The good, the bad, and the ugly
New treatment guidelines were released this month by the American Academy of Pediatrics. These guidelines are issued to provide instructions for pediatricians on diagnosing and managing ADHD.
The good news is that the academy advises behavioral management techniques should be the first treatment approach for preschool-age children. The academy also recommends that pediatricians should evaluate childhood ADHD over four to six months in both the home and another environment, like school.
The British have adopted this approach, but have also taken it a step further to include cognitive training and parent training. Of course, Play Attention has been the leader in this type of training for over 16 years. Always way ahead of our time!
The bad is that the academy advises that ADHD can be diagnosed in children as young as age 4. This opens the gateway to giving Schedule II substances (class includes cocaine, amphetamines, etc.) like Ritalin to very young children.
The lead author of the academy’s new clinical practice guidelines is Dr. Mark Wolraich. Dr. Wolraich is professor of pediatrics at the University of Oklahoma Health Sciences Center. He noted that ADHD in a preschool-age child was very different from the typically active behavior seen in most young children. Most ADHD children have poor social skills which makes it difficult to play with other children or to make friends. A child with ADHD is often prone to accidents (new research bears this out — see previous blogs) and is overactive much of the time.
“It’s not the environmental things like parties triggering it,” Dr. Wolraich said.
The ugly and controversial side of the new guidelines is that they suggest pediatricians consider prescribing Ritalin in preschool-age children with moderate to severe symptoms and when behavior interventions don’t provide significant improvement.
Ritalin and similar medicines aren’t approved by the Food and Drug Administration for use within the preschool-age years. Once drugs are FDA approved however, they are not typically regulated regarding how doctors prescribe them. Doctors often prescribe drugs for use ‘off label’.
While the academy advises that medication should be considered for preschool-age children only if they exhibit symptoms of ADHD for at least nine months and only after behavior management techniques have been tried, prescribing medication ‘off label’ is controversial; these drugs haven’t been tested on this age group and the risks are unknown.