AAP 2011: New ADHD Guidelines Allow Diagnosis at Age Four

Perhaps intentionally, the Monday morning AAP session “ADHD Diagnosis and Management in Young Children” was a blitzkrieg of ADHD facts and studies that seemed to jump all over the place (in a good way). Presenter Andrew Adesman, MD, did a nice job of keeping the audience’s attention (ironic, huh?) by including several slides with hilarious comics relating to ADHD.

But aside from pleasing the crowd, Adesman’s presentation was chock full of information and also came on the heels of the AAP’s new ADHD guidelines for young children, which were released just after midnight last night and now allow for an ADHD diagnosis in children as young as 4-years old. In order for an ADHD diagnosis to be possible in age group, overactive, impulsive behavior must be seen consistently for four to six months in both the home and another environment, like school. However, the new guidelines are a bit controversial because three out of the four common medications used to prescribe ADHD patients are not FDA approved for that subset of young patients.

Adesman started off his presentation by addressing the common argument that ADHD, which according to the AAP is prevalent in 8% of children, is not a “real disorder” because there are no laboratory tests for the condition. “Then I guess mental retardation, autism, and migraines aren’t ‘real conditions’ either because there are no lab tests for those,” he quipped.

One of the sets of data Adesman presented in particular stood out. It had to do with a study 60 four-year olds that were split up into three groups. One subset was asked to color for 9 minutes; another watched an educational cartoon on PBS for 9 minutes ; and the third group watched the fast-paced Nickelodeon cartoon Spongebob Squarepants for 9 minutes. Afterwards, all of the children were tested with “executive function tasks” (one of these functions included instructors telling the children that when they asked them to touch their head that they actually should touch their feet). The data from the study was very alarming; children who watched the Spongebob Squarepants cartoon performed significantly worse compared to their PBS cartoon and coloring group counterparts. The quick, nonstop action and multi-sensory impact of the Spongebob cartoon seemed to have a negative impact on the attention spans of those children.

During another part of the presentation, Adesman spoke the ten factors he personally considers when deciding to medicate a young child for ADHD symptoms, something that will undoubtedly become more controversial now that diagnosis can be made in four year olds. Those factors are:

- if the child has failed behavioral therapy

- if the child is ejected from mainstream preschool

- the threat of imminent ejection from mainstream preschool

- a strong family history of ADHD

- organicity (down syndrome, fetal alcohol abuse, etc)

- developmental delay or disorder where behaviors interfere with therapy

- when the child is a safety threat to self or others (peers, siblings, parents, etc)

- when the mother on verge of mental breakdown

- when the child’s parents’ marriage is on verge of dissolution

Adesman seemed to be joking (somewhat) when it came to the last couple, but he did seem serious about the rest, and, in general, seemed to support the new guidelines for ADHD. What do you think about the new guidelines? Should four-year olds be given the possibility of an ADHD diagnosis?