Is it really anxiety, or just a child's shyness in a new situation? Is it really hyperactivity, or just a growth stage the child is going through?
A recent study points out that these medications have not been approved for young children and the potential for harmful effects on them is unknown.
In the study, researchers reviewed outpatient prescription records and found the No. 1 most prescribed psychotropic drug was Ritalin.
In fact, from 1991 to 1995, Ritalin prescriptions tripled among some groups of children 2 to 4 years old, reports researcher Julie Magno Zito, PhD, associate professor of pharmacy and medicine at the University of Maryland. Her report appeared in a February 2000 issue of The Journal of the American Medical Association.
It all points to a growing crisis in mental health services, says an accompanying editorial.
"Behaviorally disturbed children are now increasingly subjected to quick and inexpensive [medication] fixes" rather than approaches that include pediatric, psychiatric, behavioral, and family care, according to Joseph T. Coyle, MD, chairman of psychiatry at Harvard Medical School.
A doctor trained in diagnosing emotional or behavioral conditions should assess any child who has been recommended for psychiatric medication, says Coyle.
A prescription, he says, should not always be the first option.
Too frequently, inexperienced parents "diagnose" problems in their young children -- when the kids are just being normal, says Oscar Bukstein, MD, associate professor of psychiatry in the Western Psychiatric Institute at the University of Pittsburgh School of Medicine.
It's true that preschoolers do have problems, he tells WebMD. "We have identified major depression in preschoolers. We know that ADHD does exist in little kids. Anxiety disorders are also very common."
However, many times the problem is related to lack of socialization -- or simply to a young child's developmental level, he says. "Kids who haven't been put in social situations before preschool will have difficulty at first. Also, the average preschooler is very often more hyper than the average school-age kid. An inexperienced parent can easily think their child has ADHD when in fact the preschooler simply hasn't been accustomed to social situations."
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.