Should psychiatric drugs be prescribed for young children?

Parents of young children with behavior disorders face an incredibly difficult decision -- do they treat their child's symptoms (like hyperactivity and anxiety) with drugs such as Prozac or Ritalin, or do they try to cope with these problems through therapy, communication and a lot of patience?

According to a study cited in the latest issue of the JAMA, an increasing number of parents are putting their toddlers on psychiatric drugs. The study, which was based on more than 200,000 preschool-aged children around the country, found a 50 percent increase in the use of these drugs between 1991 and 1995.

While the increase in antidepressant use for school-age children and adolescents has been documented before, this study is the first to focus on the increased use in toddlers. Joseph Coyle, M.D. chairman of the psychiatry department of Harvard Medical School, said the study reveals a troubling trend. "There is no empirical evidence to support psychotropic drug treatment in very young children," he said, and there are valid concerns that such treatment could impair brain development.

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The study's researchers suggest the increase is partly due to a growing acceptance of psychiatric drugs, and also to the fact that more children are attending daycare, where care providers often don't have time or patience to give special attention to children who repeatedly misbehave. The parents are often under pressure to do whatever is deemed necessary to get their children to conform to school standards of good behavior.

David Fassler, M.D. 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," as long as they are prescribed only after a comprehensive evaluation and are used in conjunction with other therapy. According to Dr. Fassler, the use of the drugs is increasing in part because doctors are getting better at diagnosing behavior disorders at an early age.

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