ADHD Medication for 3, 4 and 5 year olds?
We know that ADHD is real.
We know that ADHD is a developmental disorder - which means that it starts in childhood.
We also know that the cause of ADHD is primarily genetics - in fact genetics accounts for over 80% of the cause. Of the 20% of causes which are not genetic - these are acquired cases. Most acquired cases occur before the age of 3 years old.
So, knowing all of these facts - can’t preschoolers have ADHD?
The answer is yes.
Some kids can be clearly diagnosed at the ages of 3, 4 or 5 years old with ADHD.
The issue with treating these children with medication has been a real concern because they are so young.
Their brains are still developing, and until now - there had been no reliable published research on using medication in such young children.
The November issue of the Journal of the American Academy of Child and Adolescent Psychiatry has several articles about a large study of preschoolers with ADHD.
The study was called “The Preschool ADHD Treatment Study”, or ‘PATS’. It was a large study, with 303 children aged 3-5 enrolled. It was funded by the National Institues of Mental Health
in the US, and there were 6 major centres in the US involved in the study, incluing Columbia, Duke, Johns Hopkins, UCLA, UC Irvine and NYU.
For the 303 children enrolled in the study, the children and their parents took part in a 10 week pre-trial behavioral therapy and training course.
To take medication in the study, the children had to meet three criteria:
- The children had the most severe ADHD
- They did not benefit from the behavioral treatment
- Their parents agreed to a trial of medication
While all studies go through review boards for ethical reviews, this study went through extra steps and precautions to ensure that there was true informed consent, and that the study was designed completely ethically.
The medication arm of the study compared the use of methylphenidate (the generic medicine also found in Ritalin, Concerta, Metadate, Focalin and Biphentin) to a placebo.
The study found that preschool children responded well to doses from 3.75 mg per day to 22.5 mg per day. All doses were given three times daily in equal dosing. The average medication dose was 14 mg per day.
There was a side effect of note - showing that children of this age have some growth slowing related to the medication. This is a side effect in older children as well, though generally recognized to not occur in more than 3% of children on stimulants.
There were 11% of medication treated children who had to stop the medicine related to severe side effects. These included: decreased appetite and weight loss, insomnia, mood disturbances, feeling nervous or worried, and skin picking behaviors.
It was found that children in this age range were more sensitive to these side effects than children of older ages.
One of the main conclusions of the study is that the use of methylphenidate in preschool children can work, but children in this age range are more sensitive to side effects. Thus, the decision to treat with medicine should be considered very carefully. Certainly a good trial of behavioral treatment is a must before considering medicine.
To read the abstracts (summaries) of these studies, click here:
- Rationale, Design, and Methods of the Preschool ADHD Treatment Study (PATS)
- Stimulant-Related Reductions of Growth Rates in the PATS
- Efficacy and Safety of Immediate-Release Methylphenidate Treatment for Preschoolers With ADHD
What does this mean to you?
If you have a child who is 3-5 years old, and you suspect ADHD, please talk to your doctor. It is best to have a specialist involved - i.e. a Child Psychiatrist. If after a good trial of behavioral treatment, there is no improvement, it may be worth a trial of medication.
This study is very important, because it establishes practice guidelines for these very difficult to treat children, because prior to this, doctors would be working with very little research to back them up.
We all know that making a decision to medicate a child for ADHD can be difficult, but it is often even more difficult for a preschooler. This research sheds light on how and when to use medication in these kids.
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Written by Dr. Kenny Handelman - The ADHD Doctor
To find get a FREE special report on ADD/ADHD Medication, visit: Medication Mastery
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October 17th, 2006 at 12:50 pm
Hello Dr. Handelman,
I have a couple questions to ask you regarding my son of 7 yrs old. First of all he is on Strattera - 10 mg per day. I thought that the medication was working well with him but he is having mood swings, gets upset quite easily, he hates to do any type of work for school - both in school and at home. His attitude towards me and the family has changed quite a bit..he was a very apprecitative child and now not so much. Could this be because he has too much of a low dosage of Medication? or could these things be the side effects of this pill? He will be visiting his doctor next week but I just wanted to get your opinion before I go. Thank you in advance.
October 17th, 2006 at 11:49 pm
Hi Lori,
Thank you for your comment. It is very hard for me to comment on what is happening for your 7 year old son.
