MORE PRESCHOOLERS ON PSYCHIATRIC DRUGS

In a finding that medical experts called "troubling" and "very
surprising," researchers reported yesterday that the number of
preschoolers taking stimulants, anti-depressants and other psychiatric
drugs rose sharply from 1991 to 1995.

The use of stimulants - most commonly methylphenidate, the generic
form of Ritalin - increased twofold to threefold for children ages 2
through 4 enrolled in two state Medicaid programs and one health
maintenance organization in the Northwest, the researchers found.

The number of children receiving prescriptions for anti-depressants
doubled in the Medicaid programs. The use of clonidine, a blood
pressure drug gaining popularity as a treatment for attention
disorders, also jumped among the group of more than 200,000 children
studied.

Although researchers have known for some time that such drugs are
increasingly being prescribed for older children, the study, which
appears in yesterday's issue of the Journal of the American Medical
Association, is the first to document an increase among children under
5.

"This seems to support the anecdotes that more U.S. children are
receiving a diagnosis and treatment for attention deficit
hyperactivity disorder in the late 1990s than ever before," said Dr.
Julie Magno Zito, an associate professor of pharmacy and medicine at
the University of Maryland and lead author of the study.

Previous studies have shown significant increases in the use of
stimulants and anti-depressants to treat children 5 to 19. In a
smaller study of Medicaid enrollees in Michigan, done in 1998,
researchers found that of 223 children under age 4 who were identified
as having attention deficit hyperactivity disorder, 57 percent
received at least one drug to treat the condition.

Though the total number of very young children in the latest study who
received prescriptions for the drugs was small, 1 percent to 1.5
percent, the increase is disturbing, the researchers said, because
research on the safety and efficacy of the medications, scant for
older children, is virtually non-existent for preschoolers.

Dr. David Fassler, chairman of the American Psychiatric Association's
council on adolescents and their families, said the medications
studied "can be extremely helpful for some children, even quite young
children." But they should be prescribed only after a comprehensive
evaluation and in conjunction with other therapy, he said.

Their use is increasing in part because doctors are getting better at
diagnosing behavior disorders at an early age, Fassler said.

However, because their effects on younger children and their
development aren't known, Fassler said, the Food and Drug
Administration has recently instructed pharmaceutical companies to
study the connection.

Although the study did not examine reasons for the increases, Zito
suggested a few possibilities.

With an increasing number of children attending day care, parents may
feel pressured "to have their children conform in their behavior,"
Zito said. She also said there is a much greater acceptance in the
1990s of psychoactive drugs.

Dr. Joseph T. Coyle of Harvard Medical School's psychiatry department
said the study reveals a troubling trend, "given that there is no
empirical evidence to support psychotropic drug treatment in very
young children and that there are valid concerns that such treatment
could have deleterious effects on the developing brain.

"These disturbing prescription practices suggest a growing crisis in
mental health services to children and demand more thorough
investigation," Coyle wrote in an editorial accompanying the study.

Use of stimulants, anti-depressants, anti-psychotics and clonidine - a
drug used in adults to treat high blood pressure and increasingly for
insomnia in hyperactive children - were examined. Substantial
increases were seen in every category except anti-psychotics, though
in some cases the actual number of prescriptions was quite small.

Although the numbers were small, the researchers said the clonidine
increases were particularly remarkable because its use for attention
disorders is "new and largely uncharted." They noted that slowed
heartbeat and fainting have been reported in children who use
clonidine with other medications for attention disorders.