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Preschoolers on Prozac?

QUESTION: I have a three-year-old son who is such a bundle of energy that he drives me up a wall. Recently, his preschool teacher called me in for a conference because he is "uncontrollable." She commented that he might have an "attention disorder." Does this mean my child needs drugs?

ANSWER: Beware! The normal behavior of many two and three year olds can look like attention deficit disorder. The growing popularity of these drugs within HMOs, and pressures on parents from overwrought teachers with too many children and too little help, can set a climate for turning to drugs, rather than counseling and education to help your child. The very real danger is that a young child having adjustment difficulties becomes labelled and "drugged," instead of helped.

The increased use of psychotropic drugs to treat children in the United States in recent years is cause for concern and watchfulness. The alarming rate at which preschoolers are being recommended for drug therapy to control behavior at school is nothing short of alarming to many experts in the field! In one midwestern study, (included in an article in the Journal of the American Medical Association, February, 2000) over half of 223 children under four, diagnosed with attention deficit hyperactivity disorder received at least one psychotropic medication.

Research on the efficacy and safety of these drugs for older children is already quite small and almost nonexistent for children under the age of five. Dr. Julie Zito, professor of medicine at University of Maryland, warns parents that very few drugs of this nature are approved for use by preschool age children. Although a physician can legally prescribe drugs for your child that are not approved by the Federal Drug Administration, (called "off label" prescribing, commonly used for elderly patients) parents should be aware that the effects of these drugs on their child's developing brain are unknown.

If the unknown effects of psychotropic drugs on your child is not worrisome enough, combine this with the fact that experts such as Dr. Joseph Coyle, chairman of psychiatry at Harvard University, questions whether children of this age can even meet the criteria of attention deficit hyper activity disorder. In other words, the nervous system and psychological development of young children can manifest in behavior which looks like symptoms of this disorder, but are in fact within normal range for their age.

Consider these factors which pressure us towards considering the use of such drugs on even our youngest children:

  • Many HMOs are reluctant to authorize counseling that does not involve drugs. In my own private practice, authorization for treatment of anxiety was denied because my client refused anti-anxiety medication. Health administrators are setting guidelines for health care that is believed to be less expensive.

  • Parents and teachers may pressure the diagnosis of attention deficit hyperactivity disorder in children. Busy schedules for parents, increased use of full time day care for children under four and lack of educational resources to address the normal range of preschool behavior leave parents and teachers desperate for a "quick fix."

  • Drug advertising often offers the increased presence and promise of a quick cure. There has been a recent push by pharmacological companies to advertise the wonder of antidepressants directly to the public, recommending that you "ask your doctor" for a prescription.

  • Prescriptions for psychotropic drugs are commonly written by primary care physicians rather than specialists. Drug advertisements not only offer unfounded promise, but neglect to advise counseling for a mental health condition or that you seek information from a psychiatrist, knowledgeable about these agents, rather than your general practitioner.

Contrary to the television commercials that promise "a better life" through psychopharmacological drugs, research studies have shown the combination of counseling and drugs to be far more effective than drugs alone. When psychotropic drugs are needed, they should be used in conjunction with counseling and not a first approach, except when the potential for suicide or violence is a threat.

Focus on an assessment of your child's needs and develop a therapeutic plan to help him learn control at this age. If necessary, consult with an expert in child development who has experience dealing with children and families without drugs, before turning to drugs for the answer.

Let your son's teacher know that you feel your child is too young for such a diagnosis and that you want to work with her to develop a team approach to help him with his behavior. Work towards identifying what your son needs, in order to soothe himself and let off steam. Clarifying his needs for a nap, for a play environment that allows him to run around "wildly" without disturbing others and scheduling in one on one reading or quiet time may all be part of the answer you are looking for.

Don't forget to consider whether this particular preschool setting is the right one for your child. Is your son's teacher accepting of a broad range of behavior as normal for this age? Does the environment provide your energetic little boy enough opportunity to play vigorously and physically, or does it require him to sit quietly too much of the day?

Past studies have shown that children reflect the expectations of their teachers. In other word, they "live up" to and "down to" the expectations of adults who care for them. Be sure your son's teacher is motivated to understand your child's needs, rather than merely label him with a premature or unfounded diagnosis.


Gayle Peterson, MSSW, LCSW, PhD is a family therapist specializing in prenatal and family development. She trains professionals in her prenatal counseling model and is the author of An Easier Childbirth, Birthing Normally and her latest book, Making Healthy Families. Her articles on family relationships appear in professional journals and she is an oft-quoted expert in popular magazines such as Woman's Day, Mothering and Parenting. . She also serves on the advisory board for Fit Pregnancy Magazine.

Dr. Gayle Peterson has written family columns for ParentsPlace.com, igrandparents.com, the Bay Area's Parents Press newspaper and the Sierra Foothill's Family Post. She has also hosted a live radio show, "Ask Dr. Gayle" on www.ivillage.com, answering questions on family relationships and parenting. Dr. Peterson has appeared on numerous radio and television interviews including Canadian broadcast as a family and communications expert in the twelve part documentary "Baby's Best Chance". She is former clinical director of the Holistic Health Program at John F. Kennedy University in Northern California and adjunct faculty at the California Institute for Integral Studies in San Francisco. A national public speaker on women's issues and family development, Gayle Peterson practices psychotherapy in Oakland, California and Nevada City, California. She also offers an online certification training program in Prenatal Counseling and Birth Hypnosis. Gayle and is a wife, mother of two adult children and a proud grandmother of three lively boys and one sparkling granddaughter.

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