PROZAC CAN'T REPLACE PARENTING SKILLS

A couple of recent reports that can only be described as alarming have
revealed that an increasing number of very young American children as early
as a year old - are being diagnosed with attention-eficit/- hyperactivity
disorder (ADHD, a specific form of ADD).

More alarming still, these doctors are treating their supposedly
hyperactive, toddler patients with a variety of drugs like Ritalin,
clonidine and Prozac.

In a large Midwestern state, for example, University of Maryland researcher
Julie Magrio Zito found a 180 percent increase between 1991 and 1995 in the
number of prescriptions of stimulant drugs (such as Ritalin) for children 5
years old and younger. And arsha Ra ppley of Mich-igan State University,
after reviewing claims data for all children aged 3 or under who were
continuously enrolled in the federal Medicaid program from October 1995
through December 1996, found similarly worrisome increases in the number of
such prescriptions in Michigan.

Now you don't have to be a pediatrician, a psychiatrist or a pharmacologist
to second-guess this trend. And second-guess we must. For although we know
that ADD/ADHD affects 3 percent to 5 percent of school-age children, what's
notable about this condition in younger-aged children is precisely what we
don't know.

The present facts are these: ~ No studies have been conducted on ADD/ADHD in
children younger than 4 years old;

~ No accepted guidelines exist for diagnosing ADD/ADHD in toddlers;

~ No research exists on the safety or effective-ness of stimulant drugs such
as Ritalin for this very young age group;

~ And as any parent will attest, virtually all healthy, young children have
high energy levels and could often be described as "hyperactive" in the
general, nonclinical sense of the term.

Bearing these facts in mind, I can't help stating bluntly what many in and
out of the health-care profession are suspecting privately: many, if not
most, of these recent ADD/ADHD diagnoses and stiniulant-drug prescriptions
for mere toddlers are likely unwarranted not to mention develop-mentally
dangerous, physiologically and ethically speaking.

Thus, aside from troubling medical questions related to prescribing Ritalin,
clonidine or Prozac to toddlers, and especially in light of Zito and
Rappley's respective new findings, we need to ask some hard questions.

For starters: To what extent might pediatricians be succumbing to pressure
from demanding parents to help discipline their children by means of drugs
like Ritalin?

The question is neither gratuitous nor presumptuous. The reasons for it are
complex, varied and not altogether clear, but pressure on doctors in
particular to dole out hyperactivity drugs is real and intensifying.

Indeed, in addition to numerous pediatricians, I've had all-too-many
grade-school teachers, principals - and even a few courageously forthright
moms and dads - describe in disheartening detail the growing number of
instances in which exasperated parents, without any prior medical or
professional consultation, are adamantly insisting that their child is
hyperactive and in the same breath are begging for a medication - Ri-talin,
most often re-quested by name.

It is of course impossible to ascertain how many of these anecdotal
descriptions may have actually involved cases of verifiable ADD/ADHD. But
the sheer number of such descriptions and the degree of alarm heard in so
many educators and health professionals voices nation-wide would lead one to
suspect that many parents are seeking a quick-fix magic pill for the
demanding and painstaking process of rearing their very normal children.

And some parents, tragically, are apparently getting one, especially one
named Ritalin.

Here's hoping, first, that doctors have the moral courage to resist (as most
are) the intensifying pressure from stressed-out parents to prescribe drugs
for behavioral problems that are best treated with old-fashioned care: love,
patience and a firm verbal "no" reinforced, when necessary, with lovingly
firm and consistent consequences.

And here's hoping that, instead of impugning the motives of exasperated,
short cut minded parents, we find ever new and creative ways to educate such
parents about the very normal day-to-day challenges associated with raising
children. About how there simply are no short cuts to raising good kids. And
about how nurturing and disciplining toddlers can indeed be painstaking,
frustrating work at times. For that is precisely what raising children often
is -- bard work, albeit of the most rewarding kind.

Checked-by: Melodi Cornett