You are asking the right questions - i.e. is it that he is on too low a dose of medication, or is it that he is having a side effect to the medication.
That is the issue that you will have to review with your doctor.
I am sorry, but I do not have enough information, nor do I think it is proper for me to give direct medication advice on a blog!
Please feel free to share with the readers on this blog what happens.
Thanks,
Dr. Kenny Handelman
November 24th, 2006 at 8:51 am
I just wanted to weigh in with our very positive experience in medicating our 4 year old son beginning at age 3 1/4. He was experiencing terrible behavioral problems at home and at school which had started in daycare and both the teacher and we were at wit’s end. I grew up around ADHD; my mom has it, my sister has it, and through dealing with my son’s problems my husband discovered he has it too. So I sometimes feel like it is a common thread in my whole life.
After carefully documenting behaviors at school (teacher wrote them for me) and at home and also what we tried to do, we saw a psychaitrist who thankfully was open to medicating at that age. We started with only 2 mg of Ritalin 3x per day and the result from one day to the next was stunning. He now functions in the classroom and is the most empathetic little boy, he talks now, and can actually stop when asked to. I believe he looks forward to a bright future at school.
November 24th, 2006 at 9:41 am
Thank you, Janet, for sharing such a positive experience.
Most on the time on the net, people are sharing only the problem stories.
I know that the success stories exist too!
I am glad to hear that your 4 year old son is doing well with low dose
ritalin.
This new study can now reassure you and your doctor that this is a safe and well researced approach.
February 7th, 2007 at 2:11 am
Dear Janet:
I am considering medicating my five year old son, who has been having problems at school since he was 3. I kept hoping he’d outgrow his hyperactivity and attention deficit, but instead it’s gotten worse. But I am very afraid that medication will stunt his growth. Has your son had any problems with his growth since beginning ritalin?
best,
Cybele Pascal
April 3rd, 2007 at 3:58 am
Dear Cybele Pascal,
I can say with absolute positivity that Ritalin is not affecting my son’s growth. Not only was he still in the 90th percentile of growth for his age at his 4 year check-up in November, he is one of the tallest in his class.
There is such a small chance of stunting of growth compared with the possible help that medication can give that I never hesitated. Also my sister was on Ritalin from age 7 and she’s normal height, so I had firsthand experience to go on.
At his last parent teacher conference a few weeks ago, he has progressed socially in his preschool class to the point that not only does the teacher feel there is nothing for us to watch for and guide, but that he is one of the class leaders in positive behavior. One year ago, before starting Ritalin, it was so desperate that it was hinted that he might be ‘uninvited’ to the school because the teacher’s aide had to shadow him the entire day to keep him from destroying the room.
So for us the medication has been nothing but wonderful.
May 9th, 2007 at 11:38 am
I just started my son (who will be 4 in less than 2 weeks) on ritalin. The doctor told me to give him 1/2 of a 5mg pill ONCE a day for the first week, then one full pill once a day after that. Yesterday was his first day, and instead of his normal “running around in circles, bouncing off of the walls” self, he was nearly catatonic. He sat in one spot all day, didnt want to play with the other children at daycare, with his eyes glazed over as if he were stoned. When we got home, he attached himself to me, and wanted to lay down (he NEVER sleeps…) because “his tummy hurt”. He said he had “bees in his tummy”. This morning, nearly 22 hours after he took his meds, his fever hasn’t gone away, and he’s started throwing up…. Is his dosage too high? Might he have an allergy? What do you think? (We’re underinsured, so I dont want to make any unnecessary trips to the doctor unless its an emergency). Thank you!
May 21st, 2007 at 5:24 pm
Hi,
I am sorry that your son had a bad reaction - and I hope that you have spoken to the doctor about this.
I am sorry, but I can’t substitute for a doctor who knows your son and can do a full assessment.
What the study listed above showed was that kids under 6 still had benefits from ritalin, but they did have higher side effects.
That said, your son’s reaction was quite extreme.
Did you get an answer back from the doctor?
Can you fill us in on what happened?
Dr. Kenny
May 22nd, 2007 at 4:58 pm
I just got back from the first Psychiatric evaluation for my 5 year old son and I left feeling so helpless. I have read many articals about children younger than 5 taking these medications and yes there have been some success stories but for me the negative always seems to stand out more than the positive. For the past 3 years of my son’s life I have had him in therapy for behavior problems and they all wanted to talk about adhd meds and i was closed off to the idea, mainly because I wanted to try every possible alternative first. Well, I am officially at the end of the road with the alternative solutions. I am scared and confused on what to do next. Please if anyone has any advice i would love to hear it.
