Tuesday, May 20th, 2014
The Centers for Disease Control and Prevention (CDC) have provided new data suggesting that it is becoming common to not only diagnosis attention deficit hyperactivity disorder (ADHD) in 2- and 3-year-olds – but also to prescribe medication to these toddlers. As reported in the New York Times, data collected by the CDC suggested an estimate that 10,000 young toddlers are being given stimulant medication. And, of course, it could be more and the number could be growing.
There are many problems with diagnosing and medicating young toddlers for ADHD. Here are three primary issues:
ADHD is difficult to diagnosis – even in older children. While comprehensive, multidisciplinary clinical teams can offer productive diagnostic assessments of school aged children, ADHD is still difficult to diagnosis with certainty. It’s clear from prior analyses and studies that many school aged children are being given diagnoses of ADHD without such careful clinical evaluation and put on medications that they may not need. Given this, the idea that ADHD can be reliably diagnosed in 2- and 3-year-olds is shaky, to say the least – or simply not advisable.
The effects of stimulant medications in young toddlers have not been studied. Stimulant medications require careful clinical monitoring in school-aged children. It is controversial to administer them to 4- and 5-year olds. Prescribing them to 2- and 3-year-olds is not within the clinical boundaries. There is a reason that drugs are studied and approved for specific conditions and age groups. We don’t know the side effects of stimulants on young toddlers or how they influence the developing brain.
Behavioral management of toddlers is important but can be achieved without medication. Young toddlers need to be socialized. They need to have some structure and learn boundaries. They need to know how to modify their behavior in different settings. These are developmental goals, not the stuff of psychiatric diagnosis. If parents are having difficulties with young toddlers – and as we know, they can be rambunctious, as they should be – it’s certainly worth thinking about getting some advice or even learning behavioral management techniques that can be especially effective with some youngsters. The idea that this process may be circumvented by inappropriate clinical diagnosis and drug treatment is very troubling – especially since there is good evidence that behavioral techniques work and no evidence supporting the use of stimulant medication in young toddlers.
Sign up to get parenting tips and tricks sent right to your inbox!
ADHD via Shutterstock.com
Add a Comment
ADHD, CDC, diagnosing ADHD in toddlers, Health, Kids Health, medication for ADHD, stimulants, toddlers | Categories:
Behavior, Health, Intervention, Must Read, Parenting, Red-Hot Parenting, Stories
Tuesday, February 25th, 2014
In principle, no. But if a preschool environment is not designed with developmental principles in mind, and ADHD criteria are tossed around without regard to developmental level, then we could see artificial diagnoses made – maybe a lot of them.
Drs. Stephen P. Hinshaw and Richard M. Scheffler predict (in an Op-Ed in the New York Times) that such a scenario can lead to an epidemic of incorrect diagnoses of ADHD in preschoolers. What are the key factors parents should thing about? Here’s a few tips:
MAKE SURE A PRESCHOOL IS JUST THAT: PRE-SCHOOL
There are tremendous developmental benefits to attending preschool. These are achieved when they are designed with developmental principles in mind. That means, simply, that kids should be playing a lot of the time.
Play includes all kinds of activities, including: arts & crafts, music, using blocks to build things, pretend play, running around, and engaging in playground types of activities. Wait, what about learning letters and numbers and developing advanced reading skills and mathematical proficiency? That will come … when they get older (the idea is to promote academic readiness, not academics). For decades, we’ve known that early learning – the academic readiness that we are shooting for in preschool – operates very much through the body. Both gross motor and fine motor skills are primary for brain development and provide the sensory mechanisms underlying cognitive exploration and innovation. All that exploration sets the stage for fundamental cognitive skills that will be used later to master reading and math and writing. Consider this: the simple act of learning to copy figures in toddlerhood is a significant predictor of later academic performance in kindergarten (even after controlling for “cognitive” skills). So while some “academics” can be introduced in the preschool years, the savvy educators know how to do this in measure, and focus on the ways that preschoolers should be spending their time.
Keep in mind that interaction with adults and other kids is also critical for both social and cognitive development. It’s more important that they are being read to, than “reading” on their own. Their vocabularies are expanding tremendously but so much of this happens naturally in conversation and via planned reading group activities (rather than drills to master letters and words). Kids need to express themselves socially, and begin to learn some age-appropriate rudiments of self-control and emotion regulation. They also need to mix it up a little with other kids and learn how to get along with each other (with a little guidance here and there).
ONLY SEEK OUT ASSESSMENT FOR ADHD IF IT’S REALLY A SUBSTANTIAL CONCERN TO EVERYONE
We are now diagnosing toddlers with ADHD. Some toddlers are getting prescribed medication for ADHD. The rationale for this is to help kids as early as possible before the consequences of ADHD take hold on their development.
While this strategy has been controversial, the fact is that some toddlers show very extreme levels of behavior that are different than what you see at that age. But keep in mind that this is a very low percentage of toddlers, and that it’s very challenging to determine this clinically. Hinshaw and Scheffler point out that inappropriate diagnoses of ADHD often come about because the diagnostic process is not comprehensive, and in fact way too short. The result is then a sloppy (and typically wrong) diagnosis of ADHD, and a potentially inappropriate prescription.
