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.
Related Topics:
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
