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:

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.

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