Magazine article Clinical Psychiatry News

Methylphenidate Not Ideal for Preschool ADHD. (Evidence Base Lacking)

Magazine article Clinical Psychiatry News

Methylphenidate Not Ideal for Preschool ADHD. (Evidence Base Lacking)

Article excerpt

NEW YORK -- Methylphenidate is widely given to preschool children for attention-deficit hyperactivity disorder, but the evidence for its efficacy is weak, and the drug's labeling formally warns against its use in children under 6 years of age, Dr. Laurence L. Greenhill said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.

He recommends a conservative approach to treatment: Confirm the diagnosis, rule out environmental factors, and when medication is necessary, give young children low doses of amphetamine in a comprehensive program that includes parent support, said Dr. Greenhill, professor of clinical psychiatry at Columbia University, New York.

There has been a well-documented increase in the use of psychostimulants over the past decade, at all pediatric age levels, and methylphenidate has been one of the leading agents. A 1995 study suggested that 1.2% of children in the United States aged 2-6 years are receiving the drug.

Pharmacotherapy for preschoolers in general, and for those with attentiondeficit hyperactivity disorder (ADHD) in particular, is largely guided by the evidence base already in place for school-age children. But developmental differences can substantially influence reactions to drugs and increase vulnerability to adverse events in the preschool population. For example, younger children have been shown to suffer more withdrawal effects from tricyclic antidepressants and neuroleptics.

In addition, the preschool years are a time of active growth in dopaminergic neural systems, which could make younger children more vulnerable to stimulants' impact on development, Dr. Greenhill suggested.

There have been eight trials of methylphenidate in preschool children, involving 210 subjects. Most have been small, brief (usually i month or less), single-site crossover studies, with methodologic limitations. …

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