A recent study of pediatric specialists at Cohen Children’s Medical Center of New York examined at practitioners’ compliance with the American Academy of Pediatrics (AAP) guidelines regarding prescribing pharmacological treatments to preschoolers with ADHD. The study found that over 90% of pediatric specialists did NOT follow the AAP treatment guidelines from the AAP.

“Primary care physicians and pediatric specialists should recommend behavior therapy as the first line of treatment,” commented Andrew Adesman, MD, senior investigator and chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park. This recommendation is in compliance with the Academy of Child & Adolescent Psychiatry’s (AACAP) current guidelines, which state that behavioral therapy should be the initial stage of treatment for preschoolers diagnosed with ADHD. Furthermore, pharmacological treatment should only be considered when behavioral treatment has shown to be ineffective.

According to the study, of specialists who diagnose and manage ADHD in preschool-aged children, more than 20% recommend pharmacology as the initial treatment either by itself or along with behavioral therapy. It is not clear why so many practitioners who specialize in working with ADHD in children—including physicians, neurologists, psychiatrists, and developmental pediatricians—do not comply with the AAP’s treatment guidelines.

The AAP guidelines recommend that when pediatric specialists do prescribe medication as treatment for ADHD, it should be methylphenidate, but the study found that more than one-third of specialists start with another type of medication either ‘often’ or ‘very often’ (amphetamines and non-stimulants were a nearly even split for non- methylphenidate treatments).

More and more children are being diagnosed with ADHD before they even reach kindergarten. What sort of non-pharmacological treatments have you used for preschoolers or kindergarteners? What have you found to be effective?