The number of U.S. preschoolers diagnosed with attention-deficit hyperactivity disorder (ADHD) jumped 56 percent between 2007–08 and 2011–12, according to
data from the National Survey of Children’s Health.
Perhaps even more stunning: The number of children ages 2
to 5 taking a psychoactive medication to treat ADHD doubled,
the survey found.
In addition, nearly half of preschoolers with ADHD are not
getting behavioral therapy, the first-line treatment the American
Academy of Pediatrics has recommended for the condition
Such findings highlight a problem that concerns many
psychologists: Preschoolers are getting more medication for
ADHD, anxiety disorders and depression, although many of
these drugs haven’t been tested with young children.
Even among those that have, evidence suggests that
preschoolers who use them may experience side effects and
health risks, including irritability, sleep problems and lethargy,
says Susanna Visser, DrPH, an epidemiologist with the U.S.
Centers for Disease Control and Prevention. Plus, she adds,
little is known about how these drugs may affect a young child’s
Where are the behavioral interventions?
The increase in prescribing medications to young children
comes at a time when a growing body of research is showing
that evidence-based behavioral intervention programs for
ADHD, anxiety and depression are very effective among
preschoolers, says Mary Margaret Gleason, MD, professor
of psychiatry, behavioral sciences and pediatrics at Tulane
University School of Medicine.
The problem, Gleason notes, is that, particularly among
primary-care physicians in non-urban, non-academic areas,
those formal interventions aren’t always readily available —
nor are qualified mental health professionals to assess and treat
these young children.
“Primary-care providers are in the position of feeling like
they need to do something, and I think that, unfortunately,
leads to some of what we see in terms of prescribing
medications,” says Gleason.
She and other experts say that medications can be necessary
— and effective — for young children, but that can only be deter-
mined after a thorough, careful clinical assessment has been done.
“The first step for any child when someone is considering
treatment is really knowing what’s going on, and that means
diagnostically, but also thinking about the family context and
thinking about the developmental context of the children,”
Unfortunately, such thorough exams don’t happen often
enough, research suggests. In 2010, Columbia University
psychiatrist Mark Olfson, MD, found that the rates of
antipsychotic use among privately insured young children
more than doubled from 1999 to 2007, but fewer than half
of these children received a mental health assessment, had
a psychotherapy visit or visited a psychiatrist (Journal of the
American Academy of Child & Adolescent Psychiatry, 2010).
Another study led by Ohio State University’s Cynthia
Fontanella, PhD, found that of the children treated with
psychotropic medications from 2002 to 2008, only 29
percent received a mental health assessment, 24 percent saw a
psychiatrist and 30 percent had a psychotherapy visit (Journal of
Child and Family Studies, 2014).
Psychologists are particularly concerned that these children
are being prescribed antipsychotics, since only one rigorous
study has explored the safety or efficacy of this class of
medications among preschoolers — and even that study only
looked at using antipsychotics to treat autism.
“Antipsychotics are associated with very serious side effects,
so practitioners need to be very cautious when prescribing,
especially since these effects might be even greater in younger
children,” says Jonathan Comer, PhD, professor of psychology and
psychiatry at Florida International University. Some of the more
serious side effects include weight gain, diabetes, high cholesterol,
cardiovascular disease and tardive dyskinesia, a neurological
disorder resulting in compulsive movement. Comer’s own
research found that from 1996 to 2007, the use of these drugs for
anxiety disorders more than doubled among adults and children
age 6 and up, with the most pronounced increases among new
patients (American Journal of Psychiatry, 2011).
In an ideal world, parents and doctors would try behavioral
interventions before medication. However, it can be difficult to
refer these kids to behavioral therapy with a qualified mental
health professional, says William Pelham Jr., PhD, chair of the
psychology department at Florida International University.
Behavioral therapy is recommended as the first line of
treatment for very young children. So why is medication
use rising among this group?
By Amy Novotney