ADHD Drugs Prescribed Too Quickly to Preschoolers: What Parents Need to Know

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders affecting children worldwide. Recent research from Stanford Medicine reveals a concerning trend: young children aged 4-5 with ADHD are frequently receiving medication immediately upon diagnosis, despite treatment guidelines recommending behavioral therapy as the first-line approach.

The Stanford Medicine Study

A comprehensive analysis of medical records from nearly 10,000 young children with ADHD across eight U.S. academic medical centers found that 42.2% of children were prescribed medication within a month of their diagnosis. Only 14.1% received medication more than six months after diagnosis.

The study, published in JAMA Network Open, highlights a significant gap in medical care for preschoolers with ADHD. Treatment guidelines recommend that young children and their families try six months of behavior therapy before starting ADHD medication.

"We found that many young children are being prescribed medications very soon after their diagnosis of ADHD is documented. That's concerning, because we know starting ADHD treatment with a behavioral approach is beneficial."

— Yair Bannett, MD, lead author and assistant professor of pediatrics at Stanford Medicine

Why Behavioral Therapy First?

Children under age 6 have bodies that don't fully metabolize ADHD medications. Stimulant medications prescribed for preschoolers can cause more side effects than in older children, including increased heart rate and blood pressure, trouble sleeping, loss of appetite, and emotional irritability.

The most effective type of behavioral therapy for young children is parent training in behavior management, where therapists work with parents to teach them skills to help their child manage ADHD symptoms. This approach helps parents build positive relationships with their children and manage challenging behaviors.

CDC Recommendations

The Centers for Disease Control and Prevention (CDC) strongly recommends behavior therapy as the first treatment for children under 6 years of age living with ADHD. The CDC emphasizes that:

• Children under 6 are more likely to experience side effects from ADHD medications
• Long-term effects of ADHD medications on children under 6 are not well-studied
• Behavior therapy works as well as medication in helping manage symptoms
• Families who receive training in behavior therapy notice improvements for several years after treatment

Diagnosis Challenges in Preschoolers

Diagnosing ADHD in young children can be particularly challenging because behaviors indicative of ADHD in older children may be developmentally appropriate for preschoolers. According to research in the Journal of Child and Adolescent Psychopharmacology, several behavioral rating scales have been validated for children younger than 6 years of age, including:

• Conners Parent Rating Scale-Revised
• AD/HD Rating Scale-5 (parent and teacher versions)
• Early Childhood Inventory-4

The Preschool ADHD Treatment Study (PATS) provided the most extensive efficacy and safety data on methylphenidate for ADHD in preschoolers, showing significant improvement in ADHD symptoms with medication compared to placebo, although adverse event-related discontinuation was higher than in studies of older children.

Barriers to Behavioral Treatment

The Stanford study found that access to behavioral treatment appears to be a major barrier. Many locales have few or no therapists who offer parent training, and patients' insurance may not cover it. Some physicians report that they "don't have anywhere to send these families for behavioral management training, so, weighing the benefits and risks, they think it's better to give medication than not to offer any treatment at all."

Treatment Guidelines Summary

The American Academy of Pediatrics (AAP) clinical practice guideline for ADHD in children and adolescents recommends:

• Behavior therapy first: For children under 6 years of age, behavior therapy should be used first, before medications
• Parent training: The most effective type is parent training in behavior management
• Comprehensive approach: For children 6 and above, both behavior therapy and medication are recommended

What Parents Should Do

If your child has been diagnosed with ADHD:

1. Talk to your doctor about behavioral therapy first - Ask specifically about parent training in behavior management
2. Request access to behavioral therapists - Ask your pediatrician for referrals to qualified providers
3. Use online resources - Many free or low-cost online resources are available for parents who want to learn principles of the behavioral approach
4. Stay informed - Ask questions about the risks and benefits of medication versus behavioral therapy
5. Consider long-term effects - Understand that long-term effects of ADHD medications on young children are not well-studied

The Bottom Line

While medication can be a beneficial part of ADHD treatment for some children, it should be used carefully in preschoolers. The evidence strongly supports starting with behavior therapy, particularly parent training, before considering medication. Early identification and effective treatment for ADHD improve children's academic performance and help prepare them for success in adulthood, including maintaining employment and having successful relationships.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with your child's healthcare provider for diagnosis and treatment options tailored to your child's specific needs.

References

1. Bannett Y, et al. ADHD drugs are being prescribed too quickly to preschoolers. JAMA Network Open. Published August 29, 2025. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2025.29610

2. Centers for Disease Control and Prevention. Behavior Therapy First for Young Children with ADHD. May 15, 2024. https://www.cdc.gov/adhd/articles/behavior-therapy-first-young-children.html

3. Wigal S, et al. Diagnosis and Treatment Options for Preschoolers with Attention-Deficit/Hyperactivity Disorder. Journal of Child and Adolescent Psychopharmacology. 2020;30(2):104-118. doi:10.1089/cap.2019.0116

4. Wolraich ML, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528

5. Greenhill LL, et al. The Preschool ADHD Treatment Study (PATS): I. Rationale, design, and methods. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1330-1340