Doctors usually do not follow guidelines for treating very young children withattention-deficit/hyperactivity disorder (ADHD), a new study suggests.
In the study, about 90 percent of doctors surveyed did not strictly adhere to new guidelines recommended for treating preschoolers with ADHD, such as guidelines that address when to start medications, and which medications to use.
For instance, some doctors started preschoolers on medication too soon — before trying any non-drug treatment, such as counseling parents on how to manage their child's behavior.
The findings are concerning because doctors should recommend behavior treatments first, the researchers said.
"At a time when there are public and professional concerns about over-medication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children," said study researcher Dr. Jaeah Chung, of Cohen Children's Medical Center in New Hyde Park, N.Y. [See ADHD Medications: 5 Vital Questions and Answers.]
The researchers surveyed 560 doctors who specialize in diagnosing and managing children ages 4 to 6 with ADHD.
Results showed that only 8 percent of doctors followed all guidelines from the American Academy of Pediatrics — the rest either prescribed medications too soon, prescribed medications without first checking to see if behavior therapy was working, or did not use the drug methylphenidate as the first drug treatment.
One in five doctors said they often prescribe medications to preschoolers with ADHD as their initial treatment. The AAP said in 2011 that doctors should attempt to treat ADHD in preschoolers with behavioral therapies before prescribing medications.
In addition, about 40 percent of doctors said that when they did prescribe medications, they initially used a medication other thanthe ADHD drugmethylphenidate(sold under the brand name Ritalin). According to the AAP, methylphenidate should used first in preschoolers because it has been more rigorously studied in young children than other medications such as amphetamines.
About 20 percent of doctors said they expected the number of children they treated with medications would increase in the future.
Study researcher Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's, noted that the AAP guidelines are written for general pediatricians, and it's possible that specialists see children with more severe ADHD (who are more likely to need medications).
Still, "Doctors collectively should recommend their patients pursue behavior therapies first," Adesman said.
There may be obstacles to providing behavior therapy — the treatment is not always covered by insurance, and families may live in an areas without a specialist who provides behavior therapy, Adesman said. If this is the case, the AAP recommends that doctors weigh the risks of starting medication at an early age against the risks of delaying treatment.
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