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Ritalin for Preschoolers?

Study Shows Drug Provides 'Moderate' Help for Preschool Kids with ADHD

Half of Kids Get 'Strong Positive Effects' continued...

"For the most part, the problems with Ritalin were the same as those most often seen in older kids -- appetite loss, weight lossweight loss, sleep difficulty, stomach aches, and head aches," Greenhill says. "But some had problems with irritability, more tantrums than they had before, and that was hard to interpret. From my experience, that is the kind of rockiness that you see in kids as the medication wears off."

Ritalin had "strong positive effects" in about half the kids, Greenhill says.

"They could have improved a little more -- but it was a help," he notes. "It takes more time and focus and doctor visits if someone is put on medication at that age. They will benefit -- but they will require more supervision."

"The way I see it, the efficacy is there," Insel says. "It is not as strong or robust an effect as we have seen in other randomized trials in school-age kids. If the question is, 'Does this medication work for these kids under age 6?' the answer is yes. It is an effect that is somewhat less than you would see in older kids, and comes with more side effects. But this confers some benefit in at least some of the kids."

Is Ritalin Really Safe in Preschoolers?

Insel notes that ADHD is a severe problem for children. Ritalin can help, he says, but this benefit must be balanced against the risks.

"A lot of kids are on these medications who should not be on them, and a lot of kids would benefit who don't have access to them," he says. "It will require a much closer look at who will benefit and who could just receive some behavioral intervention and just do fine. But when the medications are helpful, the kids who need them should get them. Finding the balance is the issue for us."

Finding that balance will mean learning more about Ritalin's risks for developing minds and bodies. The NIMH study has documented the short-term risks. But the long-term risks aren't yet known.

"You are giving a medication that has powerful neurochemical effects in a developing brain. What does this mean for long-term development? We don't know," Insel says. "It will take some time to know whether there will be some worrisome side effects in the future. But we have to weigh that against the consequences of not treating. Remember, you have a risk for not treating, too."

Indeed, Greenhill notes that kids with ADHD often suffer peer rejection. This is strongly linked to poor school performance and serious problems in the teenage years.

Just because kids won't do what we want them to do is no reason to medicate them, says Leslie Rubin, MD, director of developmental pediatrics at Emory University and director of the center for developmental medicine at Marcus Institute, Atlanta.

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