New treatment guidelines by the American Academy of Pediatrics say that Attention deficit hyperactivity disorder (ADHD) can be diagnosed in kids as young as four years of age, down from six years in its previous guidelines. The new guidelines were released today both in the journal Pediatrics and at the AAP (American Academy of Pediatrics) annual meeting in Boston, also today. The presenters said the first treatment approach for preschoolers should be behavioral management techniques (rather than medication).
However, if a preschool-age child with moderate to severe symptoms does not respond to behavior interventions, doctors should consider prescribing medication, such as methylphenidate (Ritalin). ADHD medications are not FDA approved for such young children. So, the recommendation will most likely trigger controversy.
The AAP wrote on its website:
“Methylphenidate may be considered for preschool children with moderate to severe symptoms who do not see significant improvement after behavior therapy, starting with a lower dose. For elementary school children and adolescents, the AAP recommends both FDA-approved medications and behavior therapy.”
The AAP explains that recent evidence shows that diagnosis and management of ADHD in children between the ages of 4 to 18 is possible. The guidelines also include what to do when a child has hyperactive/impulse behaviors which do not fully meet the ADHD criteria.
Lead author of the report, Mark Wolraich, MD, FAAP, who is also professor of pediatrics at the University of Oklahoma Health Sciences Center, said:
“Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school. Because of greater awareness about ADHD and better ways of diagnosing and treating this disorder, more children are being helped.”
The AAP informs that ADHD occurs in approximately 8% of children and young people in the USA. It is the most prevalent neurobehavioral disorder in childhood.
Dr. Wolraich said:
“Because ADHD is a chronic condition, it requires a team approach, including the patients, their parents, the pediatrician, therapists, and teachers.”
The guidelines explain that the overactive/impulsive behaviors should be witnessed continuously for between four to six months, both in the child’s home, school or another environment. Parents should be helped so that they learn how to help modify the child’s ADHD behaviors, such as establishing a reward-and-punishment system. It is important that parents are trained on the consistent application of these techniques, the authors added.
The guidelines recommend a combination of medication and behavior training for patients aged from six to twelve years. For a child with ADHD signs and symptoms to have a better chance of academic and social success, it is important to be able to control those symptoms.
Some children may experience side effects when taking ADHD drugs, such as loss of appetite, weight loss, and/or insomnia.
“Understanding ADHD” is an online resource provided by AAP for parents with children with ADHD symptoms. It explains that ADHD – one of the most common chronic childhood conditions – is a brain condition that makes it hard for kids to control their behavior. The condition affects approximately three times more boys than girls.
A significant number of kids with ADHD are hyperactive
The resource also lists the most common symptoms experienced by children with ADHD, which are grouped according to Inattention, Hyperactivity and Impulsivity:
Important things are often lost
The child commonly does not follow through instructions
The child daydreams, frequently finds it hard to pay attention
The child frequently does not appear to listen
The child frequently does not complete tasks
The child frequently forgets things
The child is disorganized
The child is easily distracted from play and work activities
The child makes careless mistakes, and often appears not to care about details
Activities and tasks that require ongoing mental effort are often avoided
The child is constantly on the move. The AAP describes this “as if driven by a motor”.
The child cannot play quietly
The child talks too much
The child will frequently climb, jump and run around when it is not allowed
The child is fidgety, and squirms a lot
They often talk without thinking
They often act without thinking
Taking turns is often a source of problems
Not wanting to wait for things is often a problem
The child often interrupts others when they are speaking
He/she may cross the road without checking for oncoming traffic
Children do not all have the same ADHD symptoms.
The AAP says there are three main kinds of ADHD:
- Inattentive only – the child is not excessively active. As they tend not to disturb other children at home or in the classroom, their condition may be overlooked. A girl with ADHD tends to have this form more commonly than the other two.
- Hyperactive/Impulsive – the child might pay attention, but is hyperactive (excessively active) and impulsive. This type is the least common, and tends to affect younger children.
- Combined Inattentive/Hyperactive/Impulsive – the child with this type has symptoms from both types above, they are equally predominant. Lay people who think of ADHD generally imagine this type.
Written by Christian Nordqvist