10,000 toddlers in the US are being given medications for ADHD.

"The existing protocol for evaluating and treating minors diagnosed with ADHD includes behavioral therapy, evaluation of parenting skills/styles and medication, but it does not include a look at nutrition," Richardson said.

"It seems unfortunate ... that more pediatricians do not consider diet modifications as nutrition plays such a vital role in development. Nutrition plays a particularly important role before the age of 5," she said.

She continued, "While each child and their needs should be looked at individually, it seems that the need for medicating a child under the age of 4 should be extraordinary before a prescription is made."

Dr. Visser noted that ADHD medications can cause paranoia, hallucinations and slow growth, but the long-term effects of ADHD medications are not known.

Dr. Visser concluded her presentation by emphasizing the need for more research into the best ways to treat very young children with ADHD, as well as education of healthcare providers who might treat them.

A presentation of the report was delivered by Dr. Visser at the Rosalynn Carter Georgia Mental Health Forum in Atlanta in May.

Review Date: 
June 6, 2014