Thousands of the nation’s poorest children under the age of four are being prescribed stimulants like Ritalin and Adderall for ailments they’re too young to even have. A first-ever CDC study estimates that under the Medicaid healthcare program, doctors have given some 10,000 American toddlers a diagnosis of ADHD and treated them with ADHD drugs that have not been shown to be effective or safe in children that young.
The news that amphetamine-based drugs like Adderall and the methylphenidate Ritalin are being used to medicate, at a minimum, one out of every 225 toddlers nationwide outraged some medical professionals when it was first announced in May at the Georgia Mental Health Forum.
“It’s absolutely shocking, and it shouldn’t be happening,” Anita Zervigon-Hakes, a children’s consultant to the Carter Center, which sponsored the forum, told the New York Times. “[Doctors] are just feeling around in the dark. We obviously don’t have our act together for little children.”
Prescribing ADHD drugs to toddlers against the recommendations of experts may be a new practice, but it is part of a much larger trend of prescribing psychoactive drugs to children who are in foster care, juvenile detention or just living in poverty. (The practice also extends to elderly people in nursing homes.) Impulsive, aggressive behavior is common in such settings, and may be a symptom of ADHD or other medical conditions requiring medication.
“I’ve put several three-year-olds on it [as a last resort] and, with the medication, it’s like night and day,” said Max Wiznitzer, MD, a pediatric neurologist at University Hospitals Rainbow Babies & Children’s Hospitals. ”These are very challenging children. We’ve made sure they do have ADHD features, that their behavior is occurring in multiple settings, that it’s not due to poor parenting, it’s not due to poor teaching, it’s not some other medical condition.”
Yet critics ask if the practice is doing more harm than good. They say that the high rates of use of these drugs amount to gross over-prescribing.
Susanna Visser, who heads ADHD research at the CDC and who presented the report, said, “Families of toddlers with behavioral problems are coming to the doctor’s office for help, and the help they’re getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child. It puts these children and their developing minds at risk, and their health is at risk.”