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 A.D.H.D. in children below age 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 standard practice guidelines for A.D.H.D. do not even address the diagnosis in children 3 and younger let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group. Its absolutely shocking, and it shouldnt be happening, said Anita Zervigon-Hakes, a childrens mental health consultant to the Carter Center. People are just feeling around in the dark. We obviously dont have our act together for little children.
Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., said in a telephone interview: 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. Fridays report was the latest to raise concerns about A.D.H.D. diagnoses and medications for American children beyond what many experts consider medically justified. Last year, a nationwide C.D.C. survey found that 11 percent of children ages 4 to 17 have received a diagnosis of the disorder, and that about one in five boys will get one during childhood. A vast majority are put on medications such as methylphenidate (commonly known as Ritalin) or amphetamines like Adderall, which often calm a childs 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 below age 6. However, because off-label use of methylphenidate in preschool children had produced 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 childs environment were unsuccessful. Children below age 4 are not covered in those guidelines because hyperactivity and impulsivity are developmentally appropriate for toddlers, several experts said, and more time is needed to see if a disorder is truly present. Susanna N. Visser, who oversees the C.D.C.s research on the disorder, compiled Fridays report through two sources: Medicaid claims in Georgia and claims by privately insured families nationwide kept by MarketScan, a research firm. Her report did not directly present a total number of toddlers 2 and 3 years old nationwide being medicated for the disorder, however her data suggested a number of at least 10,000 and perhaps many more.
Dr. Vissers analysis of Georgia Medicaid claims found about one in 225 toddlers being medicated for A.D.H.D., or 760 cases in that state alone. Dr. Visser said that nationwide Medicaid data were not yet available, but Georgias rates of the disorder are very typical of the United States as a whole. If we applied Georgias rate to the number of toddlers on Medicaid nationwide, we would expect at least 10,000 of those to be on A.D.H.D. medication, Dr. Visser said in an interview. She added that MarketScan data suggested that an additional 4,000 toddlers covered by private insurance were being medicated for the disorder. Dr. Visser said that effective nonpharmacological treatments, such as teaching parents and day care workers to provide more structured environments for such children, were often ignored. Families of toddlers with behavioral problems are coming to the doctors office for help, and the help theyre getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child, Dr. Visser said. It puts these children and their developing minds at risk, and their health is at risk.
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