May 22nd, 2007 at 11:35 pm
Hi Amber,
Thank you for sharing your story, and for being ‘vulnerable’ about it.
I think that other parents who read this will appreciate your candor.
It can be very hard when a 3, 4 or 5 year old is diagnosed with ADD/ADHD.
My 2 cents - consider using the medication as a ‘test’. Do not consider the fact that he may be on the medicine for months or years.
Work with the doctor, and test it out.
If it has terrible side effects, you will stop it.
In kids over 6, about 70-80% of them respond well to medicine.
This is about the same in under 6 year olds, but they may have a little more side effects.
Just test it with low doses, and close monitoring.
Please post other thoughts or comments here.
Dr. Kenny
June 9th, 2007 at 2:42 am
My son started on medication at age 9 because no one took what I had to say seriously.” He is just a boy dont worry” I came from a family of all girls so I didnt know anything about little boys. I just knew things wernt right. It is so hard to see your child being made fun of or left out by other kids. Finally I made the Dr. listen to me and he was tested. We went through many meds before we got it right. I feel so much time was wasted and my son went through alot of pain and sadness that didnt need to happen. My son didnt fit all the criteria for adhd so that didnt help. He is almost 16 and doing well still taking meds but he knows he is better with it. He gets all A’s and plays in sports and has lots of friends. To Cybele Pascal, his growth hasnt been affected at all. He also had milk soy protein intolerance as a baby. Dont wait to get your son help do it before it affects his friendships. To parents, if you think something isnt right dont let people tell you that your child is fine trust yourself.
June 11th, 2007 at 10:32 pm
Thank you, Genalee for sharing your story.
It can be very hard for parents to make the decision to start medication - and it can have a dramatic life changing benefit for the child or teen taking it.
I often wish that in my office, I could pair parents of teens who have been through it all, with parents of kids who are just at the beginning. The ‘wisdom’ shared could make a big difference in getting the right treatment for ADHD early on - inclluding medication.
Dr. Kenny
August 19th, 2007 at 1:12 pm
I have a 4 year old daughter, she has attended 3 day cares and a baby sitter, out of the three day cares since the age of 2 and a half, she has been violent to other children, hyperactive, and aggressive. Both daycares could not tolerate her actions. So now she is in a Special Educational school for pre k and kindergarten children. At school she is still hyperactive, and has behavioral problems. I knew then this was a problem, so I got her evaluated again for the third time, and her new therapist wants to start her on ritalin 5mg for three days and monitor her actions. I am scared to try this medication due to horrible side effects. ADHD runs in my family, ias a child I had it, but I made it through without medication. Also I think the dosage given is a little to high, can I give her half of 5mg. There are behavioral techniques that I use at home that are not working, because she is still aggressive, and hyper. I love my baby, and I need advice qucikly before school starts. Coming from a single mom, please help!
August 19th, 2007 at 1:16 pm
I have a 4 year old daughter, she has attended 3 day cares and a baby sitter, out of the three day cares since the age of 2 and a half, she has been violent to other children, hyperactive, and aggressive. Both daycares could not tolerate her actions. So now she is in a Special Educational school for pre k and kindergarten children. At school she is still hyperactive, and has behavioral problems. I knew then this was a problem, so I got her evaluated again for the third time, and her new therapist wants to start her on ritalin 5mg for three days and monitor her actions. I am scared to try this medication due to horrible side effects. ADHD runs in my family, as a child I had it, but I made it through without medication. Also I think the dosage given is a little to high, can I give her half of 5mg. There are behavioral techniques that I use at home that are not working, because she is still aggressive, and hyper. I love my baby, and I need advice quickly before school starts. Coming from a single mom, please help!
August 19th, 2007 at 3:00 pm
Hi,
Your questions are excellent - and show how concerned you are.
When it comes to doses and side effects - I suggest you have another discussion with the doctor. The doctor needs to reassure you and answer all of your questions.
I cannot make treatment or dosage recommendations on my blog.
