We know that ADHD is real.
We know that ADHD is a developmental disorder – which means that it starts in childhood.
We also know that the cause of ADHD is primarily genetics – in fact genetics accounts for over 80% of the cause. Of the 20% of causes which are not genetic – these are acquired cases. Most acquired cases occur before the age of 3 years old.
So, knowing all of these facts – can’t preschoolers have ADHD?
The answer is yes.
Some kids can be clearly diagnosed at the ages of 3, 4 or 5 years old with ADHD.
The issue with treating these children with medication has been a real concern because they are so young.
Their brains are still developing, and until now – there had been no reliable published research on using medication in such young children.
The November issue of the Journal of the American Academy of Child and Adolescent Psychiatry has several articles about a large study of preschoolers with ADHD.
The study was called “The Preschool ADHD Treatment Study”, or ‘PATS’. It was a large study, with 303 children aged 3-5 enrolled. It was funded by the National Institues of Mental Health
in the US, and there were 6 major centres in the US involved in the study, incluing Columbia, Duke, Johns Hopkins, UCLA, UC Irvine and NYU.
For the 303 children enrolled in the study, the children and their parents took part in a 10 week pre-trial behavioral therapy and training course.
To take medication in the study, the children had to meet three criteria:
- The children had the most severe ADHD
- They did not benefit from the behavioral treatment
- Their parents agreed to a trial of medication
While all studies go through review boards for ethical reviews, this study went through extra steps and precautions to ensure that there was true informed consent, and that the study was designed completely ethically.
The medication arm of the study compared the use of methylphenidate (the generic medicine also found in Ritalin, Concerta, Metadate, Focalin and Biphentin) to a placebo.
The study found that preschool children responded well to doses from 3.75 mg per day to 22.5 mg per day. All doses were given three times daily in equal dosing. The average medication dose was 14 mg per day.
There was a side effect of note – showing that children of this age have some growth slowing related to the medication. This is a side effect in older children as well, though generally recognized to not occur in more than 3% of children on stimulants.
There were 11% of medication treated children who had to stop the medicine related to severe side effects. These included: decreased appetite and weight loss, insomnia, mood disturbances, feeling nervous or worried, and skin picking behaviors.
It was found that children in this age range were more sensitive to these side effects than children of older ages.
One of the main conclusions of the study is that the use of methylphenidate in preschool children can work, but children in this age range are more sensitive to side effects. Thus, the decision to treat with medicine should be considered very carefully. Certainly a good trial of behavioral treatment is a must before considering medicine.
To read the abstracts (summaries) of these studies, click here:
- Rationale, Design, and Methods of the Preschool ADHD Treatment Study (PATS)
- Stimulant-Related Reductions of Growth Rates in the PATS
- Efficacy and Safety of Immediate-Release Methylphenidate Treatment for Preschoolers With ADHD
What does this mean to you?
If you have a child who is 3-5 years old, and you suspect ADHD, please talk to your doctor. It is best to have a specialist involved – i.e. a Child Psychiatrist. If after a good trial of behavioral treatment, there is no improvement, it may be worth a trial of medication.
This study is very important, because it establishes practice guidelines for these very difficult to treat children, because prior to this, doctors would be working with very little research to back them up.
We all know that making a decision to medicate a child for ADHD can be difficult, but it is often even more difficult for a preschooler. This research sheds light on how and when to use medication in these kids.