A new Stanford Medicine-led study reveals that many preschoolers diagnosed with attention deficit/hyperactivity disorder (ADHD) are being prescribed medication far earlier than recommended. Current guidelines from the American Academy of Pediatrics state that children ages 4 and 5 should begin with at least six months of behavioral therapy before trying medication.
Published August 29 in JAMA Network Open, the study analyzed nearly 10,000 medical records from children across eight U.S. pediatric networks. Researchers found that 42.2% of young children were prescribed stimulant medication within just one month of diagnosis. Only 14.1% started medication after the recommended six-month therapy period.
“We found that many young children are being prescribed medications very soon after their diagnosis of ADHD is documented,” said lead author Yair Bannett, MD, assistant professor of pediatrics. “That’s concerning, because we know starting ADHD treatment with a behavioral approach is beneficial; it has a big positive effect on the child as well as on the family.”
Experts caution that stimulant drugs cause more side effects in preschoolers, including irritability, aggression, and emotional swings, since their bodies metabolize medicine differently from older kids. Many families stop treatment because the side effects outweigh the benefits.
Behavioral therapy—specifically parent training in behavior management—teaches parents strategies to guide their child’s behavior, reinforce positive actions, and create supportive routines. Medication, on the other hand, temporarily eases symptoms like hyperactivity and inattention but doesn’t build long-term coping skills.
Limited access to behavioral programs and insurance coverage often pushes doctors toward prescribing medication first. Bannett stressed the importance of expanding therapy access and educating physicians on alternatives.
“For kids 6 and above, the recommendation is both treatments,” he added. “Medication will not do that, so we never think of medication as the only solution for ADHD.”
Too Many Preschoolers With ADHD Are Prescribed Drugs Before Therapy, Study Warns
