Introduction

The number of children diagnosed with and treated for disruptive disorders including attention deficit/hyperactivity disorder (ADHD) has markedly increased over the last decade. Concurrent with this trend is a growing debate about the best way to treat such problems in children.

According to a study published in the Journal of the American Medical Association in February 2000, the number of preschool children receiving stimulants, antidepressants and other psychiatric medications "rose drastically from 1991 to 1995." The study raised concerns about the increasing use of medications to manage ADHD disorders in young children because little is known about their safety and effectiveness for children of preschool ages. Few of these drugs, the study points out, are approved by the U.S. Food and Drug Administration for prescription to young children.

For parents, especially those parents of children who have been diagnosed with a behavioral or emotional disorder or those who suspect their children have been suffering from such a problem, these new concerns about the use of psychotropic medications present nagging dilemmas. How should a parent make decisions about what course of treatment is the best one for his or her child?

Appropriate Assessment and Diagnosis Must Come First

While all children develop at their own pace, there are developmentally appropriate stages through which children progress. It is important for parents, caregivers and teachers to be aware of their children's growth and development and to watch for unusual behavioral changes or regressions. Every child will have an occasional "bad day", and it is appropriate for young children to have high energy levels. But, if your child is experiencing persistent problems that interrupt his or her participation in school or interaction with other children, or, if your child shows signs of social withdrawal, an inability to focus their attention, or is impulsive and unduly aggressive, it may be time for you to seek professional help to determine what is going on and how best to help your son or daughter.

As a general rule, it is time to consult a mental health provider if your child's behavior is age inappropriate, an on-going pattern, and, if it interferes with his or her learning, growth and social development.

Teachers, school administrators, or primary care physicians may suggest that a child's behavior is problematic and that he or she could benefit from taking a psychotropic medication. However, a thorough evaluation and diagnosis by an appropriately trained and credentialed health professional should take place before any such decision is made. Among the providers who would do appropriate assessments of your child's behavior are child psychologists, pediatricians, pediatric neurologists, and child psychiatrists. These pediatric providers should also continue to work with the child, his or her family and school to create a school and home-based treatment plan and monitor the child's progress over time. A "team" approach when treating a child is critical - the team members being the child's parents, pediatrician, psychologist, school-based counselors or psychologists, school administrators and teachers.

Behavioral Treatment Can Be An Important Part of the Treatment Plan

Treatment programs can take many forms and are best when specifically tailored for the child. They may include psychotherapy including cognitive-behavior therapy, or behavioral management training; parent education, social skills training, and family support services. If it is determined that your child needs medication in addition to the behaviorally based treatment it is often most effective if both types of treatment are employed together.

A variety of psychotropic drugs have proven to be very helpful in helping adults manage a number of psychiatric disorders, but few of these drugs have been tested for safety and effectiveness in preschool children. Depending on your child's diagnosis, behavioral, family and school-based therapy programs should be considered first and given ample time to work, before the use of medications. Your child's specific diagnosis is critical to determining the best treatment plan. Research has shown that for a diagnosis of ADHD with a co-occurring emotional disorder a combination of medication and behavioral therapy work best. For a diagnosis of ADHD only, medication based treatment is often most effective. If your child is placed on a medication-based treatment, the on-going monitoring of the medication's effects and effectiveness is critical.

More Research is Needed

The Food and Drug Administration will have approved any drug prescribed by a physician for clinical use, but not necessarily for use by preschool children. More research is needed to understand both the short and long-term effects of these drugs on children and their developing brains. In fact, the National Institute of Mental Health recently announced that it will invest more than $5 million in research on the use of Ritalin, behavioral therapy and the combination of both interventions to treat attention deficit/hyperactivity disorder in preschool children.