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Education Reporter

Into the Mouths of Babes
The drugging of preschoolers is on the rise, study shows
CHICAGO, IL — The Feb. 23 Journal of the American Medical Association reported on new research by the University of Maryland which shows that the number of children ages 2-4 taking powerful stimulant and anti-depressant drugs increased 50% between 1991 and 1995. The greatest increase was in the use of stimulants (Ritalin) and the newer class of anti-depressants (Prozac, Zoloft and Paxil). Researchers believe this rise reflects an ongoing trend.

The study results have caused alarm among experts, who worry about the dearth of research on the effects of psychiatric medications on very young children. Many are concerned about the potential danger of these drugs to the developing brains of pre-schoolers. Dr. Joseph Coyle, chairman of psychiatry at Harvard Medical School, commenting in the Feb. 23 New York Times, said: "These interventions are occurring at a critical time in brain development, and we don't know what the consequences are."

According to U.S. News & World Report (3-6-00), psychiatrists are especially alarmed at the increased number of prescriptions for older "tricyclic" antidepressants, which "have never been proven to work in children" and which "can cause fatal overdoses." They also find worrisome the jump in prescriptions for clonidine, a blood-pressure medication used as a tranquilizer for young children which "also has dangerous side effects."

As Dr. Julie Magno Zito, associate professor of pharmacy and medicine at the University of Maryland and lead author of the study, points out, few of the psychiatric drugs currently prescribed for young children are approved for such use by the FDA. "It is not really clear that children this young could meet the diagnostic criteria for either attention deficit hyperactivity disorder (ADHD) or depression, and those are the probable diagnoses given to justify the use of stimulants, antidepressants, and clonidine," Dr. Zito told the New York Times.

Many experts, including Dr. Coyle, believe that diagnosing ADHD in toddlers is difficult at best because their normal behaviors are considered signs of the disorder in older children.

Indeed, diagnosing ADHD at any age is a matter for dispute. The American Psychiatric Association's Diagnostic and Statistical Manual admits there are no "laboratory tests that have been established as diagnostic" for ADHD, and the Physicians Desk Reference describes it as "a general term for several behavioral problems previously known as minimal brain dysfunction in children."

The APA manual suggests that children who exhibit at least eight of 14 "symptoms" for at least six months have the disorder. These symptoms include fidgeting or squirming in seat, difficulty remaining seated when told to do so, difficulty following through on instructions, interrupting others, refusing to listen to others, and losing things necessary for completing tasks, such as pencils. Many experts say these "symptoms" sound suspiciously like normal childhood. Dr. Fred Baughman, pediatric neurologist and a Fellow of the American Academy of Neurology, calls ADHD "a contrived illusion of a disease that was invented in-committee at the American Psychiatric Association."

An article in the Nov. 1999 Massachusetts News notes: "Some experts think a hyperactive child is reacting to a stressful home environment, not the pain of a chemical imbalance in the brain that could make it hard for a child to concentrate." The article adds that while many doctors tell parents their children "are suffering from a chemical imbalance in the brain that can be corrected with medication, it can't be seen or measured."

"Conflicts between children and adults are being redefined as diseases or disorders within the children," says Dr. Peter Breggin, International Director of the Center for the Study of Psychiatry and Psychology. "Treatment with stimulant drugs such as Ritalin will produce greater docility in any child (or animal) without actually improving conduct or academic performance. Parents are not informed that they are trading behavioral control for toxic drug effects."

Why are parents so willing to medicate their young children when the effects of drug therapy are for all intents and purposes unknown? A greater reliance on daycare and the need to have children "conform in their behavior" is one factor cited by study author Zito. Experts also point to the ironic acceptance in the 1990s of legally-prescribed mind-altering drugs while the "war" on illegal mind-altering drugs continues unabated.

According to U.S. News & World Report, doctors who prescribe psychiatric drugs to children often complain that they are "pressured by managed-care companies and insurers to avoid referring their patients to mental health specialists and to reduce the time they spend with families." To properly assess a child's behavior relative to family problems or situations is time-consuming, they say. "You need at least four 45-minute sessions, observing the child with the family, taking a family history," child psychiatrist and author of Building Healthy Minds, Dr. Stanley Greenspan, told U.S. News. "In many situations, a child is being prescribed and diagnosed on a one half-hour meeting. Insurance coverage doesn't support the kind of assessment you need."

The study analyzed prescription re-cords from 1991, 1993 and 1995 for 200,000 pre-school age children enrolled in two state Medicaid programs and an H.M.O. The states and the H.M.O. were not identified. Methylphenidate (the generic for Ritalin) was by far the most popular drug prescribed, accounting for 90% of the prescriptions in the midwestern state's Medicaid program. While Ritalin has been decried by critics as "violence against boys," researchers found that prescriptions for Methylphenidate increased faster for girls than for boys in the mid-Atlantic state's Medicaid program and in the H.M.O., indicating that diagnoses of attention disorders in girls are on the rise.

According to a March 9 article entitled Kids on Drugs, by behavioral pediatrics specialist and author of Running on Ritalin Dr. Lawrence H. Diller, stimulant drug use in children rose 23% between 1995 and 1999. The use of Prozac and other anti-depressants for children under 18 was up 74%, for ages 7-12 up 151%, and for children six years of age and under, anti-depressant drug use rose a shocking 580%. IMS Health, a company that tracks and reports the latest trends in medication usage for the pharmaceutical industry, compiled the statistics.

Dr. Diller places the number of American children now taking at least one psychiatric drug at 5 million, and notes that American kids use twice per capita the amount of Ritalin as Canadians, and far more than children in other developed countries. "The use of psychiatric drugs other than Ritalin on preteen children is virtually unheard of outside this country," he says.

While Diller is not against prescribing psychiatric drugs for kids, he admits he has become "increasingly uneasy" with the frequency of parents' requests for medication and with doctors' willingness to accommodate them. He blames the new mindset on society's shift over the past 20 - 30 years from believing that most behavioral disorders have a psychological basis to the belief that they have a biological basis. "A logic developed that if a drug improved behavior, the problems must be biologically based," he writes. "No one speaks of a headache as an 'aspirin deficiency,' even though the drug relieves the symptoms. Nevertheless, terms like 'chemical imbalance' became increasingly fashionable in explaining problem behavior."

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