Stanford, Calif. — A groundbreaking new study has revealed that many young children in the U.S. are prescribed ADHD medication almost immediately after diagnosis — despite medical guidelines urging doctors to try behavioral therapy first.
According to the research, 42% of preschoolers with ADHD received medication within just 30 days of diagnosis, and nearly 68% were on medication before the age of 7. These findings highlight a growing gap between official recommendations and real-world medical practices.
Why Behavioral Therapy Is Recommended First
ADHD affects around 10% of American children, with diagnoses in preschoolers on the rise. A 2022 national survey found that 2.4% of children ages 3 to 5 had been diagnosed with ADHD.
The American Academy of Pediatrics (AAP) advises that children between ages 4 and 5 should begin treatment with parent training and behavior management rather than medication. These therapies are designed to help caregivers manage routines, encourage positive behaviors, and provide structure — approaches proven to reduce ADHD symptoms without the risks of early drug exposure.
However, the new study found that in many health systems, one in three preschoolers was prescribed ADHD medication almost immediately, leaving little time to test whether therapy alone could help.
Disparities in ADHD Treatment
The research uncovered striking disparities based on race and insurance type:
- Asian children were least likely to receive medication early (28.6%).
- White children had higher rates (43.9%), with multiracial children the highest at 47.7%.
- Hispanic children (35.8%) and Black children (41.8%) fell in between.
- Children on public insurance were more likely to be prescribed medication early compared to privately insured peers.
These patterns suggest that system barriers — like limited therapy access, insurance restrictions, and resource shortages — push doctors toward prescribing medication as the default option.
A Healthcare System Under Pressure
The study, which analyzed records from over 712,000 children across eight major pediatric systems between 2016 and 2023, shows how practical realities influence treatment decisions.
- Therapy access is limited: Families often struggle to find trained providers, and Medicaid patients face the greatest barriers.
- Prescriptions are quicker: Writing a prescription takes minutes, while arranging therapy can take weeks or months.
- Follow-up care is inconsistent: Only about 40% of children prescribed medication had documented follow-up visits within two months.
Doctors face overwhelming caseloads, and with limited mental health specialists, medication often becomes the fastest — though not always the best — path forward.
Why This Matters
Experts caution that while some children with severe ADHD symptoms may genuinely need immediate medication, the high rate of early prescribing suggests many preschoolers aren’t getting the therapy-first approach that guidelines recommend.
“Preschoolers’ brains are still rapidly developing, and behavioral interventions have the strongest evidence base at this age,” researchers emphasized.
Unless access to therapy improves, families may continue to rely on medication as the first — instead of last — resort.
Study Details
- Publication: JAMA Network Open (August 29, 2025)
- Lead Author: Dr. Yair Bannett, Stanford University School of Medicine
- Sample: 9,708 children diagnosed with ADHD between ages 4–5, across 8 U.S. health systems
- Findings:
- 42.2% prescribed medication within 30 days
- 68.2% prescribed before age 7
- Prescription rates varied widely (44% to 74%) depending on region and system
Bottom Line
This landmark study shows that U.S. doctors often prescribe ADHD medication to preschoolers without delay, despite guidelines recommending therapy first. Systemic barriers, insurance gaps, and resource shortages make behavioral therapy harder to access — leaving medication as the default option for many families.
Until these barriers are addressed, thousands of young children may miss out on the proven benefits of behavioral therapy, highlighting a crucial need for policy and healthcare reform.
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Parents should always consult their child’s healthcare provider for individualized guidance on ADHD diagnosis and treatment.
