Ritalin and Preschoolers
Of all topics concerning Attention Deficit Hyperactivity Disorder (ADHD) and the use of stimulants for behavior control, preschoolers and Ritalin is likely the most controversial of all. A child between the ages of 0 to 4 is considered to be a preschooler, partly because of the years and partly because the child isn’t registered in school yet. At this age, varying behaviors and personalities are to be expected, particularly among different cultures and within differing households.
Difficult to Diagnose
A child with few boundaries and free rein to do as s/he likes at home is naturally going to be very difficult to handle at daycare or in public. Consequently, a child with stricter and more consistent household rules is likely to display a more sedate temperament. The level of impact varies from child to child, yet it does significantly affect a young child’s behavior.
That being the case, making a diagnosis of ADHD or ADD can be difficult and requires a very close look at the cause of the behaviors. Let’s consider some of the major traits of ADHD: inattentiveness, aggression, immaturity and an inability to focus for long periods of time on a particular topic or event. Now consider a 2-year-old’s typical behavior: temper tantrums, excessive restlessness, an inability to focus for extended periods of time on a single topic or event. This is typical, normal behavior for all toddlers that closely mirror the symptoms listed in the Diagnostic Manual. Does this make all toddlers Attention Deficit? Obviously not.
The same can be true of a 4 year old who lacks discipline and boundaries at home. Temper tantrums are still possible in a 4 year old child who has difficulty expressing his or her emotions. This child reacts inappropriately when the expectations that everything s/he wants will be given to him or her are not met. While s/he understands the word “no”, when s/he hears it, the initial reaction of frustration and disagreement is expressed as a scream or sulk until s/he gets what s/he wants. Children at this age also appear to be restless and inattentive as soon as they feel “bored”. They are not attention deficit or hyperactive. They are typical preschoolers who need constructive activities to fill their time. Yet hypothetically, it would be very easy for a schoolteacher or even a physician to mistake such behavior for that of ADD or ADHD.
However, there are indeed children who begin early onset symptoms of ADHD. Their behaviors clearly must be so extreme and consistent across many situations that parents who do try to enforce discipline and boundaries discover that it is nearly impossible. There are several behaviors to watch for in preschoolers that may indicate ADHD:
- Energy Level – The most common aspect that highlights young children with ADHD is that they never stop, their energy level is on high all of the time. While it is normal for children to be active, their activity levels do not follow the normal pattern of highs and lows.
- Disobedience – Understand that testing limits is normal at this age, but when it goes beyond the normal level, then there may be a problem. The meaning of rules are lost upon ADHD children since they cannot focus their attention long enough to process that boundaries are indeed in place.
- Out-of-Normal Behaviors – Each child has a unique temperament and his or her own personality traits. However, sometimes there are distinct changes in the behavior or traits that are not typically portrayed. These may be noticed over time or as more abrupt changes. For example, a child can become excessively aggressive, not because the child is an angry, overly indulged child but because s/he is restless and is unable to control physical responses to various stimuli.
Choosing a Treatment
In such a case, when a child is displaying these out-of-the-norm behaviors and sufficient observations and information have been gathered by the pediatrician, a treatment plan may be intiated. There are many non-medication treatments that will be tried initially. It is usual that a physician or a child psychiatrist will place a young child on a different diet or a non-stimulant medicine in a liquid form in an attempt to minimize the symptoms. This liquid is filled with vitamins and amino acids among other man-made chemicals. In some manner, they interact within a child’s brain to help counteract imbalances and can be very effective for some children. Therefore, no further treatment would be necessary.
In other children, however, these alternative treatments are unsuccessful and as another option, a child is placed on Ritalin or another form of methylphenidate. It is a difficult choice for a parent to make and likely there are many concerns about placing such a young child on a brain stimulant.
Benefits
While placing a young child on Ritalin is always a concern, it has been provent to be effective for many. When given a small dose, it has been shown to help 75% of preschoolers behave and interact like their non-ADHD peers.
ADHD preschoolers are prone to clumsiness, leading to frequent and often dangerous accidents. Typically an ADHD preschooler suffers frequent injuries due to fearlessness and lack of reasoning in terms of risk-taking. In one case, an ADHD boy of five suffered burns after he sat on a stove to see how hot it could get. With the use of Ritalin, some of these symptoms of impulsiveness, clumsiness and irrational thinking can be lessened to allow the child to make more thoughtful choices as well as gain better control of his or her body.
They lack social skills and have difficulty interacting with other children within their own age bracket. Consequently, they become unhappy and are often outcasts, not understanding why it is that no one wants to be their friend. With the use of Ritalin in various forms, including generic Ritalin, there can be noticeable behavior improvements. The impact of Ritalin varies greatly from child to child. Sometimes the changes are not as much as many families hope for in terms of social skills and dangerous behaviors. Still the benefits are there and have been helpful for many.
Risks
Young children are more sensitive to Ritalin than older children and teens. The children need close, ongoing monitoring by a medical doctor. Fifty percent of children develop strong, adverse side effects in the initial stages of Ritalin treatment.
One of the major concerns with placing a preschooler on methylphenidate is that of stunting growth. It is a fact that Ritalin can and does cause long-term delays with height and weight. In August 2007, the Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-Up study was published in the Journal of the American Academy of Child and Adolescent Psychiatry. It found that when young children used Ritalin for extended periods, they had a lower rate of growth. On average, after three years of use, the children were one inch shorter and 4.4 pounds lighter than their peers.
With some preschool children, Ritalin can have the same effects as it does in older children including:
- Weight loss
- Lack of appetite
- Stomach aches
- Headaches
Furthermore, an ADHD preschool child will likely benefit from a small dosage of the drug, but he or she requires closer doctor supervision than an older child.
There is also the fact that some preschoolers who do suffer from ADHD may simply benefit from ongoing behavior modification therapy, rather than use of a synthetic drug. Since it is difficult for physicians and families to know which treatment option will work best, there may be several trials to find the best solution for each child. ADHD is still a condition with many unknowns and much guesswork.
The fact of the matter remains that Ritalin is a drug that has strong effects on the neurotransmitters within a developing brain. What are the long-term implications for a child who is receiving this drug? Currently, no one truly knows.
To Medicate or Not to Medicate
The decision to use Ritalin on a young child will always be a difficult one and involves the treating physician, the family and the preschool educator. There are definite risks with the use of methylphenidate in the preschool child, yet there are also risks in not using Ritalin. It is a matter of weighing the pros and the cons for the particular child and his/her situation. Since the use of Ritalin carries numerous short-term side effects and its long-term effects are yet unknown, close monitoring is imperative to successful implementation. However, it is also true that not using Ritalin also carries its own dangers in terms of physical accidents and a lack of bonding with peers and family.
Source: Ritalin for Preschoolers, Web MD
You must log in to post a comment.