New ADHD guidelines: Should Ritalin be prescribed to 4-year-olds?

The American Academy of Pediatrics has broadened its age guidelines for attention deficit hyperactivity disorder (ADHD), advocating the diagnosis and treatment of children as young as 4. The new report will be published in the November issue of the journal Pediatrics. Are preschoolers too young to be medicated with Ritalin and other stimulant drugs? Here's what you need to know:

What do the new guidelines say?

That primary-care doctors should evaluate children from 4 to 18 if they show signs of ADHD, which can include fidgeting, excessive talking, and abandoning chores and homework. The old guidelines specified an age range of 6 to 12. For kids ages 4 and 5, the academy recommends behavior therapy first, using rewards and consequences to get them to focus and control their impulses better. Another option is parent training in how to deliver positive reinforcement or help a child stay organized. If a child doesn't show significant improvement, though, drug treatment is recommended.

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Is that really necessary?

In most cases, no, medication isn't necessary. Eight or 9 percent of children are believed to be affected by ADHD, and the American Academy of Pediatrics says the new guidelines will just help more kids get the appropriate therapy. The group only recommends drug therapy for the most severe cases after all other options have been exhausted, says Ruth Hughes, chief executive officer of the nonprofit Children and Adults with Attention-Deficit/Hyperactivity Disorder, as quoted at Bloomberg Businessweek. "Most families come to medication as a last resort," she says.

Are the new guidelines controversial?

Not everyone liked the idea of medicating 6- or 7-year-olds, much less 4-year-olds. We're essentially saying kids should be medicated for being "almost child-like at times," say the editors of The Mark. This seems excessive at an age where an inability to focus results in nothing more serious than "ill-conceived Play-Doh sculptures." But ADHD can result in anxiety, or learning disabilities, says Dr. Gordon J. Rafool at News Chief, so why wait when "there are treatments available that work very well for an ADHD child"?

Source: Bloomberg Businessweek, CNN, The Mark, News Chief