A new study has found that many young children in the United States diagnosed with attention-deficit/hyperactivity disorder (ADHD) are being prescribed medication almost immediately, despite medical guidelines recommending behavioural therapy as the first step.
The analysis, published in JAMA Network Open, reviewed the cases of more than 9,700 children and revealed that 42.2% of four- and five-year-olds received ADHD medication within one month of diagnosis. By contrast, only 14.1% began drug treatment more than six months after diagnosis, the timeframe recommended by health experts.
Current US medical guidelines state that children aged four and five should undergo at least six months of behavioural therapy before starting on stimulants such as Ritalin or Concerta. These therapies aim to build skills and habits to help children manage daily challenges. Medication is considered a next step if behavioural treatment alone is not effective.
“This practice is concerning, because we know starting ADHD treatment with a behavioural approach is beneficial,” said Dr Yair Bannett, lead author of the study and assistant professor of paediatrics at Stanford University. “It has a big positive effect on the child as well as on the family.”
ADHD is one of the most common developmental disorders in children, affecting around 11.4% of Americans aged three to 17. Symptoms typically begin before age 12 and may include hyperactivity, restlessness, difficulty concentrating, and forgetfulness. Left untreated, ADHD can significantly affect academic performance and long-term outcomes into adulthood.
Experts note that while a combination of behavioural therapy and medication is often the most effective treatment, young children in particular should first be given non-drug interventions. However, access to behavioural therapy remains a challenge in many parts of the country, which may contribute to doctors prescribing medication sooner than recommended.
The study emphasised that safety concerns were not the primary issue. While ADHD medications are generally considered safe for young children, many families discontinue use due to side effects such as irritability, aggression, or heightened emotional reactions. “We never think of medication as the only solution for ADHD,” Bannett said, stressing that behavioural support is an essential component of treatment.
The researchers also highlighted limitations of the study, noting that it focused solely on the United States. ADHD prescribing patterns can vary significantly by region, with previous research suggesting children in North America are more likely to receive stimulant medications compared with their peers in Europe.
As the debate continues, the findings add weight to calls for expanding access to behavioural therapy, ensuring young children diagnosed with ADHD receive treatment in line with medical guidelines.
