New CDC Guidelines for Preschool ADHD

June 3, 2016

The Center for Disease Control has introduced new guidelines for treating Attention Deficit-Hyperactivity Disorder (ADHD) in preschool-aged children. For children five and younger, the new guidelines suggest that the first-line treatment for ADHD should be behavioral therapy, emphasizing positive communication, positive reinforcement, and structure as key tools for parents to learn. According to the CDC report, behavior therapy reduces symptoms for 70-80% of young children with ADHD. Though behavior therapy tends to require more time and effort from parents than medication does, the effects may be longer-lasting.

Key Behavior Therapy Skills for Parents

 

Positive Communication 

  • Phrase rules and instructions in terms of what your son should do, rather than what he should not do. For example, say, "Keep your hands to yourself," instead of, "Don't hit your brother." 

  • When your child makes a mistake, talk to her about how to fix it and what she could do next time. 

 

Positive Reinforcement

  • Reward behaviors that you want to see more often. Another way to phrase this one is to try to "catch 'em being good." Praise, hugs, and tickles are excellent rewards. Give your child a high-five when you see her picking up toys or helping a friend. 

  • Sticker charts that build up to bigger prizes (e.g., a trip to the park, a special toy, ice cream with Dad) are excellent ways to help your child learn and practice a new, positive behavior.

 

Structure

  • Provide a consistent routine for your child. Children need repetition in order to learn, and providing a bit of predictability helps most children feel safe and confident as they explore their world each day.

  • Use activities, rather than time, as anchors in your child's day. Tell your son, "We just had lunch, so now it's nap time," rather than "It's noon, nap time!" As your child grows, incorporating the concept of time will be important, but it doesn't help much in terms of providing structure for a young child. 

  • Talk to your daughter in advance about changes in her routine. If your partner will pick your child up from preschool instead of you today, make sure to remind her when you drop her off.

  • Pay attention to transitions. Children have less developed frontal lobes (the areas of the brain recruited when switching tasks) than adults do, so changing activities can be difficult for them. Sing a song, count, or play a game to help ease your child's way from the playground to the stroller.

So what about medication? The CDC says that, like behavioral therapy, it can be 70-80% effective for young children with ADHD. However, a literature review by the Preschool Psychopharmacology Working Group (PPWG) found that many of the effects tend to be short-term, not lasting after the medication is discontinued. The PPWG also concluded that we need much more information about long-term side-effects of using stimulants with young children to be confident that doings so is safe. Currently, the CDC and the American Academy of Pediatrics (ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/ Hyperactivity Disorder in Children and Adolescents) both recommend that stimulant medications only be used as a second option and managed with great care. 

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