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Investigators: Many doctors don't follow ADHD guidelines for preschoolers

Ninety percent of pediatric specialists nationwide are not following clinical guidelines for treating preschoolers with attention deficit-hyperactivity disorder, Long Island medical investigators have found.

Some are prescribing medication too soon, while others aren't offering drugs even as second-line treatment after behavioral therapy has failed.

"With the American Academy of Pediatrics now extending its diagnosis and treatment guidelines down to preschoolers, it's likely that more young children will be diagnosed with ADHD even before entering kindergarten," said Dr. Andrew Adesman of Cohen Children's Medical Center in New Hyde Park.

Because the academy's guidelines have the potential to increase the number of children who are diagnosed with ADHD, said Adesman, chief of developmental and behavioral pediatrics at Cohen, it is important to tabulate how well the guidelines are being followed.

He and his colleagues at Cohen surveyed more than 600 pediatric specialists in neurology and psychiatry.

ADHD is a common behavioral condition that can present difficulties for families trying to cope with an affected child. Boys are diagnosed three times more often than girls with a condition that is typified by trouble focusing and tendencies toward tantrums, outbursts and other forms of "acting out," studies show.

"The guidelines state first and foremost that behavior should be first-line therapy and medication should not be used," Adesman, the study's senior investigator said Monday.

"Medication can be used," he added, "if the behavioral therapy hasn't worked."

Yet, Adesman's investigation revealed that more than one in five specialists who diagnose and manage ADHD in preschoolers recommend medication as first-line treatment alone, or in conjunction with behavior therapy, Adesman said.

More than a third of specialists who prescribe medication for preschoolers with ADHD said they "often" or "very often" chose a medication other than methylphenidate -- Ritalin -- a stimulant and the standard drug given to children age 5 and up. Stimulants quell symptoms of ADHD in children with the condition.

Slightly more than 19 percent chose amphetamines. Another 19 percent prescribed non-stimulants, Adesman's team found.

Dr. Jaeah Chung, the study's other lead investigator, said it is important that doctors, whether primary care or specialists, pay attention to the academy's guidelines if very young children with ADHD are to have optimum care.

"At a time when there are public and professional concerns about over-medication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children," Chung said.

But Adesman noted that there may be a reason doctors are turning to medications before recommending behavioral therapy outlined by the American Academy of Pediatrics.

"There is a wrinkle in this," he said. "First of all, these are specialists and the guidelines are for primary care physicians. So the severity [of these children's cases] may have been worse."

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