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.
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