Medication for ADHD in Preschoolers

Parent Q&A

  • Meds for 4.5 year old with ADHD?

    (12 replies)

    Hi Everyone-

    My 4 1/2 year old is presenting symptoms that look a lot like ADHD. Yes, he is 4.5, but he can't sit still long enough to finish a meal, do a lego project or finish an art project at school. He is constantly in motion. He runs everywhere he goes. This afternoon I picked him up early (because he was out of control at school) he came home and knocked the Christmas tree over. I think it was an accident, but it still happened. His teachers are nearing toward their wits end with him and I'm sick and tired hearing complaint after complaint about him from other parents and his teachers. He is at a lovely school, but I feel like we are at a crossroads. I took him to see Dr. Herbert Schreirer at CHO after being referred to him by our pediatrician at Berkeley Pediatrics. I filled out a general questionnaire before our visit and checked all the boxes that applied. Needs a lot of supervision: check. Frequently blurts out in class: check. Difficulty sticking to play activities: check. The list goes on. When we went to see the doctor last week, he told me after 4 minutes of reading the form that I had described an ADHD child and that a good course of action would be to try a low dose of Ritalin-right off the bat. I was shocked. He hadn't even talked to observed my son, but maintained that he had ADHD. At first, I wanted to get up and walk out, but then as we talked more, everything he said made sense and that early intervention is the best way to go.  

    Our son is electrically charged. He is exuberant, loud, loving, rambunchuous among many other wonderful qualities. But when it comes to comparing him to other kids in his class and age group, he is an outlier for sure. Has anyone out there medicated a 4.5 year old for ADHD? Is it crazy to medicate? Lately it seems crazy not to. So we find ourselves in a quandary wondering do we switch schools? medicate? do both? 

    Thank you!!

    I am just a mom who wants to help my son thrive

    I'd recommend contacting the HALP clinic at UCSF. There may be a long-ish wait to get in, but their assessments are thorough and covered by many health insurance plans. They may advise medication as well, but first they will be able to give you a much deeper understanding of your son's neuro-cognitive profile. It's fascinating and I felt very confident in choosing medication after going over the results with the psychologists there. 

    My son also very clearly had ADHD by age 4. No doubt in my mind or the Dr’s. He had every single symptom on the checklist (to the extreme). But I also hesitated to start medication because he just seemed so young. 

    I finally gave in and started giving him Ritalin rx when he was 9 and I have to tell you the transformation in him was so amazing I have always regretted not having him start much sooner. 

    He spent ages 4-9 being disliked by all of his teachers and potential friends because the ADHD made him so hard to be around. There was a huge cost to both his self-esteem and his academics. 

    I understand your fear and concerns but if I had it to do over again I would absolutely have started medication at your child’s age. 

    Hi there,

    I totally understand your frustration as you always want to do the right thing by your kid. My 4 year old is pretty hyper as well and has sensory processing issues which results into not being able to focus on certain tasks for a long time and he is also constantly in motion!. But what I have seen is that as he is growing older things are changing for the better! We work on a daily basis with his class teacher to monitor any behavior triggers throughout the day and then come with strategies together. An example is moving heavy things gets him to a calmer state so his teacher lets him help out and move chairs before doing any project work. We also set expectations before every task both at home and school, example lunch time is coming up  "your body needs to be on the seat while eating"! small things like these have certainly helped, but its definitely a LOT of work.

    My take is that before resigning to medication, work with the teacher to identify patterns and set strategies that you use consistently both at home and at school and then report out what you see work at home and vice versa. Good luck!!

Archived Q&A and Reviews


Pre-schooler diagnosed with ADHD - treatment?

May 2012

My 4 1/2 year old son was just diagnosed with ADHD. I'm not surprised but I am somewhat alarmed by the strong recommendation to medicate him. My husband, mother and mother-in-law are strongly against it but I'm torn. I don't want to medicate my kid for the rest of his life (as the literature would suggest we do), but if he is able to more fully live up to his potential (personally, academically and socially) wouldn't I be doing him a disservice NOT to medicate? I'm really just looking for personal stories from people who have experience with ADHD - either themselves, or as the parents of a child with it. Did you medicate or not? Why did you choose to/not to medicate? What has your experience been - good, bad or otherwise? Besides parenting classes and/or behavioral modifications, did you use or explore any alternatives? If so, what, and did you find it helpful/useful or a waste of time? Thanks in advance. ADHD Mom


Please consider thoughtfully your child's individual situation and the credibility of the medical evaluation/advice you are getting and do what is best for that child--not fall in with doctrinaire ''against medication'' mindsets.

