Too young?


By Nell Boyce in Washington DC TODDLERS are being given cocktails of drugs to treat hyperactivity even though the drugs have never been tested for safety in such young children. Experts cannot even agree whether it is possible to tell if children under three have the condition the drugs are supposed to treat. Marsha Rappley at Michigan State University in East Lansing wondered how many very young children were being diagnosed as having attention-deficit/ hyperactivity disorder (ADHD) by psychiatrists. By trawling through the records of Michigan’s state-sponsored Medicaid healthcare scheme, Rappley and her colleagues found 223 children aged three and under with a diagnosis of ADHD. Of these, 57 per cent were taking drugs for the condition, while only 27 per cent were being treated through sessions with a psychologist. Many of the children had other problems with cognitive or language development, or chronic health conditions such as asthma and diabetes. For the ADHD toddlers, doctors prescribed 22 different drugs in a total of 30 combinations. A third of the toddlers were taking two or three drugs at the same time. “The extreme variation in the use of psychotropic medications suggest haphazard use at worst and uninformed use at best,” Rappley and her colleagues write. In older children, ADHD is diagnosed by matching observed behaviours against a standard checklist. But many of the behaviours—for instance, “fails to finish chores”—can’t be applied to toddlers. And apparently hyperactive two-year-olds do not necessarily develop ADHD. The condition is often treated by giving children drugs such as Ritalin, a stimulant that improves concentration. Millions of American children are prescribed Ritalin, and in Britain the number of prescriptions is doubling every year. For toddlers, such drugs are controversial as they haven’t been proved to be safe. “The age range for being treated for ADHD has gone down as people think these medications are relatively safe and effective,” says Richard Todd, a psychiatrist who treats children with ADHD at Washington University in St Louis, Missouri. But he is concerned about the trend. “This is a very important developmental period. The effects of medications on these processes are not well understood.” Stephen Grcevich, who treats ADHD at Case Western Reserve University in Cleveland, Ohio, says that it’s still unusual for toddlers to be referred to his clinic. When they are, it is usually because they are so hyperactive that they pose a risk to themselves or others. But he shares Todd’s concern about giving such young children drugs. Last year, Grcevich saw a two-year-old prescribed stimulants by his previous doctor. “We ended up discontinuing the medication because of concerns about side effects,
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