According to data provided by the Centers for Disease Control and Prevention, more than 10,000 toddlers, aged 2 to 3 years, are currently on medication to treat attention deficit hyperactivity disorder. This is not within established guidelines for pediatric physicians. Toddlers who are covered by Medicaid are especially prone to being prescribed medications like Adderall and Ritalin.
The report, released on Friday, is one of the first to try to measure the diagnostic rate of ADHD among children under four years old. The report was presented at the Carter Center in Atlanta, Georgia. Among those present were physicians from the Georgia Mental Health Forum. Along with various experts in the industry, there was vehement criticism for the use of these medications on so many young children.
Technically, the American Academy of Pediatrics guidelines do not even address ADHD diagnosis for children who are under three years old. Because the effectiveness and safety of the stimulant medications has not been thoroughly explored for the age group, their use is clearly not recommended.
A children’s mental health consultant, Anita Zervigon-Hakes, said that she was shocked, and these prescriptions should not be occurring. Dr. Lawrence H. Diller, a Walnut Creek, California behavioral pediatrician shared his feelings. He stated that these prescriptions are not within an accepted standard of care. If something were to go wrong for the patient, a malpractice suit would not be out of the question.
In 2013, the CDC conducted a survey on a nationwide scale. They found that 11 percent of 14-17-year-olds have been diagnosed with ADHD. They also found that approximately one in five males will be faced with such a diagnosis at some point in their childhood.
Most of the children diagnosed with ADHD are given a prescription for either Ritalin (methylphenidate) or some form of amphetamine like Adderall. These are often found to settle hyperactive and impulsive behaviors. There is evidence, however, that they also expose those taking them to potential bouts of insomnia, hallucinations, rapid weight gain and suppression of normal growth.
Adderall has not been approved for children younger than six years old by the FDA. Since results in the use of methylphenidate for preschool-aged children have been positive, however, guidelines have been altered by the American Academy of Pediatrics to include four- and five-year-old students. This is only after other avenues have been exhausted and unsuccessful.
The guidelines are clear. Children younger than four are not included for these options. This is mainly because, developmentally, it is expected that toddlers are going to display impulsive and hyperactive behaviors. It is not until they are older that detecting the presence of a disorder like ADHD is even possible. Ultimately, most experts agree, toddlers should not be put on ADHD medications.
The report, compiled by Dr. Susanna N. Visser, utilized two sources: Claims in the state of Georgia that were made through Medicaid and nationwide claims by families who were privately insured. The analysis found 760 cases of toddlers on ADHD medication in Georgia. There is currently no nationwide data available for Medicaid regarding this topic. Dr. Visser applied the rate of one in 225 toddlers, which matches the rate in Georgia, to the nationwide number of toddlers covered by Medicaid. The resultant number of 10,000 does not even include the 4,000 privately insured toddlers on ADHD medications.
Dr. Visser also found that non-pharmacological treatments, that have proven to be effective, have largely been ignored. Focusing on better social skills, creating a more structured environment, addressing nutritional needs and increased physical activity and exercise all tend to contribute to improvements in behavior. What is not being made clear by the prescribing physicians is that these children’s developing minds and bodies are potentially being put in harm’s way. Pre-schoolers still have a lot of growing to do. Toddlers who are put on ADHD medications are likely having that important growth compromised.
by Stacy Lamy