ADHD Drugs Prescribed to 10,000 Toddlers

At least 10,000 toddlers aged 2 and 3 years are being prescribed methylphenidate (Ritalin), amphetamines (Adderall), and other drugs for attention-deficit/hyperactivity disorder (ADHD), according to a report presented by the Centers for Disease Control and Prevention (CDC) at the Georgia Mental Health Forum at the Carter Center in Atlanta, Georgia.

Though the American Academy of Pediatrics has not issued guidelines for the treatment of ADHD in children younger than the age of 4, the report shows that children, especially those from families on Medicaid, are receiving drugs. The CDC estimates that 11% of children aged 4 to 17 years have been diagnosed with ADHD.

“It's almost unheard of to give ADHD medication to a 2-year-old,” said Max Wiznitzer, MD, a pediatric neurologist at University Hospitals Rainbow Babies & Children's Hospitals. “It does not surprise me that some children are being given medicine as the easy way out but that doesn't mean it's the right way to do it.”

He added that while ADHD medication for toddlers may be effective, it should be used as a last resort.

The CDC collected data through 2 sources: MarketScan data from Georgia, which only revealed estimates of 10,000 children, though researchers believe there could be more, and families’ claims from private insurance.

“If we applied Georgia’s rate to the number of toddlers on Medicaid nationwide, we would expect at least 10,000 of those to be on ADHD medication,” said Susanna N. Visser, MS, DrPH, who oversees the CDC’s research on ADHD.

The CDC recommends the following treatment for children with ADHD, broken down by age group:

• For preschool-aged children (4 to 5 years of age), the primary care clinician should prescribe evidence-based parent- and/or teacher-administered behavior therapy as the first line of treatment and may prescribe methylphenidate if the behavior interventions do not provide significant improvement and there is moderate-to severe continuing disturbance in the child’s function.

In areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment.

• For elementary school-aged children (6 to 11 years of age), the primary care clinician should prescribe US Food and Drug Administration-approved (FDA) medications for ADHD and/or evidence-based parent- and/or teacher-administered behavior therapy as treatment for ADHD, preferably both.

The evidence is particularly strong for stimulant medications and sufficient but less strong for atomoxetine, extended-release guanfacine, and extended-release clonidine (in that order). The school environment, program, or placement is a part of any treatment plan.

• For adolescents (12 to 18 years of age), the primary care clinician should prescribe FDA-approved medications for ADHD with the assent of the adolescent and may prescribe behavior therapy as treatment for ADHD, preferably both.