Drugged-Out Toddlers

[teko]

We thought toddlers had it easy. No bills to pay, no bosses to please--just ice cream and a little mischief on the brain. But America's tiniest citizens, some still in diapers, are now the newest members of the Ritalin and Prozac nation. The numbers are small, but in a study published in The Journal of the American Medical Association last week, researchers reported that the use of certain psychotropic drugs, like antidepressants and stimulants, in 2- to 4-year-olds doubled or even tripled between 1991 and 1995.

The study gave no reasons for the increase, but experts say frustrated parents, agitated day-care workers and 10-minute pediatric visits all contribute to quick fixes for emotional and behavioral problems. Even with the best of intentions, says Julie Magno Zito of the University of Maryland and the study's lead author, "you have a confluence of social forces together who collectively say, 'I don't have time for anything else'."

The new data raises serious questions about how doctors are making diagnoses and why they are prescribing powerful drugs that have not been fully evaluated for safety or efficacy in such young children. Unsurprisingly, Ritalin, given to tens of thousands of school-age kids to treat attention deficit hyperactivity disorder (ADHD), topped the preschoolers' list. But ADHD can be extremely difficult, if not impossible, to diagnose with any confidence in kids younger than 5. Symptoms like restlessness and inattentiveness may simply be toddler rambunctiousness, "the terrible twos and trying threes," says psychologist Susan B. Campbell of the University of Pittsburgh. Or a child might be acting out in response to serious stressors like divorce, neglect or poor child care. Experts worry that some doctors are making diagnoses based on symptom checklists rather than on thorough evaluations of a child's life both in and out of the home.

As for Ritalin, while it is known to help some school-age kids, the label warns against dispensing it to children under 6. Doctors are allowed to prescribe drugs "off label," but many experts worry that they are taking far too great a risk with toddlers--not just because of potential side effects (nervousness and insomnia are the most common with Ritalin) but because there is no data on how psycho-tropic drugs affect long-term brain development. "The period between birth and 4 is a time of tremendous change in the maturation of the brain," says Dr. Joseph Coyle, chair of Harvard Medical School's department of psychiatry. "We need to be very cautious."

The number of other drugs prescribed for toddlers in the study (which looked at two Medicaid programs and one HMO) was far smaller. But Dr. Steven Hyman, director of the National Institute of Mental Health, says he was shocked that either clonidine, an adult blood-pressure drug that appears to be increasingly used to treat ADHD symptoms or insomnia, or the older generation of tricyclic antidepressants were being given at all to preschoolers. Clonidine in combination with stimulants has been associated with heart problems in children. And there's no evidence that tricyclics, which can also have serious side effects, even work for depression in kids. Tricyclics are also used to control impulses and treat bed-wetting, which could have accounted for many of the toddler prescriptions. But in children so young, says Hyman, "I don't see a justification for using them."

More information about drug safety and efficacy in preschoolers could be a few years away. Researchers are hoping to launch a nationwide trial of Ritalin in 3- to 5-year-olds as early as this summer. But more scientific conclusions will do little to mollify those who believe the drugging of America has reached a new low.

[brice1967]

At the age of 6, my oldest son was diagnosed with a seizure disorder.  Our family doc ran to the emergency room to help us through the initial shock, and we made a plan to meet in his office a few days later.  He suggested that we go to the head pediatric neurologist in the region who was dedicated to childhood seizure disorders.

Between the pediatric neurologist and our GP, they formulated a great plan and my son got the treatment that he needed. (Actually, I think my wife and I got the treatment we needed...)  We were informed of what the treatment was going to consist of, and any potential side affects.  10 years later, our son is seizure free.

With that being said, I do think some kids are dosed too often and too early these days.  I think some docs outstep their bounds.  As a society, I think most of us are all too willing to take a pill to make it go away without looking at all options.  

For us, we looked into and continue to look into everything we subject our kids too.  Maybe we are too vigilant...if there is such a thing.

[narla]

At the age of 6 my son was put on clonidine to help with Tourette Syndrome,it did help for quite a few years but when he was 9 it stopped working,either that or his Tourettes was getting worse,so they tried him on Haloperidol next,it was fine until he was 11,then they wanted to try Risperidone,I think it's called Risperdol in the US,I had got the script filled and looked at the possible side effects and decided no more meds,
I had to take him out of school because he couldn't function in a classroom without meds.I could handle his Tourettes at home so we did home schooling it was the best decision I ever made.
He is now 25 and functioning quite well,he still lives at home,but I think that's more that he likes things done for him LOL, he has held down a job since he was 16 He has learnt to cover a lot of his Tourettes symptoms with other more acceptable behaviours,so he leads a very productive life drug free.

Denise

[specialmom]

Well, I actually said that too.  Young children especially in the toddler years are tricky to diagnose and often shouldn't be and medications on little one's is often unnecessary.  I'm very thankful that I do not have to give my kids medication.  I hate taking it myself and avoid it when possible!  I never worked with children professionally for personal reasons which included the importance of those years and not wanting to ever second guess myself from patient to patient.  That probably doesn't make sense but I think working with kids has a tremendous amount of pressure associated with it and has a lot riding on it.  I preferred not to be involved with that stage of a person's life and left it to those with thicker skin.  

