Preschoolers with ADHD
While it is usually difficult for parents to decide on a trial of medications for ADHD for their children, it is much more difficult to think about using medications for their preschoolers. Stimulant medications, such as methylphenidate (brand name Ritalin), have been studied extensively in children, but there have been few studies in younger children regarding their safety or effectiveness. The few studies that have been done have implied that preschoolers have a lower rate of response to stimulants, and possibly a higher rate of side effects. Methylphenidate is approved by the FDA for use in children six years-old and older, but its use in younger children has increased dramatically in the past five years.
The November 2006 issue of the Journal of the American Academy of Child and Adolescent Psychiatry published the results of the first long-term study on the effects of methylphenidate in 3 - 5 year-old children with ADHD, called the Preschool ADHD Treatment Study.
This study was sponsored by the National Institute of Mental Health and several major universities and was not funded by drug companies. The study began with 303 children diagnosed with ADHD (children with other serious emotional disorders were excluded). There were several different phases of the study, with 140 children entering a 10-month maintenance phase with adjustments in the dose of their medication depending on the severity of ADHD symptoms or side effects.
Up to 30% of parents reported side effects. While the most common side effects were sleep problems and decreased appetite, some children experienced irritability, emotional outbursts, anxiety, sadness, crying, social withdrawal, fatigue, abnormal movements, stomachache, increased talking, restlessness, and impulsivity. There were no significant cardiovascular side effects reported that required a change or discontinuation of medication. Side effects were more common with higher doses. While irritability, tearfulness and sadness, and tiredness seemed to improve with time, many of the other side effects did not. While there were significant improvements in ADHD symptoms in many of the preschoolers, the improvements did not seem as great as with older children.
The preschoolers who responded to medication seemed to respond to relatively low doses of methylphenidate, and experienced significant more side effects at higher doses. Preschoolers should probably be started on no more than 2.5 mg of methylphenidate twice a day, with the dose slowly increased over the first couple of weeks to 5 - 7.5 mg two to three times a day if indicated and if well tolerated. While the dose of stimulant medication varies widely from person to person, the average dose in this study was 14 mg/day. Children who initially responded to a low dose of medication sometimes required an increase in dose for continued effectiveness.
The available studies suggest that preschoolers might experience less of a response, and an increased frequency of side effects, than school-aged children to methylphenidate. Behavioral treatments and classes to improve parenting skills should be considered prior to the use of medications, as well as in conjunction with medications, for most children. However, low doses of stimulants can often be used safely and effectively in children with more severe symptoms of ADHD.
If medications are prescribed, children should be monitored closely because of the increased risk of side effects. Because stimulant medications carry a risk of appetite suppression, weight loss, and reduction in growth rate, children should be seen at least 3 - 4 times a year to measure growth rates, assess efficacy, and monitor other potential side effects of medications.
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Technorati Tags: ADHD, preschoolers, ritalin, ADD, stimulant medications
The November 2006 issue of the Journal of the American Academy of Child and Adolescent Psychiatry published the results of the first long-term study on the effects of methylphenidate in 3 - 5 year-old children with ADHD, called the Preschool ADHD Treatment Study.
This study was sponsored by the National Institute of Mental Health and several major universities and was not funded by drug companies. The study began with 303 children diagnosed with ADHD (children with other serious emotional disorders were excluded). There were several different phases of the study, with 140 children entering a 10-month maintenance phase with adjustments in the dose of their medication depending on the severity of ADHD symptoms or side effects.
Up to 30% of parents reported side effects. While the most common side effects were sleep problems and decreased appetite, some children experienced irritability, emotional outbursts, anxiety, sadness, crying, social withdrawal, fatigue, abnormal movements, stomachache, increased talking, restlessness, and impulsivity. There were no significant cardiovascular side effects reported that required a change or discontinuation of medication. Side effects were more common with higher doses. While irritability, tearfulness and sadness, and tiredness seemed to improve with time, many of the other side effects did not. While there were significant improvements in ADHD symptoms in many of the preschoolers, the improvements did not seem as great as with older children.
The preschoolers who responded to medication seemed to respond to relatively low doses of methylphenidate, and experienced significant more side effects at higher doses. Preschoolers should probably be started on no more than 2.5 mg of methylphenidate twice a day, with the dose slowly increased over the first couple of weeks to 5 - 7.5 mg two to three times a day if indicated and if well tolerated. While the dose of stimulant medication varies widely from person to person, the average dose in this study was 14 mg/day. Children who initially responded to a low dose of medication sometimes required an increase in dose for continued effectiveness.
The available studies suggest that preschoolers might experience less of a response, and an increased frequency of side effects, than school-aged children to methylphenidate. Behavioral treatments and classes to improve parenting skills should be considered prior to the use of medications, as well as in conjunction with medications, for most children. However, low doses of stimulants can often be used safely and effectively in children with more severe symptoms of ADHD.
