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“The American Academy of Pediatrics this week issued new guidelines urging doctors to begin looking for signs of Attention Deficit Hyperactivity Disorder – ADHD – in children as young as four years old. Before, the guidelines had set the minimum age at 6 years old.”

These new guidelines, discussed here on NPR’s On Point Radio Show, are designed to signal parents and professionals that signs consistent with ADHD can appear in children as young as four. As part of early identification, there’s a lot of good that can come out of this. Not surprisingly however, this has begun to generate a firestorm of discussion.

There are pieces to these new guidelines that’s entirely good and fundamentally sound. I have a couple of issues however: Especially with young children, doing a thorough and differential evaluation (which means to look at other or overlapping possibilities that explain the presenting behaviors), one needs to include a complete history and observation of the child in different settings in addition to the office. Evaluation of ADHD or other conditions has to be deep and authentic, and should not rely solely on parent or even teacher rating scales or comments. For this reason, the idea of a general practitioner or family pediatrician being able to diagnose ADHD in a 15-20 minute office visit is nonsensical. However, the idea of a pediatrician alerting or confirming to parents there’s a need to do a more extensive follow-up investigation, is a good thing.

People who are getting frantic already about these new guidelines are jumping to a conclusion that they will quickly lead to getting young kids on medications. This is not the intent of early identification. I’m not unconcerned about over medication, but overall, we applaud early identification measures for physical diseases or developmental disorders (Autism), so why not for other neurological and brain-based conditions?

[via Richard Wanderman]