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Ritalin for Preschoolers?
Oct. 19, 2006 -- Ritalin has a "moderate" effect on preschool kids with moderate-to-severe attention deficit hyperactivity disorder ( ADHD), finds a National Institute of Mental Health study.
"We found that a carefully diagnosed and carefully selected sample of 3- to 5-year-old children with ADHD can benefit from Ritalin," Laurence Greenhill, MD, tells WebMD. "But because young children are more sensitive to Ritalin side effects, we found a need for close monitoring of any young child taking this medication."
Greenhill, a psychiatry professor at Columbia University and director of pediatric psychopharmacology at New York State Psychiatric Institute, led the NIMH-funded study.
A previous study in older, school-age kids showed Ritalin to have "strong" effects on ADHD.Compared to older children, Greenhill says, "We found half the dose to be most effective, half the number getting really well, and more kids having to deal with adverse events in the early part of treatment."
Greenhill and colleagues report the findings in five detailed articles in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Why Medicate Preschoolers?
Ritalin is a stimulant medication that can make about 75% of school-age kids with ADHD act like their peers without ADHD. It can also stunt a child's physical development. Why give such a powerful medication to small children?
A major reason is that kids with moderate to severe ADHD already are at high risk of physical harm.
"They have difficult peer relationships due to lack of reciprocity and perhaps aggression. And they are very prone to accidents," Greenhill says. "Many of them were attending emergency rooms with cuts and bruisesbruises and broken bones, because their fearlessness and activity level made life dangerous for them. They had no idea how dangerous it was to lean out a five-story window, or to speed into traffic on their roller skates. One child saw his mother cooking on the stove, and perched on the stove and turned it on to see how hot it would get. They are fearless and reckless."
Another reason for the study is an eye-opening 1999 report showing that about one in 100 preschoolers was being treated with Ritalin for ADHD -- even though the drug is not approved for this age group.
"So the NIMH asked the questions: Is this effective? Is it safe?" NIMH director Thomas Insel, MD, tells WebMD. "We had no data on these questions."
Half of Kids Get 'Strong Positive Effects'
The study didn't simply give kids a generic version of Ritalin to see what happens. The eight-stage, 70-week study gave parents the opportunity to quit at any time. They could either continue with doctor-supervised Ritalin treatment or discontinue the drug.
An early part of the study made parents attend 10 two-hour training sessions to help parents deal with their child's ADHD. For about 7% of the children, Greenhill says, this was enough.
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