A parent’s face lights up with a certain kind of worry when the pediatrician talks about ADHD. It’s not really panic. What a child’s behavior is like when it goes from being a mystery to being explained is more like a door quietly closing. Often, not long after that, a prescription comes next.
That’s what a study led by Stanford Medicine that came out in late August 2025 in JAMA Network Open made very clear. Researchers looked at the medical records of almost 10,000 kids ages 4 and 5 who were diagnosed with ADHD in eight pediatric health networks in the United States. What they found wasn’t a surprise, but it was still a little scary: 42% of those kids got medicine within 30 days of being diagnosed. The American Academy of Pediatrics says that people should wait six months before using a prescription pad, but only 14% did.
There is a reason for the rules. Kids between the ages of 4 and 5 don’t fully break down stimulant drugs like older kids do. The side effects, like anger, irritability, and mood swings, are stronger and last longer. Even more importantly, behavioral therapy at this age isn’t just a nicer option. It makes something happen. The American Academy of Pediatrics (AAP) recommends parent training in behavior management as a way to help families learn how to set routines, praise good behavior, and work with the way a young child’s brain is wired. Taking medicine eases symptoms. Behavioral therapy helps people get better at things. The difference is more important than most people think.
Nadia Zaim is a child and adolescent psychiatrist at Johns Hopkins Medicine. She works in an integrated care model that tries to bridge the gap between where kids are and where the mental health system can actually reach them. This method puts mental health support right into pediatric primary care offices, which are places that families already trust, go to, and feel at ease. It is a useful answer to a problem that is really about supply. There aren’t enough psychiatrists for kids. There was never one.
The fact that the early medication trend isn’t caused by carelessness makes it even more complicated. All of those early prescriptions are based on real pressures. Boys with hyperactive-impulsive ADHD are really at risk of getting hurt. Kids who have more than one disruptive behavior disorder are kicked out of preschool and daycare, which is a crisis for parents who work.
Families with public insurance often run into a lot of problems when they try to get behavioral therapy. So medication is the fastest way to get there, but it’s not always the best way. It’s possible that when a doctor writes a prescription early, they’re not trying to save money; they’re just trying to keep a child from losing their daycare spot before they can find another one.
Still, the problem with getting early medication doesn’t make it a neutral choice. That makes it a settlement. And some deals should really be called deals.
It’s not just the prescription rate that you should pay attention to here. It’s the difference. The study found big differences between the eight medical centers in how often kids were diagnosed, when they were diagnosed, and which kids got medicine early. It depended on race, type of insurance, and sex. Early medication was more likely to be sought by white families. More drugs were given to boys than to girls. Kids with public insurance had a harder time getting behavioral therapy, which made their families more likely to give them medicine. These patterns show that the problem isn’t always clinical. It is made up of structural, economic, and social parts.
Seeing all of this makes me think that the conversation about ADHD in young kids has become too black and white: medicate or don’t medicate, diagnose early or wait, medicate or don’t medicate. The more useful question might be: what does this family in this zip code actually have access to right now? There are hard choices like play-based therapy, behavioral coaching, and parent training. They should be used as the first treatment. Trouble is, telling people to do them and actually doing them are two very different things.
Behavioral health is being integrated into primary care at Johns Hopkins, and pediatricians are being trained to help families before a crisis happens. This is a step toward something more long-lasting. Not an argument against medication, but a more honest look at what behavioral intervention can do when it’s available. If that change spreads, it could change what a 4-year-old’s diagnosis looks like. Not so much a door closing. More than one opening.