My son was diagnosed with ADD in kindergarten, in addition to focal learning issues. It has been a long and complex route, including parenting classes, therapy, small private schools, social skills, etc etc. But medication has made an ENORMOUS difference for him. With medication, he can participate in academic learning and is able to have social interactions. When he misses a day (inadvertantly), teachers and camp counselors IMMEDIATELY recognize it (he takes a short-acting stimulant), and come running to us to say he can no longer participate in the situation. He recognizes the value himself--from the start, we discussed medication with him and kept him in the decision making loop. Next year he is going off to the college he wanted, with a merit scholarship. We know it will continue to be complex, but I doubt we would have gotten to this stage without the help of medication. responsible parent


I just purchased a computer program and headset from Neurosky.com that is specially geared to help kids with ADHD (apparently, all kids can benefit from it, though). The program/game is called Focus Pocus. I can't vouch for it's effectiveness, since we just got it, but the youtube video and the description of the program make it look like a promising treatment option for ADHD. hoping this works


We are struggling with the same decision right now for our 6-1/2 year old due to major distractibility...and ''academic'' difficulties in Kindergarten (don't get me started about that). BUT, the first thing I though when I saw your post is that 4-1/2 is way too young to diagnose and medicate ADD. I feel like 6- 1/2 is too young, really. Many kids will just naturally grow out of behaviors that could be labeled ADD as they mature. It runs in our family on both sides, so my son likely will need medication somewhere along the line if other environmental adjustments are not helpful. Good luck with your decision. I know it's a difficult one and I look forward to hearing others respond to your post. It's just hard to imagine that a 4-1/2 year old is not ''living up to their potential''. -Disheartened by Pressure on Kids Today


My son was also diagnosed at a young age, and I was also someone who hated the idea of medicating my child, but I can tell you with the utmost sincerity that it has changed all our lives for the better. He is able to handle so much more with the medication. I explained to him like the literature says that he has a race car brain with bicycle brakes and that the medicine helps his brakes match his car. It literally speeds up the process to make everything match better and work more efficiently. He is a VERY challenging kid with VERY challenging behaviors and yet is incredibly smart (doing high school levels in testing at the age of eight)so I feel like this is giving him the help he needs to develop the good stuff he has. He takes 20 mg of Ritalin LA (the long acting slower into and out of the system kind)You can try it and if you all don't like it, either stop with your doctor's help or try something else. We were lucky enough to have just tried two (we started with Ritalin LA, tried Focalin, then went back.)Good luck! Best for the brakes.


I want to first off offer you my general support: parenting ADHD kids takes patience and self-awareness beyond what I imagined. I encourage you to get support, especially from other ADHD parents (as you are doing here!) through groups like CHADD and PPSNK (local listserv that offers amazing support for all special needs kids). I also highly recommend the book ''Transforming the Difficult Child: The Nurtured Heart Approach'' by Howard Glasser.

Regarding medication, who is ''strongly recommending'' this and what is their personal stake in seeing you do so? We only recently began medicating our 10 year old, who was diagnosed at age 6. We work with a doctor, Marianna Eraklis, who has been supportive of our decision to hold off. She and others suggested to us that we see how our daughter did with other kinds of supports and accommodations, and keep medicating in our back-pocket (metaphorically) for a time when school seemed especially challenging (and as many predicted, that time came at fourth grade, when school becomes more academic). Our daughter is bright, but has trouble focusing, and the structure of the classroom can be challenging for her (its not really the structure, its the lack of stimulation -- she likes high intensity environments). We have given her a number of other supports to help along the way, including social skills training (Communication Works in Oakland) and briefly Occupational Therapy, and have read a great deal, and learned some tricks for managing things at home (many from the Glasser book). Age 4 seems young to medicate, but I don't know the nature of the struggles your child is having or how they are effecting things. Still, I think trying to change other things first makes sense, as you can always turn to meds later. Is your child struggling at school? It has been very important for our daughter that her schools be places where she can get a lot of stimulation: sitting quietly is not her thing, and some schools/classes offer more opportunities for multisensory input and more chances to move around. I should think there would be a number of preschools that would be great for that. In regards to maximizing your child's potential, I don't know that meds really do that. I think they help ADHD comport in an environment that requires a particular kind of behavior (schools) but their natural potential often blossoms in other arenas (arts, sports, or learning environments that are more hands on and immersive). I'd recommending trying out some of these other things first. Best of luck! Mother of an amazing, creative, sparkling kid


I am an elementary school teacher, I have a high-school age son who has ADHD (Inattentive Type), and I have recently been diagnosed with ADHD with not much surprise after all I've read about it within the last 6 years or so. I have seen almost miraculous results in my students from medication, and medication has also helped my son and DEFINITELY myself.

