Preschoolers On Drugs

Poor concentration, distractibility, hyperactivity, and impulsiveness qualities that are not age appropriate define a behavioral and developmental disorder named Attention Deficit Hyper Active Disorder. Attention Deficit Hyper Active Disorder commonly known as ADHD has similar characteristics to those of preschool children, making it difficult to accurately diagnosis children under the age of six. In the United States, there has been a recent rise in diagnosis of ADHD in preschool children. According to the National Institute of Mental Health, from 1990 to 1995 there has been a 300 % increase in the number of preschoolers taking medications to treat ADHD. The most popular medication, Methylphenidate is a prescription drug that is causing controversy in the education and medical fields, especially when prescribed to children under the age of six. The House Subcommittee on Early Childhood, Youth, and Families announced that the methylphenidate quota increased from 1,768 kilograms in 1990 to 14, 957 kilograms in 2000.

Methylphenidate is the generic name for a mild central-nervous system stimulant prescription drug. Methylphenidate and comes in multiple brand name forms; the most popular are Ritalin and Concerta. In addition to Methylphenidate, Pemoline and Dexedrine are available prescription drugs to treat ADHD. The brand name prescription drug Adderall is a type of less mild-central-nervous-stimulant called Dexedrine. Pemoline is a psychotherapeutic agent prescription drug known as Cylert and PemADD.

To diagnosis a child before the age of six is a complicated task, due to the lack of maturity the child possesses. In fact, 50% of 3 year olds diagnosed with ADHD lose the diagnosis by age 6, and 48% by age 9. Failure to recognize high motoric level, limited attention span, and oppositional behavior are three symptoms common in all preschoolers. Preschoolers with ADHD do not have these characteristics at the appropriate age level. All other possible causes contributing to the characteristics must be ruled out before labeling a child ADHD. Visual and or auditory deficit, mental retardation, fragile X syndrome, learning disabilities, a pervasive development disorder, major depression, anxiety disorder, all produce similar symptoms to those of ADHD.

Once all other diseases and disabilities are ruled out the ADHD symptoms must be chronic and present both at school and home. Next, goals must be set for the management of the child's ADHD based on presenting complaints. If the treatment is ineffective and if goals are not being met, the child's diagnosis and treatment plan must be revaluated. Once an effective treatment is in place, a doctor should see the child every three to sixth months.

In a recent survey of pediatricians, published in the Archives of Pediatric and Adolescent Medicine, nearly 50 percent of the doctors confess to spending an hour or less with a child before making a diagnosis and prescribing medication usually Ritalin. Those who oppose Ritalin often critique pediatricians, and the medication use in children with ADHD.

The critics feel that preschoolers are still developing their personalities and still developing their brains and medication such as Ritalin stop or alter developments. Preschoolers are unable to give informed consent to take medication that is so powerful it can only be diagnosed for a thirty-day period. A particular concern is the potential risk of neuro-toxicity associated with long -term administration of a drug with Central Nervous System activity to a young child during a crucial period of Central Nervous maturation. The Pemoline stimulates the central nervous system more intensely and is advised not to be taken under the age of six because long-term treatment may inhibit growth in children. Pemoline is also capable of causing children with psychotic traits to grow worse.

"Research has shown that the dopamine receptor, which has been implicated in the formation of ADHD, reaches a peak density at about three years of age and then starts to taper off. Given that the long-term treatment of many psychotropic drugs has been shown to alter the numbers and sensitivity of dopamine receptors, a perturbation of the dopamine system at a critical developmental time period could have severe consequences. Considering that we know so little about the effect of Ritalin on the developing brain, even the developing rat brain, it seems odd that we are dispensing it to such young children".

There may be a correlation in the effects of stimulant medications on the children's brains and the opposite psychologically effects such as sadness, irritability, clinginess, insomnia, and anorexia because the effectiveness of these medications appears to be more variable in children aged three to five. In addition, stimulant drugs actually may be counterproductive for children with co-morbid conditions such as anxiety and conduct disorder. The fact that stimulant drugs have been proven to improve focus and performance does not mean that all children who benefit have A.D.H.D. Perhaps these factors are why Ritalin has not been approved for children under the age of six by the F.D.A.

In addition to scientific and health factors, there are moral factors that question the level of ethics in prescribing drugs to children. In New York, the courts would not allow the parents of a four-year old child on Ritalin to discontinue the use of Ritalin. The defense response was that, "Certainly child-protection laws and the courts are not the best way for us as a society to see that our children receive appropriate care. But when a child's well-being is at stake, we cannot default on our responsibilities to ensure that he or she gets the necessary help." If the F.D.A. does not approve the use of Ritalin in children under the age of six, how can the New York courts demand that a child stay on the drug against the will of his parents?

Another treatment solution to ADHD is cognitive behavior therapy. Behavior therapy has not been proven to work effectively alone, but in conjunction with medication. Medication works better when behavior therapy is used as well. As we have learned in class, medication is more effective than cognitive behavior because it is too challenging for children with ADHD to process what they learned in therapy into a classroom setting. Teachers can help their students with A.D.H.D. by remaining positive and by offering encouragement. A progress chart is a good idea for students to visualize their behavior. Teachers need to provide instant gratification for students with A.D.H.D. whom have no concept of time.

Child psychiatrist Carl L. Kline said that, "Ritalin is nothing more than a street drug being administered to cover the fact that we don't know what's