If medications are prescribed, children should be monitored closely because of the increased risk of side effects. Because stimulant medications carry a risk of appetite suppression, weight loss, and reduction in growth rate, children should be seen at least 3 - 4 times a year to measure growth rates, assess efficacy, and monitor other potential side effects of medications.
Related Topics:
Technorati Tags: ADHD, preschoolers, ritalin, ADD, stimulant medications
10 Comments:
Dr. Sogn, the side-effects are exactly what we faced when putting our child on Ritalin and Adderall at age 6. Backing up, we "knew" from week 17 of my pregnancy with our son that he was ADHD... we just waited until he was 6 years old to get his official diagnosis. Actually, hindsight is always 20/20 so I joke about this a little... simply put, we heard about this preschool anti-meds idea when our son was in preschool. We opted to wait until age 6 for a formal eval since we weren't comfortable with the meds at a young age. We heard that stimulants could have negative side-effects on the nervous system of these little kids so we found other things to help while we waited a bit on the meds. The Feingold Diet worked like magic for our son. Once he got to be 6 years old we tried Adderall first, then Ritalin, both with bad side-effects - crying, moodiness, aggression, more. We waited another year and a half thinking it might have been a nervous system thing... physiological maturity may have helped because we then tried Concerta with GREAT success!!! Of course, it is the single best treatment but we also insist on daily exercise and cerebellar stimulation as well as keep up with the eliminations of red 40 and yellows 5 & 6. We educate and teach our now 9 year old son all about adhd and how to come up with a plan for action when he finds himself face to face with adhd challenges. He could stand up and teach a room full of parents about how to help their adhd kids - he knows it all very well and this knowledge helps him as well as the meds do. But without the meds, he wouldn't be able to settle his mind and body to learn the info!!! I am now learning lots about omega 3's and trying to find out what the therapeutic dose is for an 80 lb boy, 9 years old, no comorbidities EXCEPT possibly sensory integration disorder. I am also trying to learn about dopamine agonists as an alternative for Concerta ONLY as a possible option, not because I am not happy with Concerta.
Hello me and my son was just recently diagnosted with ADHD and Bipolar disorder. I've always thought something was out of sorts with self but with my son I knew he was too hiper and had anger issues. But after myself and my two sisters were diagnosed with bipolar, I thought I should have him checked out. We had problems with him at school and my husband's patience was wearing thin. I had two doctor opinions, because of insurance reasons and both agreed. He does great on Seroquel 25mg. and I guess the adhd med methylin e.r. 20mg. And he seems to do alot better. I don't know much about medicines or diets but my child acts alot better and happier. He never smiled before and neither did I. I just thought thats just the way life was. I guess regular people don't realize how lucky they are to not have to worry about the abnormal world of depression, rage and anger that lays on the other side of our conscience that we have to tame with a pill. So Medications arent's so bad when they make some people smile that aren't used to.
my 4 year old is showing symptoms of adhd but his school nor his doctor want to take test to make sure if that is what he has...what should i do???
anonymous above,
To ask specific questions about ADHD and your child, please visit Dr. Sogn's message board.
Thank you.
I am 19 yrs old and am ADD, when I was younger school was so hard for me, especially math. I have been medicated since I was 6 but it took until I was 14 to find the right medicine. Adderall XR works so good for me. I think that it would be best to have a child medicated while in school. I struggled so much through school before I took Adderall. And I got depressed because I knew that I could get better grades. I always thought too hard on tests, trying to out smart myself. I would get so upset because it was so simple and I made it harder than what it really was. Don't let kids struggle through school, help them as much as you can.
Hi I have only just found this website looking forward to seeing more. My son is 3 turning 4 in july and this is his 3rd week on Ritalin I can't believe how much he has changed I was at my wits end and this had been going on since he was 1 and a half. We had seen many doctors, health care workers and 3 pediatricians who all agreed that he needed help but no one knew how to deal with him. His violence towards me, the animals and his friends, was heart wrenching, as well as the tantrums that would go for hours and he would hurt himself. His father was adhd aswell and the doctors say its genetic. There is so much more that he has done and he is only 3. With that said, now he is on Ritalin the change is amazing, his violence has dropped by 90% he is calmer and he can focus on things now. I was so worried about this trial for a month but not now and there is finally peace and harmony in our home.
