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Preschoolers on Drugs

Not all hyperactive kids need to be medicated.
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WebMD Feature

May 22, 2000 -- Nicholas Hill was an obstinate and defiant 4-year-old. He exploded into violent rages. He yelled, screamed, and threw his toys. When his parents made reasonable requests, he seemed to take perverse pleasure in ignoring their wishes and doing exactly the opposite.

"He was a 4-year-old but he was still acting like a 2-year-old," says his mother, Sue, a special education teacher in Durand, Mich. "It was taxing for him and for us."

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What Is Adjunctive Therapy for ADHD in Children?

These days, parents have several options to improve their children's ADHD symptoms. Kids who are diagnosed with ADHD often start by taking a single medicine, which is commonly from the stimulant class of medicines. If a stimulant drug doesn't work well, the doctor might recommend another type of medicine added onto it. This is called adjunctive therapy.

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Frustrated, his parents took him to the local hospital, where doctors evaluated Nicholas and diagnosed him with attention deficit hyperactivity disorder (ADHD), a condition that affects some 4.8 million American children, according to the American Academy of Pediatrics. Like most children with ADHD, Nicholas was prescribed medication to help control his symptoms.

While the drugs helped, Hill still did not feel like Nicholas?s behavior was under control. Not wanting to place her son on yet another medication, she began researching nondrug options and stumbled upon Ross Greene's book, The Explosive Child. Hill began using Greene?s behavior modification techniques with Nicholas and found they made a huge difference in managing his outbursts.

Greene, PhD, director of cognitive-behavioral psychology at Massachusetts General Hospital and assistant professor of psychology at Harvard Medical School, has developed a drug-free approach to parenting children who are easily frustrated and chronically inflexible, including those with ADHD. Greene's method teaches parents to intervene before their children explode and helps kids develop the skills to handle frustration constructively.

Growing Numbers of Preschoolers on Drugs

Greene, who has discussed his approach on Oprah and other programs, is gaining a following among parents of kids with ADHD. The Journal of the American Medical Association reported in February that the number of preschoolers being prescribed stimulants for disorders such as ADHD tripled between 1991 and 1995; those on antidepressants doubled during the same period. The long-term safety of these drugs, researchers say, is unknown, and many parents are seeking non-drug alternatives.

No one knows just how many children are being medicated unnecessarily, but some experts suspect that doctors are reaching for their prescription pads far too often. Mark Stein, MD, director of the Hyperactivity, Attention, and Learning Problems Program at Children's National Medical Center in Washington, says 40% of the ADHD children referred to him for further evaluation have been diagnosed incorrectly. Conditions that can be confused with ADHD, he says, include mental retardation and autism; and some children have personality characteristics similar to symptoms of ADHD without having the disorder itself.

"There is enormous pressure on primary care physicians in HMOs to diagnose conditions in 10 minutes -- conditions about which they know very little," says Stein, who spends 3 to 6 hours doing a comprehensive physical and psychological exam on any child suspected of having ADHD.

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