Should ADHD in preschool-aged children be treated with medication?

A new clinical practice guideline on ADHD from the American Academy of Pediatrics is making some waves among pediatricians and family physicians for its recommendation to evaluate and treat children as young as age 4 years. Past AAP guideline statements focused on identifying and treating children between the ages of 6 and 12 years. Although the AAP recommends behavior therapy as first-line treatment for younger children with inattentiveness or hyperactivity, it includes the option of starting medications in children who do not respond to behavior therapy. "In areas where evidence-based behavioral treatments are not available," the guideline adds, "the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment." It may only be a matter of time, then, before stimulants are being prescribed to large numbers of preschool-aged children.

Although unrecognized ADHD can cause significant social problems and learning difficulties in affected children, data on the incremental benefits and harms of detecting ADHD in younger (as opposed to school-aged) children and the long-term effects of stimulant medications is limited. As you consider how to incorporate information from this new guideline to the care of children your practice, we hope that you will find the AFP By Topic Collection on ADHD to be an indispensable resource.