A new Stanford Medicine–led study has raised concerns about how quickly preschool-aged children diagnosed with ADHD (attention deficit/hyperactivity disorder) are being prescribed stimulant medications. The research, published in JAMA Network Open on August 29, found that many children as young as 4 and 5 years old are receiving medication within weeks of diagnosis — despite clear guidelines recommending that behavioral therapy should be the first step in treatment.
What the Guidelines Say
The American Academy of Pediatrics (AAP) advises that preschool children with ADHD begin with at least six months of behavioral therapy before trying medication. This therapy, often referred to as parent training in behavior management, helps families establish routines, reinforce positive behaviors, and reduce negative behaviors. Studies show that it not only benefits children but also strengthens family dynamics.
However, the new analysis of nearly 10,000 medical records shows that these guidelines are not being followed consistently. Instead, medication is often the first line of treatment.
Key Findings from the Study
Researchers reviewed electronic health records from eight pediatric health networks across the United States, covering children between 3 and 5 years old seen between 2016 and 2023. Out of more than 700,000 records, nearly 10,000 children had an ADHD diagnosis.
- 42.2% of these children were prescribed medication within just one month of being diagnosed.
- Only 14.1% waited the recommended six months before starting medication.
- Even children who initially showed only ADHD-like symptoms (but not a full diagnosis) were often given medication quickly — with 22.9% receiving prescriptions within 30 days.
This rapid prescribing trend contradicts the AAP’s recommendations and highlights a gap in access to behavioral therapy.
Why Doctors Prescribe Quickly
According to lead author Dr. Yair Bannett, an assistant professor of pediatrics at Stanford, the problem isn’t simply medical oversight. Instead, it’s often due to a lack of access to behavioral treatment.
“Doctors tell us, ‘We don’t have anywhere to send these families for behavioral management training, so, weighing the benefits and risks, we think it’s better to give medication than not to offer any treatment at all,’” Bannett explained.
Barriers include:
- Limited availability of trained behavioral therapists in some areas
- Insurance coverage issues that make therapy unaffordable
- Long wait times for treatment programs
Risks of Early Medication
While stimulant medications are effective for many children with ADHD, they also come with side effects — particularly in preschoolers whose bodies metabolize drugs differently than older kids.
Common side effects include:
- Irritability
- Emotional outbursts
- Aggression
Although the medications aren’t considered toxic for young children, the risk of treatment failure is higher. Families may discontinue the drugs because the side effects outweigh the benefits.
Why Early Intervention Still Matters
ADHD is a developmental condition characterized by inattention, impulsivity, and hyperactivity. Without proper management, it can lead to academic struggles, school dropout, and difficulties in adulthood, including challenges with employment and relationships.
Behavioral therapy helps children and families build sustainable skills, while medication provides immediate symptom relief. For school-aged children (6 years and older), experts recommend a combination of both approaches.
Looking Ahead
The study underscores an urgent need to improve access to behavioral therapy resources for families. Bannett suggests that online training programs and low-cost digital tools could help bridge the gap until more therapists are available.
“Our goal is to educate pediatricians and empower families so that medication is not the only solution,” Bannett said.
With ADHD diagnoses on the rise, this research sends a clear message: preschoolers benefit most when families start with behavioral strategies, not pills.
