ADHD is being diagnosed in a growing number of preschoolers. Some of these children are appropriate candidates for medication, but many are not.
Whom should be medicated?
While the American Academy of Pediatrics recommends that the only preschoolers who should be medicated are those who have failed to respond to behavioral therapy, whom should be medicated is a highly controversial topic. A few facts to consider:
- Medication can be effective in preschoolers.
- Medication frequently has side effects in preschoolers. Some of these effects are different from those seen in older children.
- Not all side effects in preschoolers are well known because there is only one large study that looked at this issue. Long term effects of medicating during this period of rapid brain growth are not known, although it seems likely that there is no long term advantage to medicating preschoolers versus waiting until they are school aged children.
- Behavioral therapy and dietary therapy are both known to be effective alternatives to medication for some children in this age group. They may also be used with medication to reduce the dose, or to limit the times of day when medication is necessary.
The only medication that has been studied extensively in this age group is immediate release methylphenidate (Ritalin). Extended release formulations (Ritalin LA, Concerta) offer convenient, once a day dosing, but often it is difficult to get the right dose in young children. Some studies suggest that methylphenidate may be more slowly metabolized by younger children. Methylphenidate is not FDA approved in this age group, likely because experts feel that it has not proven that its benefits are worth its risks.
Methylphenidate is available as a liquid , or the immediate release pills can be crushed and given in food, such as applesauce, yogurt, a beverage of choice, or any food that isn’t heated.
Dextroamphetamine liquid is the only FDA approved medication for children with ADHD under the age of 6. There are no clinical trials in the preschool age group specifically. This product was approved based on effectiveness in older children, but approval expanded to younger children based on its acceptability to patients unable to swallow pills. If this product were to go through the approval process today, it would not have enough clinical trial evidence to prove its effectiveness or safety.
What to expect from medication
- Stimulants usually work within hours of taking them. They are typically effective for about 4 hours but this can vary a lot from patient to patient.
- The medication is supposed to stop working before dinner time to allow a patient to have an appetite for dinner, and to be able to sleep at night. You will still need behavioral approaches to be able to handle ADHD behaviors during these times of the day.
- Medication may only work for certain ADHD symptoms or may work for some symptoms more than others.
- Common side effects include insomnia and loss of appetite. Other less common side effects include moodiness, tantrums, and tics. Side effects can sometimes take up to 6 weeks to develop, but usually go away within a few days of stopping medication.
- If stimulants do not work out at this age, they still may be options in a few years. Also, more types of nonstimulants are available to older children if there is a problem with stimulants.
Greenhill, Laurence, Scott Kollins, Howard Abikoff, James Mccracken, Mark Riddle, James Swanson, James Mcgough, Sharon Wigal, Tim Wigal, Benedetto Vitiello, Anne Skrobala, Kelly Posner, Jaswinder Ghuman, Charles Cunningham, Mark Davies, Shirley Chuang, and Tom Cooper. “Efficacy and Safety of Immediate-Release Methylphenidate Treatment for Preschoolers With ADHD.” Journal of the American Academy of Child & Adolescent Psychiatry 45.11 (2006): 1284-293. Print.
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. “ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics (2011): n. pag. Pediatrics. American Academy of Pediatrics, 16 Oct. 2011. Web. 25 Nov. 2013 .