Study finds risks, benefits in giving Ritalin to preschoolers

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Study finds risks, benefits in giving Ritalin to
preschoolers
http//www.cnn.com/2006/HEALTH/10/19/preschoolers.
adhd.ap/index.html
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Pre-school Ritalin

• CHICAGO, Illinois (AP) -- The first long-term
  government study of preschoolers who take
  Ritalin, the popular attention deficit disorder
  drug, warns of side effects but also found
  benefits in children with severe problems. The
  drug isn't approved for use in children under age
  6, and the researchers said those youngsters need
  close monitoring. Preschoolers are more likely
  than older children to develop side effects,
  experts said.
• The research was done because of concerns over
  reports that soaring numbers of preschoolers are
  being given psychiatric drugs, including Ritalin.
  The study's message is, proceed with caution,
  said Dr. Thomas Insel, director of the National
  Institute of Mental Health. "We're not talking
  about fidgety 3-year-olds," said Insel, whose
  agency funded the study.
• The research involved children with severe
  attention deficit hyperactivity disorder with
  behaviors that included hanging from ceiling
  fans, jumping off slides or playing with fire.
  The researchers say the benefits of low-dose
  treatment outweigh the risks for these
  youngsters. But critics disputed that.
• "I hope publication of this does not lead to more
  overprescribing," said Dr. Sidney Wolfe of the
  watchdog group Public Citizen. "The safety isn't
  adequately established, the efficacy even less."

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The Study

• The study appears in the November edition of the
  Journal of the American Academy of Child and
  Adolescent Psychiatry. Several of the researchers
  have financial ties to makers of ADHD drugs,
  including Ritalin. Lead author Dr. Laurence
  Greenhill, a psychiatrist with Columbia
  University and New York State Psychiatric
  Institute, has been a paid speaker for most
  companies that make the drugs.
• Roughly 8 percent of U.S. children have ADHD,
  including around 3 percent of preschoolers.
  Previous research found that about 1 in 100
  preschoolers had been prescribed Ritalin, which
  has only been approved for use in children aged 6
  and older. Use in younger children is considered
  "off-label" but is not illegal.
• Dr. David Fassler, a psychiatry professor at the
  University of Vermont, said the study does a good
  job of outlining pros and cons of Ritalin
  treatment in preschoolers. "This is exactly the
  kind of information we need to help parents make
  informed decisions about treatment options for
  young children with ADHD," Fassler said.

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Particulars

• The study included 10 weeks of behavioral
  treatment along with parent training and about
  one year of drug treatment.
• Nearly 300 families were enrolled, but many
  dropped out after the first phase, either because
  the behavior treatment worked or because they
  didn't want to put their children on drugs.
• The drug phase started with 165 children, more
  than a dozen dropped out because of side effects.
• Behavior improvements were seen in children
  taking 7.5 to 30 milligrams daily, but the
  optimal dose was 14 milligrams daily -- less than
  half the usual Ritalin dose for older children,
  Greenhill said.

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Benefits, Costs

• Medicalization -Identifying or categorizing (a
  condition or behavior) as being a disorder
  requiring medical treatment or intervention.
• Has normal development been medicalized into a
  disorder requiring treatment?
• Is the treatment effective.

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Assuming treatment is effective,
Disorder
No
Yes
Benefits None
No
Costs ADHD-related Costs
Treatment
Benefits None
Benefits Improved Outcome
Yes
Costs Wasted Drug Treatment Possible Side
Effects
Costs Drug Treatment Possible Side Effects