The American Academy of Pediatrics (AAP) created some controversy with their recently released updated guidelines for diagnosing and treating ADHD. The guidelines recommend medication treatment for children as young as four years who have academic or behavioral problems and difficulties with attention, hyperactivity or impulsivity. Previous ADHD guidelines applied only to children ages 6 through 12 years.

Dr. Allen Frances argues in an article for Psychiatric Times that encouraging such early use of medication “will further the already problematic overdiagnosis of ADD/ADHD and expand the inappropriate prescription of medication to young children.” Preschool-age children are more difficult to diagnose accurately, and they may be more susceptible to side effects of the medications, such as loss of appetite, headaches, and disturbed sleep.

The lead author of the guidelines, Dr. Mark Wolralch, stated that the intent behind them was to give doctors improved diagnostic criteria while identifying children with ADHD who have gone undiagnosed or untreated. He defends the AAP’s decision by saying, “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.” In addition, the guidelines also recommend a trial of behavioral interventions first, followed by treatment with medication if the behavioral therapy is ineffective. Dr. Frances cautions that if past experience is any indication, these recommendations will be widely ignored because behavioral therapies are not easily available and medication is.

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