BACKLASH TO PILLS IN PRESCHOOL

The White House weighs in on pill dependence with a move to curb use of Ritalin and other psychiatric drugs.

WASHINGTON When a recent study reported a sharp increase in the number of preschool children taking psychiatric drugs, parents and medical experts took notice. So did
first lady Hillary Rodham Clinton.

In short order, the White House has announced an initiative aimed at
getting the word out that powerful behavioral drugs such as Ritalin
and Prozac carry risks and that not enough is known about their
effects in young children. "I think what we have here is a national
outcry at a grass-roots level that is finally reaching the
government," says Peter Breggin, a psychiatrist in Bethesda, Md., and
a longtime crusader against what he calls the overmedicating of children.

The Clinton administration's effort, while limited to younger children,
sharpens questions about how much children of all ages are being medicated
for disruptive behaviors. Recently, a United Nations panel criticized
doctors in the United States for overprescribing psychiatric drugs. The
panel reports that 80 percent of the world's Ritalin is consumed in the US.
The government initiative, announced yesterday, includes:

* Preparation of a guide for parents on how to treat young children
with emotional and behavioral disorders.

* New labeling by the Food and Drug Administration that will instruct
physicians on proper dosages of psychiatric drugs for young children. The
FDA will soon instruct drug companies on how to conduct research into uses
of hyperactivity and attention-deficit medications.

* A nationwide study by the National Institute of Mental Health on the
safety and effectiveness of Ritalin use among preschoolers diagnosed with
attention deficit hyperactivity disorder (ADHD).

* A White House conference this fall on the treatment of mental
disorders among very young children.

Advocates for the rights of people diagnosed with ADHD agree with the
need for more research on the use of psychostimulant medication among
the young. "The substantial increase in prescriptions to children ages
2 to 4 demands that we pay immediate attention to this situation,"
says a statement from Matthew Cohen, president of Children & Adults
with Attention-Deficit/Hyperactivity Disorder (CHADD), a group based
in Landover, Md. "While psychostimulant medication has been found to
be safe and effective in older populations, it's imperative that we
have the same level of assurance about its safety in young children
before this trend continues." The study that triggered this flurry of
attention to children and psychiatric drugs was published last month
in the Journal of the American Medical Association. It found Ritalin
use for preschoolers had either doubled or tripled between 1991 and
1995, depending on the group being examined. The research was done by
the University of Maryland and looked at two Medicaid programs and one
HMO.

The use of antidepressants was up by 30 percent in the HMO and about
doubled in the other two groups. Overall, researchers found that
between 1 and 1.5 percent of children aged 2 to 4 were medicated for
mental, emotional, and behavioral problems.

A backlash has been brewing for some time over the use of psychiatric
drugs with children of all ages. Some opponents of such drugs note
that several of the children involved in recent school shootings were
taking such drugs. Some teens also use Ritalin and other psychiatric
drugs recreationally. While no one condones the unprescribed use of
Ritalin, some physicians maintain that there is definitely a place for
medication in the treatment of some very young children with severe
behavioral problems. In a recent opinion piece in the New York Times,
Dr. Harold Koplewicz cited the case of a patient he treated in the
early 1980s named Christopher. The boy, then 3 1/2, had a very limited
attention span - he played with 61 toys during one five-minute period
- - and could not enroll in preschool. When Dr. Koplewicz gave him
Ritalin, the boy was able to sit still and function normally. He is
now 20, and a high-school graduate who describes himself as happy. He
is still taking Ritalin.

Koplewicz calls psychiatric illnesses in children "no-fault brain
disorders," not examples of "inadequate parenting and bad childhood
traumas." The question for some parents is how to distinguish between
wild behavior that a toddler will outgrow and a serious illness. Some
doctors believe it is never appropriate to prescribe Ritalian and
other psychological drugs to children under age six. Indeed, the label
on Ritalin reads, "Ritalin should not be used in children under 6
years, since safety and efficacy in this age group have not been
established."

But once the FDA approves a drug, it cannot limit how a physician
prescribes it. Still, some physicians never use drugs with young
children, preferring instead to focus on family behavioral issues.

"I never recommend for any of my clients, and that's 100 percent, ...
medication for kids under 6 years old," says Michael Gurian, a family
therapist in Spokane, Wash., and author of several books on boys. "It
is not the appropriate choice because we don't fully know to what
extent the child has an actual psychiatric disorder under about 6 to 7
years old." "Just altering behavior and improving bonding - in other
words, getting a mom and a dad and some other people more deeply
involved with a kid in an everyday way - is a far more humane approach
to taking care of a small child," says Mr. Gurian.

The fundamental problem, adds Gurian, is "not providing children -
especially male children - with the love they need and being too busy
to do it." Staff writer Gail Russell Chaddock and special
correspondent Brad Knickerbocker contributed to this report.