While more refined guidelines for diagnosing mood and behavioral disorders among children may explain some of the change in medication use, more stringent warnings about the potential risks of psychotropic drugs on youngsters probably also played a role. In the mid-2000s, the Food and Drug Administration started adding its strictest black box warning to alerting doctors and patients to the serious risks these treatments could pose for children and adolescents. For those reasons, more pediatric groups advise doctors to start their youngest patients on behavioral therapies first, before relying on medications to treat their symptoms. “Our findings underscore the need to ensure that doctors of very young children who are diagnosing ADHD, the most common diagnosis, and prescribing stimulants, the most common kind of psychotropic medications, are using the most up-to-date and stringent diagnostic criteria and clinical practice guidelines,” the authors conclude.

However, some recent research showed that more than one in five specialists who diagnose and recommend treatment for preschoolers with ADHD turn to drug therapy first, either alone or in tandem with behavior therapy. But it’s not because these pediatric specialists think that the drugs are more effective or aren’t concerned about the long term effects of the medications. That study also revealed that drug approaches may be the only practical or accessible ones to some parents, since behavior-based methods require a lengthy time commitment and can be costly.