Teachers’ unions and school health workers last week championed the Clinton administration’s campaign to reverse a recent upswing in the prescription of psychiatric drugs to preschoolers.
While they said classrooms should be calm places of learning, the educators echoed the White House’s concern that very young pupils are sometimes issued medications unnecessarily.
“Classrooms should be free of disruptions so all children can learn,” said Nat LaCour, the executive vice president of the American Federation of Teachers. “Pushing psychiatric drugs on a child with behavioral problems may be a quick fix, but could be quite problematic later on.”
The White House announcement came just weeks after a study published in the Journal of the American Medical Association documented a sharp increase in the use of psychotropic drugs among preschoolers between 1991 and 1995. The study found that the number of prescriptions for 2- to 4-year-olds for such stimulants as methylphenidate, the generic form of Ritalin, increased threefold, and prescriptions for such anti-depressants as Prozac doubled. (“More Preschoolers Taking Psychotropic Drugs,” March 1, 2000.)
“We aren’t here to bash the use of these medications. They have literally been a godsend for countless adults and young people,” first lady Hillary Rodham Clinton said in announcing the initiative at a March 20 press conference. But, she added, “some young people have problems that are symptoms of nothing more than childhood or adolescence. Some of them need a person simply to listen to them talk about their pain.”
Mrs. Clinton said that the administration plans to issue a fact sheet to guide parents on the risks of psychiatric drugs, and that the White House has directed the Food and Drug Administration to improve pediatric labeling information on medications prescribed to young children.
In addition, the National Institute of Mental Health will put $6 million into new research to study attention deficit hyperactivity disorder and Ritalin use in children younger than 6. The first lady also announced that the White House would host a national conference next fall to examine the diagnosis and treatment of children with behavioral and mental disorders.
More Research
Though Ritalin and such anti-depressants as Prozac, Paxil, and Zoloft were approved by the FDA for use in adults and older children, physicians have the discretion under the law to prescribe them to very young patients. Currently, little information is available on the effects of those drugs on the very young.
“We know very little in terms of prepubescent children, and we know nothing in preschoolers,” said Dr. Benedetto Vitiello, the chief of the child- and adolescent- treatment branch of the NIMH. In addition to the Ritalin study, Dr. Vitiello said the institute was planning to underwrite research on the possible long-term side effects of the use of psychotropic drugs by toddlers and kindergartners. Some educators and researchers say serious questions exist about what effect certain drugs might have on children’s early brain development.
Despite such concerns, many doctors are strong believers in the value of psychiatric drugs, which, they say, can work miracles for young children who are suffering.
Dr. Lawrence Silver, a professor of psychiatry at Georgetown University Medical School in Washington, treats many 4- and 5-year-olds in his private practice. “I saw one 3-year-old child recently who was constantly squirming, and was kicked out of preschool for not paying attention and getting into fights,” he said. Dr. Silver diagnosed her as having ADHD and prescribed a medication similar to Ritalin. “Within three days,” he said, “she was calm and focused.”
A recent study of elementary school children conducted by teams of researchers subsidized by the National Institutes of Health reported that Ritalin was more effective than behavior-modification therapy for treating children with ADHD. They found that children with ADHD who had no other psychiatric disorders were able to improve their condition with medication alone, regardless of whether they were in therapy.
Better Diagnosis
Nevertheless, Kevin P. Dwyer, the president of the National Association of School Psychologists, said the use of medication for preschool children should be the last resort. “If we medicated all the kids who had temper tantrums at age 2, that would be 90 percent of kids,” he said.
Children, Mr. Dwyer added, are often misdiagnosed because busy doctors frequently rely on school officials’ recommendations that a child with ADHD, for instance, be medicated.
Until more research is done, many parents are left to experiment on their own.
Judy Reinicke put her son, now 12, on Ritalin for four years beginning at age 6. But she took him off the drug two years ago because, she said, it wasn’t helping him with his organizational skills, and “he wasn’t being his bubbly self.”
Ms. Reinicke, who lives in New York City, decided to try holistic remedies, such as Saint Johnswort, instead. “We let the Ritalin go,” she said, “and he has grown tremendously since then.”
