ADHD Drugs Are Being Prescribed Too Quickly to Preschoolers, Study Finds
A new Stanford University-led study published in JAMA Network Open has revealed that a large number of preschoolers diagnosed with ADHD are being prescribed medication far sooner than medical guidelines recommend. The research analyzed health data from thousands of children across the United States and found that many were given stimulant medications within just a month of diagnosis, skipping the recommended behavioral therapy period that should come first.
This discovery raises important questions about how ADHD is managed in very young children and why many doctors may be deviating from established treatment standards.
What the Study Looked At
The study, conducted by researchers at Stanford Medicine, examined electronic health records from more than 712,000 children between the ages of 3 and 5 who received care at eight major pediatric health networks across the U.S. from 2016 to 2023. Out of this large group, 9,708 children were formally diagnosed with attention-deficit/hyperactivity disorder (ADHD) — about 1.4% of the total sample.
Researchers then tracked when these diagnosed children first received medication. They found that 42.2% (roughly 4,000 children) were prescribed ADHD drugs within 30 days of their diagnosis. Only 14.1% started medication six months or more after being diagnosed — the approach that aligns with the American Academy of Pediatrics (AAP) guidelines.
Another striking finding was that even among children who had only ADHD symptoms noted in their charts, without a formal diagnosis yet, nearly one in four (22.9%) still received medication within the first 30 days.
What the Guidelines Actually Say
According to the AAP’s ADHD treatment guidelines, the first line of treatment for children aged 4 and 5 years old should be behavioral therapy, not medication. Specifically, the guidelines recommend six months of parent training in behavior management before starting stimulant medications such as methylphenidate.
This kind of therapy focuses on teaching parents how to structure their child’s environment, set routines, and use positive reinforcement. It helps both parents and children develop strategies that work with, rather than against, the child’s neurological differences.
Behavioral therapy has been proven to improve outcomes in preschoolers with ADHD, including reducing hyperactivity, improving attention, and supporting emotional regulation. More importantly, it builds long-term skills — something medication alone cannot provide.
Medication, on the other hand, is mainly used to manage symptoms like impulsivity or inattentiveness and wears off once the dose leaves the body. For most older children, the best results come from combining both approaches. However, in preschool-aged children, behavioral therapy is meant to come first, not as an afterthought.
Why the Findings Are Concerning
Giving medication too early in the treatment process poses multiple challenges. Preschoolers’ bodies metabolize stimulant drugs differently than older children, which can lead to more intense or unpredictable side effects.
Common side effects include irritability, aggression, emotional outbursts, appetite loss, and sleep disturbances. Many families end up stopping the medication because the side effects outweigh the benefits. While the drugs are not considered toxic to children under 6, the overall treatment success rate is lower for this age group.
The study’s authors emphasize that beginning treatment with a behavioral approach tends to benefit both the child and the family unit, setting up healthier long-term patterns and improving the child’s ability to thrive in school and daily life.
Why Are Doctors Prescribing So Quickly?
The researchers didn’t have access to detailed notes on why physicians made these decisions, but they conducted informal conversations with some pediatricians to understand the patterns. One of the most commonly cited reasons was lack of access to behavioral therapy.
In many areas, there are few trained therapists who specialize in parent-focused behavioral training for ADHD. In other cases, insurance limitations or high costs make therapy difficult to obtain. For some doctors, prescribing medication immediately might seem like a practical compromise — offering some form of treatment instead of leaving the child untreated while waiting for therapy options.
Another reason may be the pressure from parents who want to see quick results, especially when their child is struggling in preschool or early elementary settings. But experts argue that short-term symptom relief shouldn’t replace long-term developmental strategies that can have lasting benefits.
ADHD in Preschoolers: What Makes It Different
ADHD is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. While it’s often diagnosed in school-age children, symptoms can appear as early as age 3. However, identifying ADHD at this young age is complex because many typical preschool behaviors — such as high activity levels or short attention spans — can mimic ADHD symptoms.
That’s why early intervention needs to be careful and comprehensive. When ADHD is confirmed in preschoolers, treatment aims to balance symptom management with supporting brain and behavioral development.
In older children and adults, stimulant medications like Adderall, Ritalin, or Vyvanse can be highly effective. But for children under 6, their developing nervous systems make them more sensitive to dosage and side effects. This reinforces why guidelines recommend a behavior-first approach.
The Bigger Picture: Gaps in Pediatric Mental Health Care
The findings from this study highlight broader issues in pediatric mental health infrastructure. Even when evidence-based treatments exist, access and affordability remain major barriers.
Behavioral therapy programs require specialized providers, yet training programs for these professionals are limited. Additionally, insurance coverage for behavioral treatments is inconsistent — some plans cover only partial sessions, while others exclude them entirely.
The study’s lead researchers have expressed a hope that these results will encourage pediatricians and policymakers to find ways to close this gap. Some free or low-cost online behavioral training resources for parents are already available, but awareness and integration into standard care remain low.
Why Early ADHD Management Matters
Properly addressing ADHD early on can make a huge difference. Studies show that effective early treatment can improve academic performance, help children develop stronger social skills, and reduce the risk of later problems like school failure, unemployment, or even legal troubles in adulthood.
However, rushing into medication without giving behavioral approaches a chance may undermine these benefits. As the study shows, there’s still a disconnect between research-based guidelines and everyday clinical practice, particularly for the youngest patients.
Moving Forward
The Stanford study doesn’t claim that medication should never be used in preschoolers — it simply underscores the importance of starting treatment with behavioral therapy first, as the AAP recommends. For children aged 6 and above, both medication and therapy are typically advised together.
Ultimately, this research is a reminder that ADHD treatment should be personalized, considering each child’s unique developmental needs, family circumstances, and access to resources.
As more pediatricians and families become aware of these findings, the hope is that more young children will get the right kind of help at the right time — starting with understanding and behavioral support before moving to medication.
Research Reference:
ADHD Diagnosis and Timing of Medication Initiation Among Children Aged 3 to 5 Years – JAMA Network Open (2025)
