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ADHD in Children Health Center

Does Your Preschooler Have ADHD?

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Behavioral Therapy Comes First

For preschoolers and toddlers diagnosed with ADHD, behavioral therapy is the first line of treatment.

"Based on the research, more than half of young kids will respond positively to behavioral interventions," DuPaul says.

This type of treatment involves behavior modification by parents and teachers. Techniques include praising and rewarding good behavior, ignoring negative behavior, and using time-outs. Structure and routine are also important for young kids with ADHD.

The Medication Question

What if behavioral therapy doesn't seem to be enough? It's still going to be part of the plan.

If you've tried various types of behavioral therapy for at least 6 months without significant progress, low-dose treatment with ADHD medications may be tried in addition to behavioral therapy in children as young as 4, according to the AAP.

"But don't ever give up on behavioral therapy," Perrin says. "Behavioral therapy is important even when a child is on medication." Perrin headed the AAP's guidelines committee in 2000 and was part of the group that wrote the AAP's 2011 guidelines.

The FDA has not approved the use of some ADHD medicines in children younger than 6. But many doctors prescribe these drugs off-label for preschoolers with ADHD.

Are these medications safe to use in children so young?

Although there can be side effects in some children, the AAP feels that the benefits outweigh the risks in young children who aren't getting better with behavioral therapy.

A study found that young children are more sensitive than older children to the side effects of one of the more commonly used medications, methylphenidate. Those side effects may include growth delay, loss of appetite and weight loss, insomnia, and anxiety. The issues, including growth delay, were reversed once the kids stopped taking the medication, DuPaul says.

Also, "ADHD medication doesn't work as well for this age group," Perrin says. "It definitely does work, but it works less powerfully and less predictably in younger children than in an older child."  

There aren't any studies on the long-term effects in children who start ADHD drugs at such a young age. However, there are long-term studies of the medicines' effects and safety for children started on treatment in elementary school, DuPaul says. "Those studies… have not indicated any long-term side effects of treatment," he says.

Deciding whether to medicate your child is not easy. It's a decision that must be made after carefully weighing the pros and cons. What is right for one child (and family) may not be right for you. Talk to your pediatrician, and together you can decide what is best for your child.

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Reviewed on December 17, 2013

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