Drugs or therapy for preschoolers with ADHD? Local doctor weighs in

WASHINGTON — The Centers for Disease Control and Prevention said behavioral therapy should be the first line of treatment for children under 6 with ADHD. But far too many little kids with attention deficit hyperactive disorder who need therapy, don’t get it.

“There is just not enough resources for these kids,” said Dr. Bhavin Dave, a psychiatrist with the Children’s National Health System and associate director of their Infant and Toddler Mental Health Program.

He said there are only two or three psychiatrists in private practice in D.C. who work with preschoolers, along with those seeing kids through the city’s Department of Behavioral Health.

“Finding therapy resources is even more difficult,” Dave said, adding that he often has to scramble to try to find referrals for children who show up in his clinic.

It appears here, as in most other places around the country, trained therapists who can coach parents through the process of working with their ADHD children are in short supply. As a result, many of these kids are diagnosed or treated by family physicians or pediatricians who opt for drugs because other options are not readily available.

The CDC said three out of four kids with ADHD are still put on medications, despite lingering concerns about side effects. Studies have shown behavioral therapy to be just as effective and potentially much safer.

Dave said the advantage of medications is that they are available — all you need is a prescription and a pharmacist — and finding a therapist who deals with small children is difficult at best.

The CDC’s message to parents is “keep trying.” Also, there is a not-so subtle message to the health insurance industry, that it might be missing out on a more effective form of treatment.

“Finding a therapist is one obstacle and then once you find a therapist, finding one that is covered by insurance, that is the second big obstacle,” Dave said.

Coverage is actually better for kids on Medicaid than those covered by private insurance, he added. The CDC said 54 percent of preschoolers with ADHD on Medicaid got psychological services annually, compared to 45 percent of those with employer-sponsored insurance.

During behavior therapy, a therapist trains parents how to guide their child’s behavior using praise, communication and discipline.

“It really is those skills that every child needs to learn, it is just that it is a little bit harder for kids that have ADHD because their attention span is short and they have less impulse control,” Dave said.

ADHD makes it hard for kids to pay attention and control that impulsive behavior. More than 6 million American kids have it, and about one-third are diagnosed before the age of 6.

Local resources for kids with ADHD — in addition to programs at Children’s National — include the D.C. government’s Strong Start Program and Mary’s Center, which operates clinics in D.C. and Silver Spring.

The Associated Press contributed to this report.

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