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Children's Health Issue

The Drug Dilemma

The increased use of powerful psychiatric medicines in children under 6 has raised concerns about over-medication and long-term effects. With so many unknowns, parents face an agonizing choice.


Teri Burley realized her 2-year-old son, Tanner, was out of control when he threw his brother, Tayler, off the jungle gym in the schoolyard playground, breaking the older child's arm.

From the time he was a baby, Tanner had been a blur of activity. "He was into everything and rarely slept," says Burley, adding that she and her husband took turns staying up throughout the night because they never knew when their overactive child would awaken. "But we figured he was just energetic."

The playground incident was a watershed, however, and preschool officials felt compelled to expel Tanner. "They said he was too much of a liability," recalls Burley. Desperate for answers, the Burleys shuttled their child from one pediatrician and psychologist to another near their home in Whittier.

But no one could determine what was wrong in a child so young. Finally the Burleys were referred to a clinic at UC Irvine, where Tanner was diagnosed with attention deficit hyperactivity disorder, or ADHD. The UC Irvine doctor prescribed Ritalin, a stimulant that has a calming effect on hyperactive kids and helps them to focus.

Burley kept the prescription in her purse for days before she filled it, and it took her several days more before she could bring herself to give her toddler the drug. "My husband and I agonized, but we felt we had no choice," recalls Burley. "It was either remove him completely from society or dope him up with drugs to make him manageable."

The Burleys are not alone in their dilemma. Parents of very young children who show signs of mental disturbance face a difficult choice. Should they do nothing, in hopes that this is merely a phase--the so-called terrible 2s and 3s--that their child will outgrow? Or should they give their toddlers psychiatric drugs--none of which have been tested on children under 6--to control what may seem to outsiders to be garden-variety problems of childhood?

Growing numbers of parents are choosing the latter option, though often reluctantly.

A study published in the Journal of the American Medical Assn. in February revealed an alarming rise in the use of powerful, mood-altering psychotropic drugs among children ages 2 to 6. The use of stimulants like Ritalin in this age group more than tripled from 1991 to 1995. Further, prescriptions for antidepressants such as Prozac doubled, and those for clonidine, an adult blood pressure medication used as a sleep aid for kids with ADHD, spiked significantly.

These troubling results prompted First Lady Hillary Rodham Clinton last month to announce plans for a $5-million research project to be conducted by the National Institute of Mental Health, or NIMH, on the use of these medications in preschoolers, and to convene a conference on the issue in the fall.

'Everyone Wants to Point Fingers'

Some blame the sharp increase on managed care, saying pediatricians who aren't trained to spot symptoms of mental illness are encouraged to dispense pills rather than refer children for costly therapy.

Others accuse harried parents of being too busy to adequately discipline rambunctious kids. Teachers and day-care workers share the blame, they say, for insisting that toddlers be docile in their overcrowded classrooms.

But some experts and parents say the increase in prescriptions for young children is a legitimate trend, driven by the increasing sophistication and diagnostic accuracy of mental health professionals.

"Everyone wants to point fingers," says Julie Magno Zito, the principal author of the JAMA study and a professor of pharmacology at the University of Maryland in Baltimore. "But it's really the result of a confluence of [these] factors."

The sharp uptick in the use of these drugs in very young kids "does seem to neatly coincide with the ascendancy of HMOs," says Joseph T. Coyle, chairman of the department of psychiatry at Harvard Medical School in Boston. But it is also true that scientists now have a much better understanding of the delicate mechanisms of brain chemistry, an advance that in turn has engendered more acceptance of the use of drugs to treat behavioral disorders.

Additionally, the diagnostic guidelines for ADHD and its milder cousin, ADD (attention deficit disorder), once considered problems that only affected boys, have broadened. Now many young girls who aren't hyperactive but do have persistent problems concentrating take Ritalin too, which may account for some of the increase.

Further, with public school resources steadily shrinking, parents complain that they are under tremendous pressure to make their kids conform.

Clearly, medication is called for to help severely impaired kids. But they're a tiny fraction of the population, say experts, certainly not the 1% to 2% of preschoolers now taking such medication.

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