My son was diagnosed in middle school, and he is a HS senior right now. He was a very high scorer all the way up to 5th grade or so, always Advanced on the CST scales. None of the teachers EVER mentioned a problem because I think he's not hyperactive, just not focused. Because of his age at the time of his beginning the meds, it was a battle against a certain level of resistance on his part. I don't think it will be as difficult with a small child. It's very sad to see children unable to read by 3rd grade because they are unable to focus long enough to even listen, or they are totally unable to stop talking. I was totally against medication for a long time because of the ''urban legends'' about it, but I have made a 180 degree turn.

I would suggest you approach the pediatrician with a request for the smallest dosage possible, and work your way up. This could amount to say, 5 mg of Adderall perhaps given twice a day. Take a look at this wonderful website: www.chadd.org To find the right medication is not an easy task, but keep trying. If you are able, go in and observe your child at school to get a clear picture of how the medication is affecting him/her. If you can't go yourself, ask the teacher(s) to give a report daily in a notebook that goes back and forth between you and them. This doesn't have to be an essay every day, just a note to let you know their opinion on how your child behaves with the med. I've seen kids on too high a dosage almost fall asleep (from a stimulant!), and I've seen kids who obviously need the medication increased or changed. Don't believe alarmist statements. It's a slow process to find the right med, but it is WORTH it. Good luck. ADHD and happy to have found out


hi - i've got 2 kids with ADHD. both are taking medication. when my youngest was diagnosed he was 5. he was in preschool and getting ready to go to kindergarten. he was in a special, full inclusion (BUSD) preschool for his special needs. i remember this vividly because it was April and the teacher sadly told me he was not on track to attend kindergarten in the fall because he just couldn't grasp the curriculum he was being taught.

he started meds that month. by June she said he had the most dramatic turnaround she had seen in a kid. the medication allowed him to calm down enough to 'let the learning in'. she recommended he go to kindergarten with no reservations.

its not all honey and roses - he still has issues. but i found medication allowed him to just slow down, focus and have the attention needed to learn in our schools. he is not a zombie by any means. he can simply stay focused at school to sit on the rug and listen, learn and then do his work effectively.

the days i've run out of his meds or somehow forgotten (rare), his teachers tell me they had to peel him off the walls and no work got done. they were in triage mode with him.

my son has a BAD case of ADHD, so may not be the same as your child. but i doubt my son would have progressed as he has if i chose not to medicate him. just another mother's story


My oldest son has ADHD. He is now 14 yo and been on medication since he was about 9 yo. He is much more successful in school on medication, currently Vyvanse. He has never really had trouble with academics, more with social situations, talking out of turn, joking, argumentative, etc. Outside of school, he is happier and more fun off the meds, but has alot of energy. As he gets older, he is more able to be sucessful without medication. He had a psych eval last year which indicated he had some ADHD issues and IQ scores in the genius range. This was interesting because when he was evaluated when he was 8 yo, the doctor who tested him at that time said his ADHD was severe, which we felt was absolutely incorrect.

You do not address what kinds of behavior your son presents relating to his ADHD. When my son was in preschool he had trouble with empathy,cooperative tasks that involved focus on other children, and biting (yikes!) There were lots of meetings at school every year regarding his behavior, I think Kindergarten year was the worst. After moving him from private school to public school, we started trying medication and he was much more successful which boosted his self esteem considerably.

Another note, my neighbor's son is in first grade and is taking Adderal during school but not in the summer or on weekends, and is doing quite well in school. He is very bright and recognizes the focus the medication gives him in school.

I would trust your instincts with the meds, without knowing what issues you are facing with your son it is hard to give advice, but preschool seems so early to start meds but only you can know for sure. East Bay Mom