Should Ritalin be prescribed to children under age 6?

[cmdunn1972]

Results of a study regarding side effects of Ritalin on preschoolers were just released to the media. Here are two articles on the same topic, one from WebMD and the other from MSNBC:

http://www.webmd.com/content/article/128/117189.htm
http://www.msnbc.msn.com/id/15336510

Do you think children should be prescribed Ritalin before age 6?

(ETA URLs for articles)

[lizajane]

i just don't know. but as the parent of a potentially ADD kid and the wife of an ADD dad and the sister of an ADD sister... it is on my mind. i do not want to drug my child, nor do i want to make him suffer because i refuse to try a treatment that is available to make him learn more easily.

i will wait and see what happens in kingergarten. so far, we are able to get him out and about and running around enough so that preschool has never been an issue. it is hard to focus him at home, but there is a lot more going on at home than at preschool where the teachers/class are entirely geared toward maintaining the attention of eight 3 year olds. mommy doing laundry isn't of much interest to any 3 year old, much less one with ADD.

[mamalou]

I hate to say there is a right or wrong here for everyone, but I am inclined to say generally, no, preschoolers should not be prescribed ritalin because there are known possible negative short-term side effects (including stunted growth) and that and the long-term effects are unknown.

The first article states...
"Long term effects are not known... 'You are giving a medication that has powerful neurochemical effects in a developing brain. What does this mean for long-term development? We don't know.'"

The main reason the first article gives to perscribe ritalin is better peer interaction and reducing possible injuries... as in, the kids could get hurt falling out of a five-story buildings, roller skating in traffic, or touching a hot stove. We are talking about 3-5 year olds! It makes it sound like these kids need better supervision.

The second article states "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."

Given the opportunity at 3-years old, my DS would have tried these things too. At 5, he is thriving in kindergarten.

I'm sure this is just bad journalism to some degree. The actual research I hope would define ADHD better.

[cmdunn1972]

My Mom is a 5th grade Catholic school teacher, so I hear about ADD/ADHD all the time from her from a professional standpoint.

Playing devil's advocate here, but I'm wondering if we're expecting too much from children too young. Even with family history of psychiatric problems, I wouldn't expect much attention span from a 3 year old. How do you measure what's normal 3 year old behavior and what's a disorder when they're still learning how to pay attention? I would think that it'd be even more difficult when diagnosis is subjective in nature.

It's good that you're aware that it could be an issue. That way, you're not surprised if/when an elementary teacher wants to discuss it. You're also less likely to let it fall through the cracks. It's also good that you're waiting until your child is of school age to make that determination. I do hope that the main basis for it is not difficulty completing homework, since we really shouldn't be expecting much in the way of academics from children at that age anyway.

[cmdunn1972]

You make some good points. I hope that they would research Ritalin more thoroughly as well! Ritalin is a very old drug that has been used to treat psychiatric problems for a long time. It is my understanding that it was approved before professionals knew exactly how it worked, they just observed that it somehow did.

I'll play devil's advocate with you as well, if you don't mind. ;) We all know how hard it can be to keep up with the toddler set. They're an active bunch, and the population of "older" parents is growing. There are quite possibly many parents who are weighing the risk of their child being injured in the blink of an eye with possible long-term risk of side-effects which may or may not exist for their child.

[bunnisa]

Personally, the widespread use of Ritalin frightens me.

We've taken recess out of the public schools, and then we drug the children who can't sit still in class (mainly boys).

If my child were exhibiting ADD/ADHD symptoms (at an appropriate age to look for such - NOT at 3!), I'd go the Feingold route first, add on some herbal remedies, and create the proper environment for the child as well (homeschooling would probably be best in that situation).

Do we really understand potential long-term effects of Ritalin on children whose brains and nervous systems are still developing?


...blessed wife and mama to two!

"And children are always a good thing, devoutly to be wished for and fiercely to be fought for."
-Justin Torres

[cmdunn1972]

It's almost a chicken-and-egg thing, isn't it? I mean, it's good that we've advanced to the point that treatments are available, but then we wonder if the treatments cause more (yet different) problems than they solve.

