Posts Tagged ‘ medication for ADHD ’

Medicating Young Toddlers For ADHD: A Disturbing New Trend

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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Life with ADHD and Sensory Processing Disorder
Life with ADHD and Sensory Processing Disorder
Life with ADHD and Sensory Processing Disorder

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ADHD: 2012 In A Snapshot

Sunday, December 30th, 2012

Two themes stand out for me this year with respect to research on ADHD: 

Diagnosis: We continued to observe a potential paradox – ADHD may be overdiagnosed, yet many kids do not receive proper diagnosis and care. Here’s why. The overdiagnosis aspect comes about because kids are given a label of ADHD without going through a rigorous interdisciplinary evaluation. And that’s where some kids slip through the cracks – some kids with severe symptoms do not get evaluated properly and struggle for years without appropriate intervention. So even though studies suggest that the rate of ADHD is very high (like some of the data reported by the Centers for Disease Control and Prevention), that does not translate into saying that all kids who may suffer from high levels of severity and impairment are getting the clinical services they need.

Treatment: The debate about using medications to treat ADHD got more extreme this year. A controversial opinion piece by a leading developmental researcher essentially negated the role of biology as a root cause of ADHD. On the other side of the issue, there were suggestions that kids as young as 4 years of age should start receiving medications to control their symptoms – and there were reports that in some (economically disadvantaged) areas of the country doctors are giving kids ADHD medication (without assessment and diagnosis) to try to improve their behavior and performance in school. Lost in the debate is the very real need for behavioral treatments that focus on parental strategies to help kids with ADHD function better both at home and in school. My viewpoint on all this continues to be that behavioral approaches should be tried first and should always be in place – and that once those effects are established clinicians and parents can have a more meaningful dialogue about the possible additional advantages of medication.

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