Is Four Too Young For an ADHD Diagnosis?

Are we in danger of medicating away youthful exuberance?

The American Association of Pediatrics has released new guidelines that drop the recommended starting age for evaluating children for Attention Deficit and Hyperactivity Disorder from six to four years old, raising concerns about medicating children so young and that diagnoses will become even more widespread.

Per the Chicago Tribune, “There is now enough evidence to address this broader age range,” says Dr. Mark Wolraich, the lead author of the report that was released last weekend, “We know that identifying and treating kids at a young age is important … because the earlier we can provide treatment, the better chance of success.”

As a mother of a son who was diagnosed with ADHD at five and started medication just shy of six, even I am alarmed when I hear that four-year-olds are being diagnosed and labeled as ADHD. I am well aware of the fact that ADHD manifests itself in many ways and feel for any parent of a “difficult” child, but it just seems like a bad idea to open this up and invite irresponsible doctors to prescribe medication to children that are barely out of their toddlerhood.

The guidelines recommend starting behavioral therapy and parental training as the first method of treatment for diagnosed four-year-olds, noting the importance of instructing parents on how to build the structured environment that ADHD children need to help control their impulsivity, hyperactivity and inattentiveness (while hopefully NOT make everyone else in the family crazy in the process).

But how many families fail at creating such an environment and quickly turn to medication? I am sure that they are well-intentioned, but can’t help but imagine the exhaustion level of these parents (many of whom suffer from varying levels of ADD, as well). The promise of medication to make the calls from the preschool stop, to help restore order to their days, and/or to just make life easier is difficult to resist.

According to the U.S. Center for Disease Control, ADHD is now being diagnosed in almost 1 out of every 10 American children, and is the most widespread neurological disorder in children. It can have devastating long-term effects from the low self-esteem that comes from constantly being told that something is wrong with them, to a higher rate of dropping out of school (32% compared to the average of 16% among other students), to problems with substance abuse later in life.

I believe strongly, from personal experience, that medication can make a world of difference for ADHD kids. I can tell you about that February evening when, after our son’s first day on a low dose of Ritalin, his kindergarten teacher called to tell us that he had played in the “home life” area of the classroom that day for the first time and had said to her, “This is so much fun!! When did you put these toys here??” because he had never even noticed that part of the classroom before. I can also tell you about the times before and how my heart would break every time he would cry after school while telling me that nobody would talk to him at school and that “everybody hates me.” And then I will tell you how the medication enabled him to slow down long enough to take the time to make friends with those same children.

I can also tell you, with hesitation and not a little humiliation, that before we started the medication, I was an absolute mess. My husband and I had tried our best to manage our three children (all under the age of seven) with Raising Your Spirited Child and Parenting With Love and Logic as my guides, but it was not enough. Our evenings were chaotic and whatever progress I might make with the one, would be erased by another’s regression. Add marital discord over whether or not to medicate and how to deal with the increasing disorder in our household and you can see how I would be profoundly grateful that medication ended up taking away at least one of the stresses in our lives … but more importantly, and to the point, it eased almost ALL the stress that our son was experiencing at school.

So, while I agree with Dr. Wolraich and the study that treatment is vital for children with ADHD, I just can’t get behind anything but behavioral counseling at so young an age.

Why do I draw a distinction between four and five? Because preschool is not SCHOOL.

Because children at four are expected to run around. Because even though your little tyrant might be making you crazy, he is still just a vulnerable, tiny four-year-old that, at the end of the day, just needs to be loved by his parents and accepted for who he is no matter what.

Consider your time spent defending your child from advice to medicate as training to become your child’s advocate — a role you will have to take up quite vigorously when they enter the school system.

Read more of Amy’s writing at Bitchin’ Wives Club.
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Article Posted 5 years Ago

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