Earlier May Be Better for ADHD Meds in Kids

June 25, 2012— -- Children with ADHD who start taking medications as early as fourth grade may be more likely to score better academically than those who start taking medication in middle school, according to a study published Monday in the journal Pediatrics.

Attention deficit hyperactivity disorder is a developmental disorder characterized by problems focusing and erratic behavior. Since 2007, 5.4 million children ages 4 to17 have been diagnosed with ADHD, and 66 percent reported taking medication to treat their symptoms, according to the U.S. Centers for Disease Control and Prevention. A majority of children are diagnosed with ADHD by age 7.

Researchers looked at data of nearly 12,000 Icelandic children born between 1994 and 1996, each of whom began taking medication for ADHD sometime between fourth and seventh grades.

By the time the children reached seventh grade, those who had begun taking medications within the first year of fourth grade showed only a 0.3 percent drop in their math score, compared to a 9 percent drop among children who started medication around sixth or seventh grade.

"Performance of kids with ADHD tends to decline over time, especially if medication is delayed," said Helga Zoega, an epidemiologist at the Institute for Translational Epidemiology at Mount Sinai School of Medicine in New York, and lead author of the study. "Starting medication earlier may halt this decline."

The girls among the group only showed improvement in math after starting medication. The boys showed improvement in both math and language arts.

A majority of kids are diagnosed with ADHD by age 7, Zoega said.

Besides medication, treatments for ADHD include behavioral interventions, education plans, and parental training. The interventions may be the first line of treatment before medication, or may be used in combination with medication.

The study data did not show whether the children received other forms of treatment besides medication, and whether these additional treatments may have influenced their performance.

According to Dr. Stefani Hines, director of the center for human development at Beaumont Children's Hospital in Royal Oak, Mich., medication should not be considered a substitute treatment for other education plans.

"Although ADHD medications do not make a child smarter, they do improve those target symptoms that can hinder academic performance and progress, namely distractibility, attentional weaknesses, and impulsivity," said Hines.

The number of children diagnosed with ADHD has increased 22 percent from 2003 to 2007, and has continued to steadily increase, according to the CDC.

The rise in diagnosis has led to an increase in children who are prescribed stimulant medications such as Ritalin and Adderall.

However, the question remains among many parents and experts is whether children are overprescribed medications without necessarily needing it, experts said.

"This study showed that for kids with ADHD that early intervention is beneficial for them," said Zoelga. "The important thing is the drug reaches the kids who need it at the right time."

In 2011, the American Academy of Pediatrics broadened its ADHD guidelines, recommending that experts begin screening for the disorder in children as early as kindergarten and to begin medication treatment in children as young as age 6.

"We are encouraged to start looking at these issues younger, rather than later," said Hines.

But ADHD is not a one-size-fits-all diagnosis, which has made it challenging to diagnosis and properly manage the disorder in some, said Dr. David Rosenberg, professor of psychiatry at Wayne State University in Detroit, Mich., who was not involved with the study.

Because ADHD has many symptoms and subtypes, a correct diagnosis is key to being prescribed a treatment that works, he said.

"When the diagnosis is made correctly earlier treatment markedly improves response and functioning," said Rosenberg. "The best predictor of good response and fewer side effects is making an accurate diagnosis."

"This is easier said than done," he added.

Zoega agreed, saying future research should look into categorizing different symptoms and create more exact subtypes for an ADHD diagnosis.