The American Academy of Pediatrics has lowered the age of potential diagnosis of Attention Deficit Hyperactive Disorder to 4 years. Even though it appears that the diagnosis is still controversial. Sounds a lot like not very long ago when autism was mostly diagnosed based on clinical observation with very few validated scales. We arrived at the ADOS and ADI-R, but are now also about to arrive at the DSM-5; and open up that continuum, no more Autistic Disorder or Asperger's, just Spectrum. Anyhow:
From the Globe and Mail piece today:
The guidelines emphasize behavioral therapy as treatment for children diagnosed under the age of six before resorting to drugs such as Ritalin. The policy won praise in Canada, where ADHD occurs in about 5 per cent of the population and doctors are more conservative than their U.S. counterparts about making an official diagnosis of ADHD.
For older children they are still recommending behavioral treatment plus stimulants.
From the National Institutes of Health:
Attention deficit hyperactivity disorder or ADHD is a commonly diagnosed behavioral disorder of childhood that represents a costly major public health problem. Children with ADHD have pronounced impairments and can experience long-term adverse effects on academic performance, vocational success, and social-emotional development which have a profound impact on individuals, families, schools, and society. Despite progress in the assessment, diagnosis, and treatment of ADHD, this disorder and its treatment have remained controversial, especially the use of psychostimulants for both short and long-term treatment. Although an independent diagnostic test for ADHD does not exist, there is evidence supporting the validity of the disorder. Further research is needed on the dimensional aspects of ADHD, as well as the co-morbid (coexisting) conditions present in both childhood and adult forms. Studies, (primarily short term, approximately three months) including randomized clinical trials, have established the efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD and associated aggressiveness and have indicated that stimulants are more effective than psychosocial therapies in treating these symptoms. Because of the lack of consistent improvement beyond the core symptoms and the paucity of long-term studies (beyond 14 months), there is a need for longer term studies with drugs and behavioral modalities and their combination. Although trials are underway, conclusive recommendations concerning treatment for the long term cannot be made presently. There are wide variations in the use of psychostimulants across communities and physicians, suggesting no consensus regarding which ADHD patients should be treated with psychostimulants. Consens statement.
A few days after this post was published, this Time article was published and responds to my concerns, which clearly are everyone's concerns; will more and more kids be diagnosed and be treated with medication, and younger and younger? The author says no, don't worry, the new guidelines are here to ensure the opposite. Hopefully.
She also says:
She also says:
For one thing, the new guidelines advise doctors to ascertain that the core symptoms that generally lead kids to be diagnosed with ADHD – inattention, hyperactivity, and impulsivity, most notably – have been present, in more than one situation, for nine months, rather than the six months currently specified by the psychiatric Bible, the DSM-IV. For another, they strongly recommend that medication be used only as a last resort for very young children (and then only in cases where the child’s symptoms are causing “moderate-to-severe continuing disturbance” in his or her life). They instead recommend behavior modification as a first-line treatment.Read the full article.