What I can say - is that in general, most children who actually have ADHD, do well with medication with minimal side effects. The study of 3, 4 and 5 year olds shows that there may be a higher rate of side effects and doses need to be lower.
Although school is coming soon - make sure to get all of your questions answered - and consider a short test of medicine - as the therapist has suggested.
All the best.
Dr. Kenny
October 15th, 2007 at 9:24 pm
Dr. Handelman,
My son is 4 and a half years old and was started on 10 mg Daytrana patch 10 days ago. It has shown to have positive effects on behavior and attention span on school. The only problem I have encountered is his appetite. He was doing fine until 2 days ago, when he had no interest in food. I was thinking that I would have seen a change in his appetite sooner than 8 days if this were going to be a side effect for him. He also had a slight flu bug the last 2 days with unexpected vomiting during two meals followed by a fever the next day. I am lead to believe that there is no “build up” of the med. in his system, or could it really take over a week before any potential side effects occur??? any helpful hints on this? I also just increased the dose to 15 mg yesterday, but the appetite declined before this.
January 18th, 2008 at 1:54 am
My son is a sophomore in college. Graduated from a perstigious private high school where gaining admittance is very difficult. Now attending a prestigious and highly selective university. Scholarships and grant money practically pay for his education, but most of all he is a delight. I wanted to balance this discussion a bit offering my experience as the parent of a boy, who around three started to receive negative response from teachers when he entered preschool. There was steady pressure on us to have him evaluated, but more important….teachers were very judgmental and blunt in their belief we should medicate him, and we received quite alot of pressure in the form of “fear based warnings” and “statistics” suggesting if we did not medicate him then we risked his failing in academics, using drugs and alcohol, etc. etc. We explored this feedback taking the suggestions at face value. I did extensive research, then we had him tested privately at our own expense at an education evaluation center located at Yale University. He was anxious. Not hyperactive. One result of the evaluation was that we should find another placement for him since the counsellor identified for us that the classroom and shool we had enrolled our son in preschool and elementary school was a terrible placement for him…..we were urged to get him out of there as soon as we could do so. It was a private school…and we followed the advice to find a better placement. He continued to be his unique and outgoing, creative, verbal, inquisitive and sensitive self. But, he had sucess wtih our support and love to guide him. He is sensitive, compassionate, precocious in intellect, and very observant as well as consistenly more mature than his peers as demonstrated by his verbalizations and comments….that were always notably beyond his years. He wrote poetry….starting at age three when he popped up to ask me if I wanted to “hear” what he “just wrote.” He wrote poems in his head long before he could write, and continued to do so throughout his growing up. Beautiful prose just comes to him in response to his passionate engagement in life. He is passionate and expressive. He does not invest much time or thought into what other people may think of him, but he loves people and seeks the company of others when not resting or at school….he has lots of friends. He was definitely unique. Always stood out, even though he was not looking to do so. Very social….driven really. We elected for play therapy after learning he was anxious. I don’t know if there was any benefit, but it took the pressure off of him when teachers were informed that we had him tested at Yale and were addressing his anxiety with play therapy. Then guess what happened? He grew up…..spared the experience and whatever else comes with drugs such as Ritalin…..we have no idea what the long term effects of these drugs will have on our kids….be careful. In our case we were also honest enough to recognize our bright, sensitive, observant child picked up on the distress we as parents could not hide from him…..we were not consistently financially secure, which lead to some loud fights…..very upsetting for our sensitive child. He was very aware of our grown up concerns regarding our financial stress…and this is probably what made him so anxious….but he survived it all….grew up and is 100% the best kid a parent could claim.
February 7th, 2008 at 7:49 am
I have a 3 year old son who goes non stop at about 100mph a day. He hasnt taken a nap since he was 1 year old. He wakes up 4 - 5 times a night, he throws tantrums all day and bangs his head into the floor several times a day. I cant reason with him in any way and his answer to everything is NO NO NO. He had open heart surgery for a malaligned VSD when he was 9 months old, now hes facing another open heart surgery to replace a leaking pulmonary valve. I am at my wits end…please help me to do the right thing. I want to take him to his pediatrition but i dont know if i should because he told me that my son is “normal”. I have to believe something is wrong and i believe he has ADHD. Please advise me on what to do . Thanks
February 7th, 2008 at 1:22 pm
Hi,
I suggest that you talk to your pediatrician again, and consider getting a referral to a ‘behavioral pediatrician’, or child psychiatrist. This will help to get a specific assessment for ADHD.
