Wednesday, December 06, 2006

From The Atlanta Journal Constitution

The Atlanta Journal Constitution
Drugs for preschoolers? Hit alarm

The controversy over using medications to tame easily distracted and hyperactive schoolchildren hasn't stopped millions of parents from asking doctors to prescribe the powerful stimulants for their children.

The benefits of the medication — better school performance and a calmer child — outweigh the risks, many parents believe.

However, the most recent trend of prescribing Ritalin, Adderall, Concerta and other controlled medications for preschoolers ought to alarm federal regulators, especially now that some studies are suggesting low doses of the drugs could be helpful in very young children with moderate to severe forms of attention-deficit/hyperactivity disorder, or ADHD.

Such "off-label" use of stimulants for children younger than age 6 is prohibited by the Food and Drug Administration. Yet a study in the Journal of the American Medical Association in 2000 estimated at least 200,000 preschoolers were getting prescriptions for the drugs. Most experts believe the number has since doubled.

Caution is all the more important because researchers are finally starting to compile data on the use of the drugs in children 3 to 6 years old.

In one study, 40 percent of the children who took Ritalin developed side effects. About 11 percent of the children were withdrawn from the 70-week study because of severe problems, including irritability, weight loss, insomnia and slowed growth. Those are rates well above what happens to school-age children who experience similar side effects.

Still, Dr. Scott Kollins, a Duke University psychologist, believes limited use of Ritalin and other stimulants should not be ruled out in very young patients with extreme cases of hyperactivity. Small doses of the drug significantly improved behavior in about half the children in the study. "It's very clear there is a set of kids for whom this will be very important," Kollins told the Scripps Howard News Service.

That echoes the justification pediatricians and child psychiatrists used decades ago when Ritalin first came on the market. The drug was supposed to be prescribed only in the most extreme cases and for only a few years, until children outgrew the brain chemistry problem thought to cause the disorder. Researchers estimate 3 percent to 5 percent of children have ADHD.

But over the last 20 years, use of the stimulants became commonplace, with many elementary and middle school teachers reporting at least a third of their male students taking Ritalin or one of the other drugs daily. Previous studies have indicated that metro Atlanta is a hotbed for prescriptions in school-age children.

More recently, advertising campaigns by the drug manufacturers have emphasized that older children and adults could improve their performance in college or on the job by taking the medication.

There is little question that drugs are effective at helping regulate brain activity. But they are powerful compounds, even when prescribed in low doses, and their long-term effects are still largely unknown. Using stimulants instead of teaching children with mild forms of the disorder how to modify behavior remains controversial.

The FDA should post stronger warning labels and notices to reinforce to parents and physicians alike that widespread use of these stimulants in preschoolers is not encouraged.

— Mike King, for the editorial board

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