Ritalin for Preschoolers?
Study Shows Drug Provides 'Moderate' Help for Preschool Kids with ADHD
Is Ritalin Really Safe in Preschoolers? continued...
Finding that balance will mean learning more about Ritalin's risks for developing minds and bodies. The NIMH study has documented the short-term risks. But the long-term risks aren't yet known.
"You are giving a medication that has powerful neurochemical effects in a developing brain. What does this mean for long-term development? We don't know," Insel says. "It will take some time to know whether there will be some worrisome side effects in the future. But we have to weigh that against the consequences of not treating. Remember, you have a risk for not treating, too."
Indeed, Greenhill notes that kids with ADHD often suffer peer rejection. This is strongly linked to poor school performance and serious problems in the teenage years.
Just because kids won't do what we want them to do is no reason to medicate them, says Leslie Rubin, MD, director of developmental pediatrics at Emory University and director of the center for developmental medicine at Marcus Institute, Atlanta.
"Kids are designed to be active, to run and play and climb and tumble and explore," Rubin tells WebMD. "When you contain kids in a limited space and have them do things that are constrained and dutiful, it may be difficult for them. If kids watch a lot of TV and don't have structured play, this might result in difficulty for kids to respond to structures in preschool programs. The easiest thing to do is give medicines that control the behavior. What is more difficult is to try to understand the child, to work with the child, to provide more structure."
Insel and Greenhill second Rubin's concerns.
"These are tough problems. It's really difficult because this is a disorder the whole family feels," Insel says. "What you want to make sure you do is not write a prescription and just walk away. The medication is helpful but not sufficient. It involves a long-term relationship, including psychosocial intervention and the need for ongoing medical supervision."
Greenhill says that parent training may ultimately prove to be more effective than medication.
"We teach techniques such as the proper balance of rewards to time outs, the methods of being consistent in commands, recognizing good behavior and rewarding it even if it is rare, and not going overboard when a child loses control," he says. "The parent is literally coached in working with the child. They have a small receiver that fits in their ear, and the trainer sits behind a one-way screen and coaches them. It is very helpful."