Attention-deficit/hyperactivity disorder (ADHD) is characterized by difficulty paying attention to others and impulsive behavior. Behavioral management therapy and stimulant medications are usually used to treat ADHD.

Children diagnosed with ADHD at ages four and five should begin behavioral therapy treatment within six months of diagnosis before adding medication, according to recommendations from the American Academy of Pediatrics.

Medications for ADHD can cause more side effects in four- and five-year-olds whose bodies cannot fully metabolize the drugs. Kids may become more emotional, aggressive and irritable.

Unfortunately, preschoolers are too often receiving medication soon after diagnosis, a team led by researchers at Stanford University found.

These findings are concerning. Yair Bannett, lead author on the study, pointed out that starting ADHD treatment with a behavioral approach benefits both the child and the family. Behavioral management therapy teaches parents how to reward children's good behaviors and ignore bad behaviors. It helps families develop skills and form habits compatible with how the child's brain works.

Medications for ADHD also can cause more side effects in four- and five-year-olds. Their bodies cannot fully metabolize the drugs before the age of six, so kids may become more emotional, aggressive and irritable.

“We know there is a high likelihood of treatment failure because families decide the side effects of medication outweigh the benefits,” said Bannett.

Almost 23 percent of kids who were not formally diagnosed with ADHD, but who displayed ADHD symptoms, were given medication within a month.

When researchers analyzed the electronic health records of more than 9,700 children who were diagnosed with ADHD when they were four and five years old, they noted that many were given drugs before behavioral management therapy. About 68 percent of them were prescribed ADHD medication before the age of seven, and more than 42 percent received a prescription within a month of their diagnosis.

Only 14 percent received a prescription six months after diagnosis and after trying behavioral management therapy. Almost 23 percent of kids who were not formally diagnosed with ADHD at first, but displayed ADHD symptoms, were given medication within a month.

Lack of access to behavioral management therapy is one reason why children are offered drugs first. When the researchers talked to pediatricians who were not involved in the study, they found that some areas don't have therapists who offer behavior therapy, or it is not covered by insurance.

“Doctors tell us they don't have anywhere to send families for behavioral management therapy, so after weighing the risks and benefits, they think it is better to prescribe medication than not to provide treatment at all,” said Bannett, an assistant professor of pediatrics at Stanford. Parents and physicians can find some online resources and links to behavioral management therapy here.

The study is published in JAMA Network Open.