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Very often, school staff has the best perspective on a child's behavior. "The staff knows what's normal and what's abnormal. They'll know if a child is 'way off the chart.' It's harder for parents to gauge that," Bukstein tells WebMD.

In too many situations, primary care physicians who don't have access to specialists will prescribe medications when they're not necessary. "A perfect analogy is prescribing antibiotics for viruses. It's a very similar situation," says Bukstein.

"But preschoolers, because of their vulnerability, need special assessment," he tells WebMD. "It behooves doctors to go the extra mile to diagnose the problem. There are some very effective behavioral treatments that can help young children."

There's risk involved in prescribing for these very young kids, says Bukstein. "They have considerably more side effects to these [psychiatric] medications. They also don't have the same response rate to the drug that older kids have."

Patients in his clinic are involved in two multisite studies looking at preschoolers' response to medications.

Keep in mind, he says, "medication alone often does not solve a child's problems. If the child does have ADHD, stimulants may be the single best treatment, but behavioral therapy does have an additional effect. It adds to the medication's efficacy. Kids who get therapy often don't have to take as high of doses."

Reviewed by Michael W. Smith, MD, August 22, 2002.

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Reviewed on August 22, 2002

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