I do like your more wholistic approach to the problem. I'd like to understand more about what the Feingold route is, if you don't mind providing the info. I have heard that approaches such as biofeedback and counseling are usually more effective when paired with chemical treatments such as Ritalin. I also would hope that children who are diagnosed early are suspected to be the most severe of cases, so one might assume that some degree of chemical intervention might also be necessary. Given that, would you advocate doing research to find a chemical solution that has fewer incidences of side-effects for these children?

I'm curious to hear your thoughts.

[icunurse]

If you had asked me this about 5 years ago, I would have easily said "no". However, my niece was diagnosed with ADHD during kidergarten and her meds have made all the difference. She was fighting, easily distracted, just generally disruptive, and then some. The school finally said that if they didn't look into some kind of treatment for her, she was going to be kicked out. Her parents took her to 3 docs (one was from the school, one was a referral from the school doc, and the last was one they found on their own) and they all said the same thing - she needs meds. So, after a lot of trial and dosing changes, she takes meds every day (and when she doesn't, you see it pretty darn quickly in her behavior). She does well in school, people enjoy being around her, she can pay attention and isn't as explosive as she was before...she's happier, too. They are hoping to try and wean her off to see what happens. We're all hoping that she doesn't need them, but what good was it for her the way she was unmedicated, KWIM?

That said, I do think too many parents try to label correctible behavioral issues as "my kid must have ADD" and I think a lot of docs give the meds too easily (though I do think with more time, knowledge, and especially awareness of the side effects, docs are being a bit more cautious). Each kid should be assessed thoroughly and several times (and preferably by more than one doc).

Traci
~Mom to DS 02/2004~
Hoping, waiting...

[cmdunn1972]

Traci, I do wonder if it's our hastiness that mistakes in diagnoses are incorrect.

My brother was diagnosed with ADHD when he was school age. He was medicated on typical ADHD meds, which incidentally are often the same class of meds used to treat depression. When he hit puberty, the meds stopped working. He was rediagnosed with clinical depression. The doctor said that while inattention is a symptom of both conditions, his primary symptom was low self-esteem. With a more accurate diagnosis and a different set of treatments, things got better.

[lizajane]

i don't expect too much of my young children at all. they are little KIDS not little adults and they think and act differently. i don't get all bent out of shape if they wiggle and squirm at the dinner table at a restaurant. i DO get bent out of shape when they run circles around the restaurant, bumping into things and people, and ignore all requests to return to the table.

here a tiny example of why i think my older child may have ADD and why my younger child does not. if my older child sits in my lap, he never stops moving. he twitches. he squirms. he changes position. he kicks his foot. he taps his toe. he moves CONSTANTLY.

when my younger child sits in my lap, he just sits. and when he is ready to move around, he gets up. and he is not a quite/reserved child at ALL. he is always on the move, very curious, climbs things, etc. but when he is still, he is still. and his older brother is NEVER still.

as a baby, schuyler SCREAMED for hours at a time riding in the car. as a baby, dylan stared out the window for hours at a time.

schuyler is 3.5 and can't get to sleep and struggles every night. dylan is 21 months and climbs right into his bed and snuggles down, and only very rarely complains (cries) and hardly ever for more than 15-30 seconds.

these children have the same parents who used the same parenting methods. and while birth order definitely has an effect, i don't think it has anything to do with sitting still. and FWIW, my sister was the kid who couldn't ever sit still, who screamed in the car, who could never get to sleep. and she is the first child. and she was diagnosed with ADD at age 22. (ish.) and after going through college with good grade, but struggling to go to class without a diagnosis, she flew threw law school loving every second of it on ritalin.

not arguing. just remarking. i do love the devil's advocate game. just wanted to explain my thoughts and why i will be on the look out.

[cmdunn1972]

It does seem obvious, especially when you describe your two children side-by-side. It's probably a good thing that Schuyler has a younger sibling with a different personality. Otherwise, you might not have noticed that his behavior was any different from that of his peers until he was school age.

