Boy, 4, given meds after just one appointment
Queensland children four and under are being prescribed strong medications for ADHD despite them not being recommended or trialled on kids under six.
It took just one hour for four-year-old Lewis to be prescribed ADHD pills Vyvanse at his first paediatrician appointment.
But experts insist parents shouldn't feel any urgency to medicate young children and other treatment options should be explored first.
Mum Emily Watson said she felt she had no choice, particularly when the doctor compared leaving her son un-medicated to depriving a diabetic of insulin.
However, the medicine that was supposed to help the little Brisbane boy only made his symptoms worse, with Lewis bursting into tears over small things, screaming and wetting his pants.
In the 2018-19 period there were 6383 mental health prescriptions dispensed nationwide for children aged up to four years old.
Ms Watson said although the decision to medicate Lewis was ultimately their decision, she felt like she would be a "bad parent" if she did not.
"The doctor gave us all the pros and cons and explained the stats about medicated vs un-medicated children but basically, he acted as though that was the only option," she said.
"He pretty much made the idea of not medicating Lewis seem very dangerous, he sort of said boys with ADHD tend to be impulsive and that can put them in danger - obviously that scared the crap out of us.
"He gave my husband and I the analogy that you wouldn't deprive a diabetic of insulin, so to us we're like 'That is so logical, yep, totally on board with that option'.
"I asked him outright, should we be finding access to OTs or any kind of therapies to help Lewis with his ADHD and he literally said 'once he's on medication he'll be a normal little boy'."
ADHD Australia board member Dr Patrick Concannon said it's an experience he's heard from families before.
"Not that often, but enough of them that it shouldn't happen," he said.
"I think sometimes what happens is the busy doctor gets caught running out of time, so they talk about the things which are easiest.
"The obvious and quickest solution is just to put them on medication, but it's not always the best way.
"I think the parents are right that especially in a four-year-old, you don't jump to medication."
Ms Watson said when Lewis started the medicine he would burst into tears when he couldn't place a toy block into place.
"We got to the point about the fourth day trying the medication he got so upset over something very, very minimal and he screamed until he wet his pants, he's toilet trained," she said.
"That was the day we took him off his medication"
The family called the doctor who said Lewis was probably on too small of a dose and recommended the family up the dose from 5mg to 10mg.
"At that point our gut feeling was that we don't want to give him any more of this stuff," she said.
The mum-of-two said she knows medications work and change families' lives but was concerned about how quickly a four-year-old was prescribed Vyvanse.
She said it was "bizarre" treatment options like OT and lifestyle changes were not offered as legitimate options to try before or in conjunction with medication.
Professor James Scott, who is a Child and Youth Psychiatrist and leads the Child and Youth Mental Health Research Group at the QIMR Berghofer Medical Research Institute, said medication was not usually considered appropriate for children under the age of six.
"The evidence is from age six because that's when the clinical trials allow for children to be recruited into them," he said.
"They do work in younger children, for sure, but there's still this issue that the need for a 4-year-old to sit still is not as much as an eight-year-old, as they're not sitting in class all day."
"For young children we'd normally start trying other strategies first before we go to medication so there are things like parenting strategies, extra educational support, modifying activities in the classroom and at home so that the symptoms can be better managed or accommodated," Professor Scott said.
"When a child is very young you've got time, you've got time to try other strategies.
"As the child grows older and tries various interventions perhaps they'll funnel down to choosing medication, but in the first instance I think it's worth thinking broadly about what the options are."
Professor Scott said non-medication interventions on average only had small benefits for ADHD, but that they can be very effective for certain children.
"There's a whole lot of things that can result in a child having difficulties with attention … If you actually got 100 kids with ADHD and randomised them with these interventions like changing diet or OT interventions or not, you'll find that the benefits are very negligible for the whole group of children, but they might be very large for some children," he said.
Originally published as Boy, 4, given meds after just one appointment