September 2014 – NCBDDD’s Strategic Health Initiative: Aligning Current Practice with Best Practice for the Treatment of ADHD in Very Young Children

Data suggest that clinical best practice guidelines for attention-deficit/hyperactivity disorder (ADHD) are not being followed.  CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) is working to align current practice and best practice to make sure young children (2-5 years of age) receive recommended behavioral therapy treatment for ADHD.  This first-line treatment can safely and effectively treat ADHD symptoms in young children, leading to more U.S. children who grow healthy, reach their full potential, and live a productive adult life.

ADHD is a serious public health problem because of its high prevalence; chronic nature; significant impact on school performance, family life, and peer relationships; and estimated annual cross-sector costs of $38-72 billion.  It is also the most common neurobehavioral disorder of childhood, diagnosed in 11% of children 4-17 years of age. Children and adults with ADHD experience higher rates of injury, academic and career failure, and earlier death.

Fortunately, the American Academy of Pediatrics has published guidelines for ADHD, describing best practices for the diagnosis and treatment of ADHD for children as young as 4 years of age and as old as 17 years of age.  The challenge is that although these guidelines recommend behavioral therapy as the first-line treatment for children 4-5 years of age, national data suggest that a large number of these children are being treated with medication and less than half of 4-to-5 year-olds who have been diagnosed with ADHD receive behavioral therapy.  Further, new data indicate that many children as young as 2-to-3 years of age are being diagnosed with ADHD, and many of these children are receiving medication for treatment.

NCBDDD uses data to inform clinical and state programs and policies, important work that must continue.   More must be done, however, to evaluate the reasons for the misalignment between current clinical practice and best practices for the diagnosis and treatment of ADHD in young children.  NCBDDD can help clinical and public health partners identify and address the barriers to meet these best practice guidelines and provide data that can be used for strategic, data-driven action to give children the care that best supports their health and development.  Learn more at or contact Dr. Susanna Visser ( to get your organization involved.

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