RITALIN PRESCRIPTIONS UP

The use of Ritalin for preschoolers as much as tripled in the early 1990s,
while use of Prozac and other anti-depressants doubled, a new study finds.

Between 1 percent and 1.5 percent of children aged 2 to 4 took drugs for
mental, emotional and behavioral disorders, according to a University of
Maryland study of two Medicaid programs and one HMO.

The study, published in today's Journal of the American Medical Association,
raises disturbing questions about whether it's safe to prescribe
psychotropic drugs to toddlers, researchers said.

"There are valid concerns that such treatment could have deleterious effects
on the developing brain," Dr. Joseph Coyle of Harvard Medical School wrote
in an editorial in the journal.

Pharmacist Julie Magno Zito and colleagues examined records of more than
220,000 children enrolled in an HMO in the Northwest and Medicaid groups in
a Midwestern and a Mid-Atlantic state. The study examined trends between
1991 and 1995, the most recent year data were available.

Ritalin use doubled or tripled, depending on the group. Use of
anti-depressants increased by 30 percent in the HMO and roughly doubled in
the other two groups.

Overall, there was a 20-fold increase in clonidine, an adult blood pressure
drug used to treat insomnia in children with attention deficit hyperactivity
disorder, or ADHD.

Advocates say Ritalin can reduce hyperactivity and improve attention and
school performance in children with ADHD. Side effects can include loss of
appetite, weight loss, insomnia and a temporary slowing in growth.

Ritalin has not been studied on children under age 4, and the label warns
against its use in kids younger than 6. However, a doctor can prescribe the
drug for toddlers as an "off-label" use.

"In some cases, it's very appropriate," said Peter Jaksa, a clinical
psychologist in Deerfield who specializes in ADHD. "Some kids are so
hyperactive they will hurt themselves. They're running around jumping off
things."

Like Ritalin, other psychotropic drugs generally have not been studied in
young children. Thus, it's unknown how safe or effective they are. Although
there have been few reports of problems, "the possibility of adverse effects
on the developing brain cannot be ruled out," Zito and colleagues wrote.

Zito said earlier starts on medicine mean children likely will take the
drugs for longer periods. The long-term consequences should be studied, she
said.

Zito also questioned whether it's possible to make an accurate diagnosis of
depression or ADHD in toddlers.

Zito suggested several possible reasons for the increased medication use.
The criteria for ADHD have expanded, so children now can be checked even if
they are not hyperactive. This broader definition has increased the number
of girls with ADHD.

Parents and doctors are more willing to use drugs to treat behavioral
problems. And a 1990 federal law requires schools and preschools to be on
the lookout for ADHD and other disorders, Zito said.