Attention-deficit/hyperactivity disorder (ADHD) is
no longer diagnosed just in schoolchildren. ADHD has
already become the most common mental health diagnosis
for children ages 3 to 5. Researchers have now begun
to explore the use of drugs and other treatments for
preschoolers, reports the September 2007 issue of the Harvard
Mental Health Letter.
At the preschool age, it can be hard to tell whether
certain behaviors represent a real problem or just “kids
being kids.” Clinicians compare a child with
others the same age to determine whether the symptoms
are inconsistent with the developmental level. Preschoolers
with ADHD are not just rambunctious. They seem unable
to wait their turn or think before acting. Despite
warnings, they may play with matches or rush into traffic.
They are noisy and constantly interrupt others, and
they can sow chaos at home or in day care.
Stimulant drugs are increasingly prescribed for younger
children, although the FDA has not approved them for
children under age 6. The first large, controlled trial
of methylphenidate
(Ritalin and others) in children ages 3 to 5 found
the drug was not quite as effective as it is in school-age
children.
The most popular alternative to drug treatment is
parent training, which is based on the belief that
parental negligence, intrusiveness, or harsh discipline
might trigger hyperactive behavior in a child with
a predisposition to poor impulse control. Parents are
shown how to set appropriate limits and use moderate
rewards and punishments. The bottom line, according
to the Harvard Mental Health Letter: Be slow
to make the diagnosis, and consider parent training
and specialized day care before resorting to stimulant
drugs.
Also in this issue:
- Endophenotypes: A new way to look at psychiatric
disorders
- Ignoring hallucinatory voices
- When both partners are violent
- Muscle relaxation
- Borderline personality disorder
- Children, depression, and the FDA
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