Too many toddlers getting ADHD drugs, experts say

ATLANTA — More than 10,000 American toddlers 2 or 3 years old are being medicated for attentiondeficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Centers for Disease Control and Prevention.

The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of ADHD in children younger than 4.

Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts, strongly criticized the use of medication in so many children that young.

The American Academy of Pediatrics standardpractice guidelines for ADHD do not even address the diagnosis in children 3 or younger —

“It’s absolutely shocking, and it shouldn’t be happening.” — Anita Zervigon-Hakes Carter Center consultant

let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group.

“It’s absolutely shocking, and it shouldn’t be happening,” said Anita Zervigon-Hakes, a children’s mental-health consultant to the center.

Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., said: “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.”

Last year, a CDC survey found that the disorder has been diagnosed in 11 percent of children ages 4 to 17, and that it will be diagnosed in 1 in 5 boys.

The vast majority are put on medications such as methylphenidate (commonly known as Ritalin) or amphetamines such as Adderall, which often calm a child’s hyperactivity and impulsivity but also carry risks for growth suppression, insomnia and hallucinations.

Only Adderall is approved by the Food and Drug Administration for children younger than 6. However, because offlabel use of methylphenidate in preschool children had had some encouraging results, the most recent American Academy of Pediatrics guidelines authorized it in 4- and 5-year-olds — but only after formal training for parents and teachers to improve the child’s environment failed.

Children younger than 4 are not covered in those guidelines because hyperactivity and impulsivity are appropriate for toddlers, several experts said, and more time is needed to see if a disorder is truly present.