[teko]

I understand and agree with both of you. My concern is starting drugs on children at such an early age would surely take a toll on their bodies over time. I mean, will they end up with liver damage at some point or kidney failure? I do think it would be irresponsible at best to discount those possibilities and like I said before, when children have a behavior issue or mom just cannot handle them for whatever reason and the child is misdiagnosed and medicated, what happens when the drugs are stopped? These are my main concerns. I have heard young moms talk about giving their children medication just to calm them. The whole thing is scarey to me. Adults or children over 16 or even 14 doesnt cause me as much alarm as giving to small children. Like I said, maybe my age is showing but it does not give me warm and fuzzy feelings that we are doing this at such an alarming magnitude. It seems like every one you talk to their child is ADD, ADHD etc. It is sooo widespread.

[specialmom]

There is no doubt that child and adolescent psychiatry is important and that many suffer at an early age.  I am actually glad that there is a growing number of therapeutic options for both adults and children diagnosed with true illnesses and disorders.  As Iladvocate has pointed out, they can save lives in some cases.  And not only save lives but improve the quality of life.  What is tricky with tiny kids is that diagnosing them is very very difficult.  There ability to articulate what is going on within is quite limited---------  and what parents report can be skewed (IE:  they might leave out that they scream at each other every day and occasionally throw furniture around in front of their child and that type of thing) as well as all the differences in maturity and development that go along with the toddler years.  

I agree that all of these disorders were around before they had a name everyone knew------  and those that had them suffered.  So it IS good to be able to diagnose those who need to be.  But unfortunately, in some areas it has gotten a little out of hand.  That is where a good doctor comes into play to make an accurate diagnosis at the right time and pick the best treatment option based on that patient.

[ILADVOCATE]

  There wasn't the specific medical knowledge of those psychiatric disabilities but they did exist. Medication can be helpful for some people, for some its a choice and for others it is needed. I take Clonidine. It has a severe side effect profile but I do know that for some people (such as people with Tourettes Syndrome) it can be quite helpful. I also know someone with Adhd (an adult) who takes Ritalin and finds it of help. Both of those medications when used judiciously in children can be of help but they should be used to treat specific symptoms not for behavioral control.
   As regarding SSRI's I do know when I was in high school there was a student (I didn't find this out until later) who took Prozac for depression and who when they discontinued it took their life which was because it was treating their depression and they did not realize they needed it. I did have the standard symptoms of schizoaffective disorder starting at age 13 and regardless of the severe side effect profile of the current generation of antipsychotics because without treatment I was psychotic and isolated myself from people then do wish I had started medication then. When I sought help I did not have the support of the family at first because they were raised in an era when there was little understanding of what psychiatric medication was for and knew someone who abused it for purposes other than prescribed.
As regarding the use of medication in children actually the FDA is reevaluating the use of many medications, not just psychiatric medications for their proper dose for young people and whether in some cases they should be used at all. As an example some cough medicines have now been labelled as not for use in very young children. All this research should have been conducted a long time ago and it should be required now not just for approved medications but for all medications, especially psychiatric medications for dosage, efficacy and safety. And some psychiatric disabilities such as ADHD respond to cognitive behavioral therapy which in some situations can be used instead of medication. But a working diagnosis at all times is needed before any treatment is given and behavioral concerns can be addressed by working with the family and guidance counselor and sometimes family therapy and should not be confused with specific symptoms.

[teko]

I remember when my children were small, there was absolutely not possibility that your child was on drugs of any kind. I wonder sometimes where all these diseases and disorders come from. You simply never heard of such things back then. Add, AdHd, etc. I sometimes wonder if these come from lifestyle changes that have occurred over time. I have a grandson who has been diagnosed with aspergers, another that was non existent back then or maybe simply a name change? Not sure there, but the only way to get him to act normal is the drugs. I do worry what these drugs will do in time to their little bodies and also wonder what the effects will be when taken off of them. I am also not at all sure about antidepresants for one so young. I guess maybe due to my age, I am very skeptical of all this and sometimes wonder if it is another money making scheme for the medical profession or if the so called experts really do know what they are talking about. However, since no generation has been drugged like this one before, we will have to wait a generation to find out the results of all this.

I am also very wary due to the drugs released on the market and then proven unsafe and recalled. Are our children simply being used as guinea pigs? I just dont know what to think of it all.

[specialmom]

Interesting.  I will say that the years you mention are the years that there was much change in the psychiatric world in terms of available medications.  SSRI's took off in the early 90's and the drugs typically prescribed for add/adhd were coming to market around that time.  This is also really when add/adhd became mainstream and well known.  Sure, it was around before that time but there was not the awareness that we have now and that started in the early to mid 90's (man I sound old, don't I?).  

I will tell you that typical protocol is to not diagnose a child and treat with medication until the earliest age of 6.  That should be the standard of care every where.  And if I had a child that I feared this diagnosis------------  I'd only see a psychiatrist that specializes in children.  Period.  Primary care docs should not handle this.  And------- I'm really on my soap box now----------  treating add/adhd should be a full comprehensive strategy.  Just a pill isn't the best approach.  

Many parents ask for medication for their kid and for other reasons than you may think.  They may want to help their child but they also want to clear up any issues they are having with their kids and make their own life easier . . . but a large group like the add/adhd diagnosis and other mental health conditions so that they can claim disability benefits for their child.  

I'm a proponent for medication but am conservative about it.  Our little one's are probably over medicated in this society.  That is a shame.  I've seen medication really work wonders for kids with add/adhd but I would never sign on for them to start meds before 6.  And my own son has a disorder that could be easily confused with add/adhd and someone may  have suggested chemical intervention had I not been educated on the subject.  Sometimes the general public is at the mercy of experts----------- let's hope the "experts" do their job!!