https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2838257
ADHD Diagnosis and Timing of Medication Initiation Among Children Aged 3 to 5 Years
Question What is the prevalence of attention-deficit/hyperactivity disorder (ADHD) diagnoses and timing of initiation of medications among children aged 3 to 5 years seen in primary care?
Findings In this cohort study of electronic health records for 712 478 children seen in primary care practices at 8 US pediatric health systems, the prevalence of ADHD was 1.4% (range across institutions, 0.5%-3.1%); 68.2% of patients were prescribed medications and 42.2% had medications prescribed within 30 days of diagnosis, with variation by race, ethnicity, and insurance type.
MeaningThese findings suggest that investigation of barriers to nonpharmacological interventions, as well as factors associated with early prescriptions of ADHD medications, for preschool-age children is warranted.
Abstract
Importance Early identification and treatment of attention-deficit/hyperactivity disorder (ADHD) symptoms in preschool-age children is important for mitigating social, emotional, and academic problems. Clinical practice guidelines recommend first-line behavior intervention before considering medication treatment for children aged 4 to 5 years.
Objective To assess variation in rates of ADHD identification and rates and timing of medication initiation in children aged 3 to 5 years in primary care settings across 8 US pediatric health systems and to identify patient factors associated with the time from diagnosis to prescription.
Design, Setting, and Participants This retrospective cohort study used electronic health records from primary care clinics affiliated with 8 academic institutions participating in the PEDSnet Clinical Research Network. Participants were children aged 3 to 5 years seen between 2016 to 2023. Data were extracted from the PEDSnet database on April 18, 2025.
ExposureADHD diagnosis at age 4 to 5 years.
Main Outcomes and Measures The primary outcomes were (1) rate of ADHD diagnosis, (2) rate of stimulant and nonstimulant prescription after diagnosis before age 7 years, and (3) time from first ADHD-related diagnosis (including symptom-level diagnoses) to medication prescription. Independent variables included institution, year of diagnosis, patient age, sex, race and ethnicity, medical insurance, and presence of comorbidities. Multivariable Cox proportional hazards models were used to estimate associations between clinical and demographic variables and time from diagnosis to prescription.
Results Of 712 478 children seen in primary care at age 3 to 5 years, 9708 (1.4%) received an ADHD diagnosis at age 4 to 5 years (range across institutions, 0.5%-3.1%; median [IQR] age at first ADHD-related diagnosis, 5.31 [4.86-5.66] years). Of those with ADHD, 7414 (76.4%) were male, 1762 (18.1%) were Hispanic, 122 (1.3%) were non-Hispanic Asian, 3014 (31.0%) were non-Hispanic Black, 479 (4.9%) were non-Hispanic multiracial, 3782 (39.0%) were non-Hispanic White, 148 (1.5%) were non-Hispanic other, and 401 (4.1%) were of unknown race and ethnicity. Of 9708 preschool-age children with ADHD, 6624 (68.2%) were prescribed ADHD medications before age 7 years, and 4092 (42.2%) were prescribed medications within 30 days of the first documentation of an ADHD-related diagnosis (range across institutions, 26.0%-49.0%). Asian (adjusted hazard ratio [aHR], 0.51; 95% CI, 0.38-0.68), Hispanic (aHR, 0.75; 95% CI, 0.70-0.81), and Black (aHR, 0.88; 95% CI, 0.83-0.94) children with ADHD were less likely to be prescribed medication early compared with White children. Older vs younger patients (aHR, 1.62; 95% CI, 1.55-1.69), male vs female patients (aHR, 1.17; 95% CI, 1.11-1.25), and publicly insured vs privately insured patients (aHR, 1.09; 95% CI, 1.03-1.15) were more likely to be prescribed medication early.
Conclusion and Relevance In this retrospective cohort study of preschool-age children with ADHD seen in primary care in 8 large pediatric health systems, many children were prescribed medications at or shortly after the first documented diagnosis. Analysis of clinical documentation is needed to understand early prescription patterns.
https://www.cbsnews.com/news/young-children-diagnosed-adhd-often-prescribed-medication-too-quickly-study-finds/
Young children diagnosed with ADHD are often prescribed medication too quickly, study finds
A new study released Friday found that young children diagnosed with attention-deficit/hyperactivity disorder, or ADHD, are often prescribed medication too quickly.
The study, led by Stanford Medicine and published in JAMA Network Open, examined the health records of nearly 10,000 preschool-aged children ages 3 to 5 between 2016 and 2023 who were diagnosed with ADHD.
"ADHD is a disorder characterized by difficulty paying attention, or what we call hyperactivity, which is sort of like kids that have a hard time sitting still, they have a lot of energy," explained Jamie Howard, a senior clinical psychologist with the Child Mind Institute, which specializes in treating anxiety and mood disorders in children.
Howard, who was not involved in the study, said that when treating ADHD in young children, clinical guidelines call for starting with "behavioral intervention."
"We always want to start with the lowest possible harm," Howard said. "It does very little harm doing a behavioral intervention."
The Stanford study found that about 68% of those children who were diagnosed with ADHD were prescribed medications before age 7, most often stimulants such as Ritalin, which can help children focus their attention and regulate their emotions.
Ritalin = Speed