Parents need to be appropriately cautious (but not dismissive) of concerns that their toddlers are showing signs of ADHD, particularly if they are in a preschool that is expecting them to behave like “school kids.” One of the hallmarks of ADHD is that it is pervasive – it should be a big problem at home, at school, almost everywhere. Maybe not all the time, but you shouldn’t see “symptoms” in just one context, like a preschool classroom. And you should see the “symptoms” occurring much more frequently than you see them in other toddlers. Often times (not always) a hallmark is very impulsive behavior that can put a youngster at risk for injury. Being distracted now and then and not wanting to sit still is what we call … being a toddler.
BE A SAVVY PARENT
The reality is that parents need to be savvy, both about the type of preschool environment that’s right for toddlers, and how ADHD gets wrongly diagnosed, especially in very young children. A preschool should look and feel like a preschool when you go in there. Kids should be acting like kids, having fun, but have some structure and purpose in mind. They should be playing a lot more than they should be doing “schoolwork.” Educators know how to nurture their developing brains and bodies to promote the very real and necessary social, emotional and cognitive development that takes place in those critical years that provide a foundation for academic readiness (a term which, by the way, shouldn’t go away in the early school years either). And if your preschool is concerned about ADHD, take the concern seriously, but be discriminate. Here’s an interview with an ADHD expert that provides a good feel for knowing when to be concerned about ADHD, and what to do about it.
Kids Playing via Shutterstock.com
Help your child organize her homework assignments with our helpful worksheet.
Add a Comment
ADHD, ADHD overdiagnosis, Health, Kids Health, NY Times Op-Ed, preschool, stimulants for ADHD, toddlers, toddlers with ADHD | Categories:
Behavior, Health, Intervention, Must Read, Parenting, Red-Hot Parenting
Wednesday, December 18th, 2013
Is ADHD underdiagnosed? Overdiagnosed? Overtreated? Undertreated?
These questions continue to get debated in 2013 with no resolution. On the one hand, we see statistics indicating how the rate of ADHD is going up – although many times these studies do not perform gold standard diagnoses of kids but rather report how many kids have been given a diagnosis. Yet talk to many practitioners and they will have stories of kids who clearly show evidence of ADHD yet do not receive a diagnosis.
How do we make sense of all this? One lens to apply is a simple one: we need to know how kids are getting diagnosed. I have contented that we have an ADHD paradox in this country – many kids get the label (and a pill) when they probably wouldn’t be diagnosed if they went through a comprehensive evaluation, yet many kids with ADHD are not properly diagnosed and treated (including behavioral and psychosocial interventions) because they don’t get a comprehensive evaluation. The common denominator here is a lack of a comprehensive evaluation. Ideally this is done by an experienced team that can apply a multidisciplinary perspective to fully examine cognitive, neuropsychological, behavioral, educational, and emotional functioning – and then offer an evidence-based plan of action.
That’s what is lacking. But it takes funding, insurance coverage, and a national commitment to mental health research and treatment.
ADHD Diagnosis via Shutterstock.com
Add a Comment
Monday, July 29th, 2013
The FDA recently approved a technique for evaluating brain waves (using electrical recordings or EEG) that may be used to help diagnose ADHD. Does this mean we are moving closer to a more “objective” biological approach to diagnosis?
Maybe. Maybe not.
It’s clear that ADHD has a biological component. There’s certainly evidence that we can see differences in brain functioning in kids with ADHD when compared to kids without ADHD. But that’s where the fuzziness comes in.
Complex disorders like ADHD don’t easily yield to “either/or” diagnostic approaches. ADHD symptoms are varied, change with age, and are heavily influenced by environmental context. If you were to evaluate a large group of children, using the symptoms of ADHD, you wouldn’t get two clear-cut groups (one with ADHD, one without ADHD). You’d see a range of symptoms, with some kids having many, some having none, and many having some.
It makes sense to try to cut through this “noise” using biological technology. But it is unrealistic to think that it will provide a magical approach to diagnosis. Skilled clinicians will still need to collect all the information they now collect, and use their judgments to decide if intervention is required. Evaluating brain waves may add some good information to this diagnostic process, but it is unlikely that it will become the gold standard for diagnosing ADHD. ADHD is just too complex of a developmental construct to reduce it only to brain activity.
So while this approach is certainly worth pursuing, it’s wise to not promise – or expect – too much from it in the near (or far) future.
EEG via Shutterstock.com
Add a Comment
ADHD, diagnosis, EEG, FDA, Health, Kids Health | Categories:
Behavior, Health, Intervention, Must Read, Parenting, Red-Hot Parenting
Friday, May 31st, 2013
The big theme this month was DSM-5. It’s here, we’re reacting – and parents will be dealing with the implications of this diagnostic system for quite some time.
So …. here’s a recap of what was covered this month:
General Issues: Changes Made, Controversies Raised, And What To Expect
An Overview For Parents
The “Saving Normal” Debate
Specific Disorders: What You Need To Know
Autism Spectrum Disorder
Disruptive Mood Dysregulation Disorder
Add a Comment
ADHD, autism, conduct disorder, DSM 5, Health, Kids Health, Saving Normal | Categories:
Behavior, Genetics, Health, Intervention, Must Read, Parenting, Questions, Red-Hot Parenting