Recently both the Clinton White House and the National Institute of Mental Health made a public statement about treating young children with psychiatric medications like Ritalin, Prozac, Luvox, Zoloft and others. Based on an editorial by Dr. Joseph T. Coyle, Chairman of the Psychiatry Department at Harvard Medical School (published in JAMA) "[children with behavioral disorders were] "increasingly subjected to quick and inexpensive pharmacologic fixes" [even though] "there is no empirical evidence to support psychotropic drug treatment in very young children."

The rationale for using behavioral approaches first is that there aren’t many studies using these medications in very young children, and that the brain is rapidly growing at that time and the long and short term effects of medication are unclear.

Dr. Steven E. Hyman, director of the National Institute of Mental Health (NIMH), stated "As a rule of thumb, doctors, psychologists and social workers should attempt to modify the behavior of a child and deal with family crises before drugs are prescribed." He also went on to state: "If a kid is engaging in aggressive behavior, self-mutilation, head banging, and is otherwise uncontrollable, you should try medication."

Another issue brought up was that these medications are being prescribed "off-label" - meaning that the FDA hasn't approved these medications for a specific use. The problem with this issue, however, is that much of what doctors prescribe is based on scientific literature, training and experience - not on whether a group of physicians (FDA) has passed judgement on a particular treatment. There are a lot of politics involved with government intervention - and a great deal of money invested by pharmaceutical companies. Changes in FDA approval can take many years, and patients can die or be permanently harmed by "the process." An example is aspirin to lower heart attack, stroke and colon cancer risk, which is not FDA approved, but the scientific literature is clear on the benefits. Fortunately in the United States there is freedom from government intervention, and patients (or their parents/guardians) with their physicians have the right and obligation to do what's right based on scientific information, observation and training.

The long term effects of early onset depression, out of control behavior, attention deficit and anxiety problems aren’t well studied yet - although many people know their problems began early in childhood. Some physicians and other believe letting the brain "learn" to be depressed, inattentive, violent, anxious or unstable is unethical - especially since this rapid learning phase can "teach" the brain self-defeating and self-esteem harming concepts. The long term effects of behavioral therapy aren’t well known yet either - and are merely "assumed" to be better. A recent study showed that treating ADHD with medications and counseling was no more effective than medication alone. Virtually everything in treating early childhood psychiatric problems is a good guess - and medical science will not have the long term answers for decades, possibly not in our lifetime. Decisions need to be made on an individual basis, by parents with their physicians. Parents/guardians have the ultimate responsibility for what happens to the child.

The information from NIMH (National Institute of Mental Health) can be found at http://www.nimh.nih.gov/publicat/childmedmenu.cfm.

(Note: the quotes in this article are from Robert Pear and the New York Times, as quoted in the Palm Beach Post on 3/20/00)