Is Age 4 Too Young for ADHD Diagnosis?

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I don’t have a child with ADD or ADHD, so I certainly cannot in any way speak from personal experience as a parent. As a former teacher, I can say that I did have one student who could not focus, could not sit still, could not stop talking, could not make friends, could not finish assignments no matter how I presented them or expected them to be completed (learning styles were not an issue), and was clearly outside the norm compared with his peers. I tried to do what little I could with behavior modification, but in a class full of students, that’s not very practical. The reason I bring this up is that the American Academy of Pediatrics (AAP) has expanded the age range for the diagnosis of ADHD from age 4 (previously age 6) to teenagers (previously age 12).

According to the study, early diagnosis of ADHD will help patients get earlier treatment. And that later diagnosis into the teen years results from the recognition that children don’t “outgrow” ADHD. Many fear, however, that early treatment translates to earlier use of drugs such as Ritalin, and later diagnosis means more teens using stimulants.

According to WebMD, “Mark L. Wolraich, MD, chairman of the committee that developed the guidelines, says he doesn’t think the new guidelines will encourage more prescribing of medications. Instead, he says, the update and evidence-based recommendations are important because so many primary care doctors are already treating ADHD without much guidance about what works.

Wolraich is a professor of pediatrics and director of the child study center at the University of Oklahoma College of Medicine, in Oklahoma City. “It’s clear from the studies that looked at medication use that there are a number of children that are being treated,” Wolraich says. “We wanted to make sure that primary care physicians, if they were going to be evaluating children, were using the best evidence for both evaluation and recommendations for treatment.”

Before prescribing medication, the guidelines call for behavioral therapy and training parents on how to create the structured environment that hyperactive kids need to control their inattentiveness and impulsivity.

In a perfect world, maybe this would be the case. I’m all for getting early treatment for any disease or problem. But I’ll play devil’s advocate. I can see many parents thinking that a super-active toddler may have ADHD. Since the diagnosis of ADHD is largely dependent upon how parents fill out a form, in consultation with the child’s pediatrician, parents may not know much about child development and many have no basis of comparison with a child’s peers. There may be all kinds of reasons that a child without ADHD is acting out, throwing tantrums or exhibiting behavior that may look like symptoms of ADHD. Symptoms could result from ongoing stress in the family, lack of sleep or other problems. While I would like to think that most pediatricians are professionals who spend lots of time with their patients, and would go slowly in prescribing medication, I think the reality may be that many will not. Our medical system isn’t set up to spend lots of time with patients. And many parents, once they have a “diagnosis,” might desire a quick fix such as medication rather than learning the more time-consuming techniques of behavioral modification. Already exhausted parents may opt for getting medication for their child rather than working through other avenues.

I also wonder about the child having symptoms of other problems that might look like ADHD, when actually the child may have anxiety, a  learning disability or some other issue. One time, when my son was in early elementary school, I took him to an eye doctor for an exam. My son was so anxious that he couldn’t sit still or follow the directions from the doctor, who proceeded to tell me that my son had ADHD. It actually wasn’t ADHD, but anxiety. And, I had to wonder why an eye doctor was labeling a kid with ADHD after spending approximately 15 minutes with him. My point is that not all doctors are good, and not all symptoms are ADHD.

What about you? Do any of you have children with ADHD? Would you have medicated them earlier if you could have gotten an earlier diagnosis and possibly more support from the medical community? Do you think 4-year-olds should be given medication for ADHD?

Categories: Editor’s Blog