MY son , now 14, was diagnosed with adhd when he was 2 and a half as well as possible MMR and OCD. It was so sever that I found my self restraining him in stores to calm him down enough just so we could leave. Reasoning with him was impossible. By the age of 3 I decided to try ritalin against his fathers wishes. It was amazing to see my son actually play with a purpose for the first time in his 3 year old life. But then the side affects were sever. He would have massive melt downs in the evenings, he would jsut sit in my lap and cry for hours for no reason at all. I decided that I would just learn to parent him differently until he was of age to go to school and needed the help in school. He started a preschool early for speech problems just after he was 3 but I waited until he was nearly 4 to begin the medications and then only during the school year. Summers always proved hard but we got through them. He is 14 now and this last October he was diagnosed with 'Conduct Disorder'. He is not MMR on the contrary his IQ is extreamly high, and the OCD problems subsided over time as he grew up and were just symptoms of his ADHD. Because of my son I looked into my family to see what the mental health was like. On my fathers side I found a long line of ADHD to include myself my brother my father and many others. The family also has many other mental disorders that vary from individual to individual. With that long story stated, I introduce my Daughter whom is 2 and a half. I am seeing a lot of the same problems with her that I saw with my son, such as the ocd problems and the inability to reason with (yes you can reason with a 2 and a half year old). The only factor that seems to be missing between the two is she is not violent towards self and others. I dont think that I will be seeking medical advice concerning my daughter until either the violance begins and is uncontrolable or she becomes school age and suffers for it. This last year my son was with out medication but was in an extreamly small extreamly strict and extreamly individually focased enviroment because of an incodent that happened at school. He was only suppose to be there for 3 months and he was doing so well I begged them to keep him. He did well all year no medication in this inviroment. We taught him a lot about learning to control himself (which is hard with the conduct disorder) and that the medication was a tool to help him focus in school and not a tool or an excuse for his behavior. I guess Im telling our story because I want new parents to know that there is hope for a happy ending with kids that are diagnosed ADHD. Its imparitive to teach the kids to not rely on the medication for their behavior and that its a tool in which to help them learn the tools they need for life. I hope my story helps at least one other parent that feels hopeless about the situation.
First off, all this information is extremely helpful and stress-relieving.
My son was finally diagnosed with ADHD at 3 1/2. And to prove it I'm 24 with about 30% grey hair. LOL! It has been a very long hard three+ years. We knew we were going to have problems from the time I found out I was pregnant. It was a hard pregnancy and an emergency C-section labor. My son would never sit still, he rarely ever smiled. He has always been hard to entertain. I have struggled to get the rural doctors around our area to get a diagnosis for anything. Most simply come up with he is a normal toddler and he'll grow out of it.He has always been without fear and has no sense of danger. I constantly must keep my eyes on him. I have also had to take my son screaming bloody murder out of a shopping center...many, many times. For no reason other than he felt he needed to be loud. It is not an easy road and a BIG hand to all of us who choose to deal with it and not let someone else raise our difficult children. I am currently considering medication, but I want to exhaust all resources before him suffering from any side effects. The diagnosis alone was so relieving because I was re-confirmed that when people stare and make comments, it isn't because I'm a bad parent... it's because my son was born with problems alot of people don't have to deal with. All the information logged above is so usefull, I plan on checking into the diets and etc. Thanks to everyone and good luck to us all. Our children really do appreciate our patience! P.S. I do agree with lori o'day "that we must tell our children that meds is not an excuse but a tool." ADHD is never an excuse for bad behavior, just perhaps a reason for a change of environment.
My 3 yr old son is bipolar. A lot of these stories mimic his behavior exactly. Please be very careful in letting your dr. diagnose ADHD when the major problem could be bipolar. The meds for ADHD when the child is actually bipolar can send them directly to the hospital and it may take 3 months or relatively immediately. Please do research on bipolar along with ADHD as the symptoms are very close. The bipolar must be treated first and usually takes care of the ADHD.
To share an experience with my nephew who just finished a very successful year in 1st grade. Psychologist, pediatrician and others considered him to have ADHD and suggested medication. He is very impulsive and had trouble in kindergarten with respecting personal space and behavioral issues. This resulted in him being asked to leave the small private school and his friends he loved. Psychological and educational testing proved he was at the high end of intelligence for his age range, but his fine motor skills were weak. Thus, an occupational therapy evaluation was suggested. After reading about Sensory Integration Disorder on the internet, an OT evaluation was requested from his new public school. It clearly identified he was suffering from a sensory processing disorder. Reading the symptoms it sounds like just normal kid stuff, but when there are several, it all starts to make sense. Occupational therapy was begun immediately, and he was given a cushion to sit on in the classroom. Instantaneously, he was able to sit in his seat all day without any issues. Not, only that, but he is much less frustrated and the behavioral issues have become nonexistent. I wonder how many other children are suffering from a sensory processing disorder and they are being medicated and treated for ADHD? Thank goodness, my sister decided to exhaust every other possibility on earth, before she went the medication route. A simple occupational therapy evaluation, which can be requested from any public school district, saved this bright little boy from having to be medicated. Not only that, but it has been an educational process for the teachers and many others who hear our story. Nobody seems to know about this disorder. Seems to me, pediatricians should be taught to screen children and make appropriate referrals to OT before these children enter school. This should be part of the kindergarten screening process. This little guy’s self-esteem was in the pits at the end of his kindergarten year. We assumed all was going well, as we hadn’t heard of any problems, but it seems the school had given up on him at the half year mark. I guess they just kept him until the end of the year so they could receive the full tuition.
What is sensory integration dysfunction?
Children with sensory integration dysfunction have difficulty processing information from the senses (touch, movement, smell, taste, vision, and hearing) and responding normally to that information. These children typically have one or more senses that either over- or under react to stimulation. Sensory integration dysfunction can cause problems with a child's development and behavior.
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