That said - having had cardiac surgery, there is a concern about any of the ADHD medications.
To learn more about the ADHD warnings, see here:
http://www.addadhdblog.com/fda-to-study-cardiovascular-risk-of-adhd-medication/
To learn more about medicines for ADHD, visit http://www.medicationmastery.com
All the best,
Dr. Kenny
February 10th, 2008 at 1:35 pm
Hi, I have a 4 1/2 year old boy who has been on dexedrine 10mg a day slow release for about 4 months now. We started him on medication for his adhd 6 months ago and have been changing the doses ever since. It works for a little while and then we have to change it again. The doctor said that he cant put my son on anything else but dexedrine becuase he is not 6 yet. I was just wondering if there is anything else I can try other then rydolin cause we have tried that and that was so wrong for my son. Please let me know as he needs a med change again, his mood swings are back and he is not paying any attention at pre-school, and being half way through the year, they are trying to get him ready for kindergarden. thank you very much. Any ideas will be helpfull.
October 8th, 2008 at 1:11 pm
Hello,
I just want to say that I am glad that i founb this website. My little one is almost four and we are struggling with hyperactivity. I am scared to medicate him but at this point I do not feel there is an option. His quality of life is not what it could be. Don’t get me wrong he is happy, he and his brothers are the light of my life. However when he enters into the “real world” I fear that he won’t be as cherished because he is difficult to deal with and that would kill me. Reading what others parents have had to say has given me hope that there is help and that I wont be killing my son if I medicate him. Thanks.
October 28th, 2008 at 6:35 pm
hi,
my son will turn 5 in 3weeks.he hasnt been diagnosed of adhd by a doctor but from my reseach i have discoverded that most of the characteristics of kids with adhd matches his.am very concerned about the effect it has on his accedamics,he hates to do his book work both at home and in school.i have been trying behavour therapy but i dont think am getting much result with it.
i dont know what to do.
October 29th, 2008 at 9:44 am
Hi ese,
The best first step is to get a proper assessment and then once you know exactly what is going on - i.e. ADHD or something else, then you can create a strategy to help with it.
Best,
Dr. Kenny
November 12th, 2008 at 5:03 pm
My son is 4 years old, and the light of my life. He had been diagnosed with ADHD in the extremes ( no wonder I would lock myself in the bathroom for some mommy time!) We are currently seeing a child psychologist who refuses to put him on meds, but we are trying out a program called EEG, or commonly known as neurofeedback. He goes in 2 times a week for this and we have done about 18 sessions for this… I see NO change in behavior and feel we have now wasted thousands of dollars on a treatment plan that hasnt worked. I am at my wits end! He is disruptive in his preschool class, and cant sit still to do any actual learning. While his teachers are wonderful and love to work with him, I feel he isnt focusing on his work like he should be, I mean yes he can write his name, but he wont sit still to do it. He has found at leat 400 different ways to sit in a chair, and refuses to sit still for story time. I am afraid if we cant get a handle on this now that he will be very behind when he goes to kindergarden. I dont know what to do. I was against putting him on any medication, but now that this is disrupting my marriage, and our home is no longer a peacefull household I am beginning to think that maybe medication would be helpful. What should I do? His psychologist is totally against medicating him, and has even thrown countless books at me about medicating children and how it is the evilness of the world. So with that in the back of my head I would feel totally horrible about the medication, but a part of me would love to see my son come home from school and not have a meltdown, and flash that smile at me that I so very miss.
So with that in mind what do I do?
November 19th, 2008 at 2:43 pm
I guess I dont get a response.
November 21st, 2008 at 10:25 am
Hi Brandylee,
I can’t always get to giving personal answers (and sometimes when I do, it takes a little time…)
If your child psychologist is not giving you the treatment you need, find another one!
The other thing about it is that psychologists can’t prescribe medication. You’ll need to see a medical doctor to get a prescription anyway. Best to find a pediatrician or child psychiatrist who can assess your son and see if medicine can help, and then he/she can give you a prescription if it is right for your child.
Dr. Kenny
p.s. for more information on medication, I have a free report - and a complete course here: http://www.medicationmastery.com
p.p.s. for a community of other people interested in ADHD - where you can discuss and get help/support, visit: http://www.ADHDWorld.com