PharmaGossip: Say what!? Preschool Children May Be Prescribed Attention-Deficit Drugs, Doctors Say

Children as young as 4 years old may now be treated with medications such as Novartis AG (NOVN)’s Ritalin for attention deficit hyperactivity disorder, under new guidelines from the American Academy of Pediatrics.

The recommendations, the first in a decade, expand the age range of kids who may be prescribed the drugs from preschoolers through 18-year-olds. Earlier guidelines included children ages 6 to 12. ADHD affects about 8 percent of children and youth and is the most common neurobehavioral disorder in kids, according to the American Academy of Pediatrics.

Expanding the age range will help ensure more children get the appropriate therapy, according to the guidelines. Treating preschoolers may increase their chances of succeeding in school and targeting teens recognizes that ADHD is a long-term condition that may even extend into adulthood.

“Because of greater awareness about ADHD and better ways of diagnosing and treating this disorder, more children are being helped,” said Mark Wolraich, lead author of the report and a professor of pediatrics at the University of Oklahoma College of Medicine in Oklahoma City, in a statement.

For preschoolers with the disorder, it’s recommended that parents and teachers first try to manage children with behavior therapy that uses a system of rewards and consequences. If that doesn’t work, then doctors can prescribe medications, according to the recommendations being presented today at the American Academy of Pediatrics National Conference and Exhibition in Boston.

Early Intervention

Parents and doctors won’t rush out to give small children medication before trying all other alternatives, said Ruth Hughes, chief executive officer of the Landover, Maryland-based nonprofit Children and Adults with Attention- Deficit/Hyperactivity Disorder, or CHADD.

“Most families come to medication as a last resort,” Hughes, who supports the guidelines, said in an Oct. 14 telephone interview. “Behavioral intervention should be the first line when we’re talking about kids who are younger than school-aged. There are children out there with very severe ADHD and very severe co-symptoms while their parents may have worked closely with the therapist and done all the interventions, and it may not be sufficient.”

Under the guidelines, primary-care doctors should start an evaluation for ADHD in any children ages 4 through 18 who have academic or behavioral problems and symptoms of hyperactivity, inattention or impulsivity, the report said. During the evaluation, doctors should consider other conditions that may co-exist with ADHD, including anxiety, depression, oppositional defiant disorders, developmental disorders and physical conditions like sleep apnea.

Behavior Therapy First

For 4- and 5-year-olds with moderate to severe ADHD symptoms who don’t see a significant improvement after their parents first use behavior therapy, then treatment with medicines is recommended. For elementary school children and older kids, the academy recommends behavior therapy and FDA- approved medicines, which include Ritalin, or Shire Plc (SHP)’s Adderall and Johnson & Johnson (JNJ)’s Concerta.

Heidi Feldman, a professor of pediatrics at Stanford University in Palo Alto, California, and a member of the subcommittee that developed the practice guidelines, said the new recommendations are available for parents to review. She said the guidelines don’t advise giving drugs to the youngest children, but include it as a possibility when needed.

ADHD symptoms include fidgeting, excessive talking and abandoning chores and homework. The condition is usually diagnosed in childhood and can continue as an adult.

ADHD Diagnosis

Andrew Adesman, chief of Developmental and Behavioral Pediatrics at Cohen Children’s Medical Center in New Hyde Park, New York, said to be diagnosed with ADHD, preschool children must exhibit symptoms that cause problems not only at home but in other settings.

“What the American Academy of Pediatrics is doing in a helpful regard is acknowledging that hyperactivity has its roots in preschool years and that clinicians are often encountering concerns around behavior in the preschool years,” said Adesman, who wasn’t an author of today’s guidelines. “It’s appropriate for clinicians to be very selective in choosing when to use these medications in very young children and they should be reserved for children who have significant behavior issues that are unresponsive to behavioral therapy.”

The guidelines will be published in the November issue of the journal Pediatrics.

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net