Most still had moderate to severe symptoms over six years of follow-up.

The current debate over ADHD medication focuses on whether the benefits -- improved concentration, better behavior, better performance in school -- outweigh the potential risks of medicating young children. Complicating all the abuse potential of ADHD drugs, with students using them off-label to get ahead in school and incidences of addiction, sometimes borne to tragic ends.

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In the youngest children diagnosed with ADHD, parents may choose to eschew medication altogether in favor of alternative methods like changes in diet, exercise, and behavior modification programs. But a new study out of Johns Hopkins suggests that the "benefits" used to rationalize medication might not even exist. Or at least, don't have lasting impact.

Six years after diagnosis, given when they were about four and a half years old, 160 out of 180 children followed by the researchers continued to meet the criteria for moderate to severe ADHD. Over two-thirds of the children followed were on medication, but they met the clinical conditions for ADHD symptoms at rates slightly higher than the kids who hadn't been medicated (62 and 58 percent, respectively, for hyperactivity and impulsivity, and 65 and 62 percent, respectively, for inattention).

The researchers can't say whether the problem was poor drug choice, incorrect dosage, poor adherence, or medication just not being an effective treatment for preschoolers with ADHD. 

But having repeatedly checked in with parents, educators, and pediatricians, they were able to conclude that ADHD was chronic over the six years of observation, and that it was characterized by severe symptoms and impairment. For most kids, it appeared to be untreatable, at least using the current available methods.

The other interpretation that will probably be raised is that hyperactive behavior is normal in preschoolers, and that ADHD is wildly overdiagnosed. The authors write that seven percent of U.S. children are currently being treated for the condition. Regardless of whether that number's too high or too low, we clearly need better interventions.