I think your observations are especially helpful since you're noticing a pattern of behavior over time instead of just isolated incidents from approximately the same developmental stage.

It sounds like Schuyler, from how you described him, might also be extremely sensitive to sensory input. (I forget what EI therapists call that, but it's been mentioned here before.)

Not that you're asking for or need my opinion or anything, but I think it's great that you're considering family history and noting your observations. It'll help so he doesn't run any risk of slipping through cracks like your sister. (Slipping through cracks is no fun, and because boys tend to physically manifest symptoms more than girls, girls tend to slip through cracks more often.)

[lizajane]

thanks. :)

schuyler is the "highly sensitive child." he doesn't seem to have sensory integration disorder- has no issues with textures, tags, etc. but WOW is he ever highly sensitive. and what most interests me in this book is that it turns out *I* am the highly sensitve person and i never knew it. i just thought every one else wasn't paying much attention to all the things i noticed immediately.

[cmdunn1972]

LOL So, you're the observant one in the crowd. :)

I was always a sensitive child too. Plus, I was little, uncoordinated, and a geek. I got picked on mercilessly for it until high school. It was awful. However, I think that sensitivity starts to work in your favor somewhat when you grow into it. When you know what it's like to be picked on as a child, you're less likely to be mean to other people.

[lizajane]

what was interesting was that i wasn't a sensitve child. i wasn't picked on. i was outgoing and social and didn't get hurt easily physically or emotionally. but i notice EVERYTHING. anyhoo. interesting.

[cmdunn1972]

LOL It's called "being observant". ;) I would think it's a good quality, in many regards. :)

[bunnisa]

>I do like your more wholistic approach to the problem. I'd
>like to understand more about what the Feingold route is, if
>you don't mind providing the info.

It's a diet that has been used successfully to treat ADD/ADHD symptoms. I know many families who have benefitted. We follow a loose Feingold diet in our house, just because I think it's wise.

http://www.feingold.org/

From the website:

Numerous studies show that certain synthetic food additives can have serious learning, behavior, and/or health effects for sensitive people.
The Feingold Program itself is a test to determine if certain foods or food additives are triggering particular symptoms. It is basically the way people used to eat before "hyperactivity" became a household word, and before asthma and chronic ear infections became so very common. Used originally as a diet for allergies, improvement in behavior and attention was first noticed as a "side effect." It is a reasonable first step to take before (or with if already begun) drug treatment for any of the symptoms listed on the Symptoms page.

The Feingold Program eliminates these additives:

Artificial (synthetic) coloring
Artificial (synthetic) flavoring
Aspartame (Nutrasweet, an artificial sweetener)
Artificial (synthetic) preservatives BHA, BHT, TBHQ
In the beginning (Stage One) of the Feingold Program, aspirin and some foods containing salicylate (Suh-LIH-Suh-Late) are eliminated. Salicylate is a group of chemicals related to aspirin. There are several kinds of salicylate, which plants make as a natural pesticide to protect themselves. Those that are eliminated are listed in the salicylate list which is included also in the Program Handbook. Most people can eventually tolerate at least some of these salicylates.
We call this dietary program the Feingold Program rather than the Feingold "Diet" because fragrances and non-food items which contain the chemicals listed above are also eliminated.

As far as pharmeceutical "solutions" for ADD/ADHD, no, I don't support those except in extreme cases.

The goal is to heal, or to develop the child's ability to cope and control the problems. Masking the problem does not solve the problem.


...blessed wife and mama to two!

"And children are always a good thing, devoutly to be wished for and fiercely to be fought for."
-Justin Torres

[Elilly]

Another big vote for dietary intervention as treatment. My ADHD, with a very big H, nephew went on a gluten free diet and his hyperactivity subsided greatly.
Don't stone me, but I believe that ADHD, ADD, and SID are on the very mildest end of the spectrum. That's why interventions like feingold, gluten and casein free diets,and vitamins supplements that are used for autistic children often work for ADHD etc. as well.