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Are the 2011 AAP Guidelines Influencing How Often We Diagnose and Treat ADHD in Preschoolers? :

November 30, 2016

If you care for patients in the primary care setting, it has become common for parents of preschoolers to ask if their child might be hyperactive and ask about their need to start medication for attention-deficit hyperactivity disorder (ADHD).

If you care for patients in the primary care setting, it has become common for parents of preschoolers to ask if their child might be hyperactive and ask about their need to start medication for attention-deficit hyperactivity disorder (ADHD). In fact during the last decade there has been an increasing trend of children age 4-5 years diagnosed and often treated with a stimulant medication for what was considered ADHD. For this reason the AAP in 2011 put out evidence-based guidelines to help all of us better decide whether a preschool child really meets diagnostic criteria for ADHD or not, and when pharmacologic treatment is warranted.


Given that guidelines often go unheeded despite their evidence-based derivation, Fiks et al. (10.1542/peds.2016-2025) decided to see if the 2011 AAP Guidelines were doing anything to curb the increasing trend in ADHD diagnosis before the age of 5. The authors used electronic health record data from 63 primary care practices in a consortium and compared rates of ADHD diagnosis and stimulant prescriptions before and after the 2011 AAP Guidelines were published.  While prior articles we have published have been disappointing in how little the guidelines change behavior—pay attention to this study—because it appears these particular guidelines have stemmed the tide of what may be overdiagnosis of ADHD once guideline criteria are applied.  While the number of children diagnosed with ADHD seems to be no longer increasing yearly, the number being treated appears to have not changed over time with the publication of guidelines, despite the guidelines suggesting medication is not first-line for young children with this disorder. 

ADHD expert and behavioral and developmental pediatrician Dr. Mark Wolraich (10.1542/peds.2016-2928) helps us make sense of these ADHD findings pre and post AAP guidelines in an accompanying commentary that should stimulate you to use these guidelines if you aren’t already while also stressing the importance of doing a better job to coordinate and integrate care plans for these young patients with other mental health professionals, pediatricians and families themselves .  Are you diagnosing more or less children under 5 with ADHD nowadays and are you using the AAP 2011 Guidelines to do this?  We welcome your thought and comments by responding to this blog, sending a comment to our website where the article is posted, or sharing your thoughts on our Facebook, Twitter, or Instagram sites.

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