A Stanford Medicine-led study finds that many young kids diagnosed with ADHD are prescribed medication immediately.
This is even though guidelines recommend starting with behavioral therapy.
Published in JAMA Network Open, the research emphasizes that current American Academy of Pediatrics guidelines suggest first implementing six months of behavioral therapy before starting medication.
And that’s even if you truly believe that behavioral therapy is much needed.
Medication Often Comes First
It’s always easy to just hand a pill and glass of water to your little ADHD’er and say, “Take your medicine.”
But you’ll want to question if rushing into this as a shotgun reaction to the new diagnosis is the smartest thing to do for the long-term.
For the research, analysis of medical records from nearly 10,000 kids across eight U.S. pediatric health networks showed that many young patients received ADHD medication right after diagnosis.
Yair Bannett, MD, was the study’s lead author. Dr. Bannett says that the immediate reliance on a drug is concerning “because behavioral therapy has a big positive effect on the child and the family.”
ADHD Medication Risks for for Kids Under 6
Stimulant medications, the most common ADHD treatment, can cause stronger side effects in preschoolers.
Those under six metabolize these drugs more slowly, which can lead to irritability, emotional swings and aggression.
Dr. Bannett explains that the side effects can outweigh any benefits.
This is why behavioral therapy should be the first go-to.
Behavioral Therapy vs. Medication
Behavioral therapy focuses on the child’s environment, helping parents build routines and reinforce positive behaviors.
Though it can sometimes be difficult to distinguish between “It’s the ADHD” and “It’s normal behavior for an active energized child,” there are some ADHD features that can be troublesome.
These include being way too energized, such as not being able to stay in their seat at church, at a wedding or at a restaurant.
It could mean difficulty focusing on learning an age-appropriate task.
Parent training in behavior management, recommended by the American Academy of Pediatrics, teaches parents to reward good behavior, ignore negative actions and use tools like visual schedules to keep their kids organized.
Medication targets symptoms like hyperactivity and inattention — but only works while the drug is active in the body.
Research shows preschoolers do best when behavioral therapy is tried first, followed by medication as a very last resort.
Study Details and Key Findings
The researchers reviewed over 712,000 records from children ages three to five seen at eight U.S. academic medical centers.
Of the 9,708 kids diagnosed with ADHD, 42.2% received medication within 30 days of diagnosis.
Only 14.1% started medication after six months.
Even those initially showing ADHD symptoms without a formal diagnosis were often prescribed drugs quickly.
There are a number of conditions in kids that can mimic ADHD!
Barriers to Behavioral Therapy
Limited access to trained therapists and insurance coverage are major challenges.
Some doctors are apt to promptly prescribe a drug when they know there’s nowhere to send the patient for behavioral management.
But this doesn’t mean a dead-end for these parents.
Free or low-cost online resources can help them learn behavioral techniques at home.
Facebook groups with a dedication to parents of ADHD’ers can be a very helpful resource.
Behavioral therapy also benefits older children, teaching long-term skills that medication alone falls short on.
“Medication is never the only solution for ADHD,” says Dr. Bannett in the paper.
The paper was published in JAMA Network Open (August 2025).
The Great Mimicker of ADHD in Kids
Obstructive sleep apnea can easily be misdiagnosed for ADHD in children (and adults, for that matter).
The symptoms of both conditions overlap significantly.
You cannot rule out sleep apnea in your child just because they’re not overweight, as OSA has numerous causes unrelated to body weight.
Only a sleep study can diagnoses OSA; a physician cannot rule this out by simply looking at your kid in an exam room.
