Posted: May 21, 2014 10:00 AM
Normal toddler behavior can look an awful lot like attention deficit disorder. The AAP recommends doctors not diagnose ADHD in children until at least 4 years of age, so why are thousands of 2- and 3-year-olds taking Adderall and Ritalin to regulate their behavior?
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Two toddlers, two types of behavior

I could take my toddler daughter anywhere. A bit reserved by nature, she stays near familiar people until she's utterly comfortable in a new situation — even as a 6-year-old. She is inquisitive, curious and asks a billion questions before breakfast, but I could summon her back to my side with her name or a glance.

My son, well, he's different. His feet don't seem to understand walking speed — he runs, especially when he's playing with his friends. At stores, he picks up food to inspect it, gets out of the car cart to "change the tire" and generally makes me wonder if something is wrong with his hearing — until I whisper something about ice cream in the kitchen and he runs in from an upstairs bedroom.

Normal toddler behavior can look a little wild

Despite my completely different experiences with the transition years between toddlerhood and preschool-aged children, I've never seriously considered either of their behaviors anything but normal. From playgrounds and indoor bounce houses to churches and Target aisles, toddler behavior looks like everything from a person weaving between his mama's legs to one — literally — bouncing off the walls, floor and everything in between. There are times that behavior can happen within a 10-minute span. I'm not an expert, but I've seen a lot of toddlers between my moms' clubs, school functions, preschool classes and the children of friends and relatives. I was saddened to read news of a report stating around 10,000 toddlers — kids under 4 — are currently taking stimulants as part of an ADHD diagnosis.

Side effects of stimulant use in young children

Adderall and Ritalin are two of the most common medications used for children diagnosed with attention deficit hyperactivity disorder (ADHD). The stimulant medications, which work almost like speed for children and adults without ADHD, help children diagnosed with ADHD focus and control their impulsivity. While the medications are generally effective for improving behavior, parents understand they may have to accept side effects with the welcome tool. Side effects of Adderall and Ritalin include loss of appetite and disruptions in sleep patterns.

Adderall and toddlers don't mix

The problem with prescribing ADHD medication to 2- and 3-year-old children seems to be twofold. The American Academy of Pediatrics recommends not evaluating children for ADHD until at least 4 years of age. Some of the benchmarks for the disorder, including inattention and impulsivity, are actually developmentally appropriate for toddlers. Prescribing medication to counter those behaviors may be a short-term solution, but it robs children and parents of working together to develop age-appropriate techniques to counter those behaviors.

In addition to the developmental appropriateness of the medication, the physical effects are problematic. Long-term studies haven't been conducted on stimulant use in young children, so experts are unsure how medication used on 2- and 3-year-olds will affect them in future years. The basic side effects in slightly older children can be even more pronounced in toddlers, who are already prone to picky eating and interrupted sleep patterns.

The Medicaid factor

Adding a layer onto the disturbing factor of the number of children currently taking Adderall and Ritalin is the fact that toddlers covered by Medicaid are prescribed the medications at a statistically higher rate. Speculation about the increase — overall numbers for the study were extrapolated from data collected from Georgia's Medicaid and private insurance records — is only speculation but includes the idea that some of the children in underprivileged homes are reacting to general chaos in their lives with behavior mimicking ADHD symptoms.

Whatever the reason, those children are being prescribed a medication most experts agree should be an absolute last resort for toddlers. Keith Connors is a long-respected expert in the ADHD field and a psychologist and professor emeritus at Duke University. He is quoted in The New York Times article as saying, "… he had occasionally recommended it when nothing else would calm a toddler who was a harm to himself or others."

Keep questioning Adderall use in toddlers

Questioning the use of stimulants in regard to toddler behavior isn't an attempt to vilify parents who are at their wit's end with their children. Parents using the medications are doing so at the advice of their pediatricians, and many of them are simply doing their best to help their children be the best version of themselves they can be. The problem with diagnosing ADHD in toddlers is the best version of a toddler is often one who is hyper, then calm, impulsive, then deliberate, loving, then defiant — all in one afternoon.

More about toddler behavior

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Why little kids don't want to share
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