Specialists Sidestep Treatment Guidelines for Preschoolers with ADHD

Christina Samuels cross-posted an article from On Special Education blog for Education Week’s blog “Early Years.”  The article she cross-posted summarized findings regarding use of prescription drugs with preschoolers who exhibit attentional deficits.  The findings originated from a survey study that was released during a recent meeting devoted to research in child development.  The article Samuels cross-posts makes me highly uncomfortable for two reasons.  

First, and foremost, the inconsistency with which medical professionals prescribe drugs for attention deficit issues during the early years of development seriously concerned me.  The article reveals that only about 10 percent of medical professionals responding to a survey on their treatment methods for attention deficit hyperactivity disorder in preschoolers (Side note:  Of 3,000 surveys sent to preschool ADHD specialists, only 714 surveys were returned!) said they followed American Academy of Pediatrics (AAP) guidelines exactly.  The article tells us that “many chose medication as a first-line treatment” versus prescribing behavioral therapy.  Dr. Anthony Adesman, chief of behavioral and development pediatrics at Cohen Children’s Medical Center of New York and one of the authors of the survey study, found that “611 specialists in preschool ADHD who responded, about 20 percent said they recommend first-line treatment with medication “often” or “very often,” regardless of “the availability of behavioral therapy options.  About 30 percent said they “rarely” or “sometimes” recommend medication if modifying behavior has not been successful.  The survey also found that doctors were choosing to prescribe drugs other than methylphenidate, even though the AAP recommends that only that particular drug be used with 4- and 5-year olds.  Some survey respondents, about 19 percent, indicated they are choosing to use amphetamines such as Adderall or Dexedrine (which is FDA-approved for children aged 3 or older), while another 18 percent are prescribing non-stimulant drugs such as Clonidine (which is FDA-approved for children aged 6 or older).  The most likely respondents to adhere to AAP guidelines were child psychiatrists while general psychiatrists were the least likely.  In an interview, Dr. Adesman pointed out that one possible explanation for inconsistent survey results could be that some doctors “are reluctant to recommend behavior therapy, or give it a chance.”

His statement therein provides me with my second cause for serious concern.  The early years, between the ages of 3 and 5, are so crucial for so much learning for school readiness and success in life.  I can’t help wondering whether medical professionals truly understand the impact of prescribing heavy-duty drugs on a child’s development.  Are they aware that preschoolers are, by their very nature, meant to have “attention-deficit” issues?  In my blog on May 4, I summarized an interview with and a TEDTalk given by Alison Gopnik, professor of psychology and philosophy at the University of California, Berkeley.  During her TEDTalk and interview, she passionately describes her research findings that children are designed to have “lantern-type” attentional capacity and consciousness for best learning, versus the “spotlight-type” attention and consciousness that adults have for focusing on and completing tasks in a purpose-driven way.  She tells us that young children are meant to explore their world actively and “get into everything.”  The last time I checked on the effects of ADHD medicine, the drugs do not allow for the kind of open-mindedness that, according to her research as a psychologist and philosopher, is an absolute perfection in the design of children so that they can learn about their world.  The fact that medical professionals consider prescription medication for preschool children before every other type of intervention has been considered and tried (e.g., behavior therapy, occupational therapy, speech-language therapy, physical therapy, sensory processing intervention, vision therapy, parent/caregiver classes, play therapy, art/music therapy, etc.) truly worries me.  

I am well-aware of the benefits of medicine on helping children.  My 3-year old Sam, who shows up so frequently in my blog, suffers from a rare autoimmune disorder that was diagnosed when he was 9 months old (after being quite sick from the time he was 10 weeks old and nearly dying, until he received the right treatment from his amazing physician Dr. Ben Shneider at Children’s Hospital of Pittsburgh).  I shudder to think where he might be today if it weren’t for his daily doses of immuno-supressant drugs.  I thank God every day for the medical profession (in particular for Dr. Shneider!) and all the wonderous drugs, cures and interventions the profession makes available to people to save their lives, make their lives more comfortable and much more.  But, when it comes to ADHD medicine use with preschoolers (and even with older children and adolescents), I wonder how much medical professionals communicate with other professionals who might know a lot more about child development than they do (or who may even know a lot more about a particular child than they do), such as child psychologists, speech-language pathologists, occupational therapists, educators, philosophers, and parents, before they prescribe drugs that actually negate or “mellow” what nature has instilled in preschoolers:  an intense desire to learn, a curiosity about life, an exploratory sense unmatched by grown-ups, and a lantern of consciousness that shines brightly on everything around them so that they can get ready for school and life.