Psychiatric Medications for Preschoolers
Giving autistic children psychiatric medications is a not uncontroversial topic; giving children—young children—such medications is equally controversial. The December issue of the Journal of the American Academy of Child and Adolescent Psychiatryhas issued guidelines for the use of psychiatric medication in preschoolers. The guidelines were issued by the Preschool Psychopharmacology Working Group which (as noted in the December 4th Science Daily) includes “clinicians and researchers in early childhood psychiatric disorders, psychopharmacology, general and behavioral pediatrics, neurodevelopmental processes, and clinical psychology.” The guidelines were created to address the phenomenon of more and more preschool-aged children taking stimulants, antidepressants and other psychiatric drugs. Under lead authors Mary Margaret Gleason, M.D., of the Bradley Hasbro Children’s Research Center, “treatment algorithms” were developed:
The algorithms guide the clinician through recommended assessment and treatment steps. The first step in each algorithm is a comprehensive diagnostic assessment, taking into consideration the child’s emotional and behavioral symptoms, relationship patterns, medical history and developmental history and status.If a psychiatric diagnosis is confirmed, the authors recommend clinicians start with family-focused psychotherapy — such as parent management training or dyadic (parent-child) psychotherapy — before considering medication. However, if the child is not responding and medication is deemed necessary, they suggest it be used in conjunction with psychotherapy.
Treatment algorithms were established for attention deficit and hyperactivity disorder, disruptive behavior disorders, major depressive disorder, bipolar disorder, anxiety disorders, posttraumatic stress disorder, obsessive-compulsive disorder, pervasive developmental disorders (such as autism), and primary sleep disorders.
Not that my son has ever done psychotherapy…………..It is the case that he takes some medications (and some commenters have not been shy about expressing their objections to this). It was not an easy decision to start him on medication, especially when he is a child who is not able, linguistically and otherwise, to explain how the medicine makes him feel. We monitor him carefully and he takes quite low dosages. There is no specific “algorithm” to describe how we came to our decision and how we continue to discern how the medications are working for Charlie, aside from time spent listening, observing, and interpreting. I would have hesitated to give him medication as a preschooler—-looks like it may now be the Ritalin Wars are starting up for the toddler set.
13 opinions for Psychiatric Medications for Preschoolers
M
Dec 4, 2007 at 5:24 am
I say that we begin medication during the blastocyst phase. It’ll be way, way easier. Once the brain develops, it’s just too complicated to figure out.
Regan
Dec 4, 2007 at 6:22 am
Kristina, are you sure that at some level you have not been implementing some of the suggestions from PMT and parent-dyadic therapy?
I have respect for professional training, but I don’t believe that one has to be a pro to follow some of the principles–interact positively, set definable, fair and consistent boundaries, reward the good, don’t make a huge hullabaloo about the not so good, fade in demands and share control….
Maybe some of this might look at least a little familiar–
Parent Management Training
Alan Kazdin, Ph.D.
http://www.oup.com/us/companion.websites/0195154290/?view=usa
Google book preview
http://tinyurl.com/3dkdv5
Reprint fr:
Feldman, J. & Kazdin, A. E. (1995). Parent management training for oppositional and conduct problem children. The Clinical Psychologist, 48(4), 3-5.
http://www.apa.org/divisions/div12/rev_est/pmt_child.html
BOOK REVIEWS
http://www.jaapl.org/cgi/content/full/34/1/135
————————-
Parent Child Interactive/Dyadic therapy
http://yfsa.net/pcit.htm
(even though the example is from a clinic, I just posted because it seemed a clear description, not a recommendation of either program or clinic)
?
Rose
Dec 4, 2007 at 7:34 am
Medication was by far the hardest decision we ever made for Ben. Without having had a speech teacher whose youngest son was on ritalin, we’d have never even considered it.
Having said that…without medication, Ben would have been in an enclosed special ed classroom, where I know from my own experience less learning takes place. Because of lack of exposure to the breadth of the regular classroom curriculum, I wonder if Ben would be considered retarded instead of gifted….it’s a tough call.
Leanne
Dec 4, 2007 at 9:10 am
For me, personally, I shudder to think of preschool age children being medicated. I do appreciate the merits of older children being medicated (although never having faced the decision myself I’m not aware of all the angles) but seems to me a preschool child should be given a chance to grow and mature a bit more before putting drugs in their little bodies.
Beth
Dec 4, 2007 at 10:01 am
My son began Ritalin just shy of 6. It was a very difficult decision and it was recommended to me by 3 seperate (and unrelated) professionals before I was willing to try it. I don’t think that I could have been willing to try it with a preschooler. It has made such an incredible difference for him.
All of the psychotherapy in the world could not help my son focus in class and control his impulsive actions. My son does not get individual psychotherapy (nor do I believe that it would benefit him) but I do agree that medication alone is not the answer. In lieu of psychotherapy, I think a supportive academic environment with some group counseling in the school setting would be a better recommendation for children this young (or in my son’s case) where they do not have the capacity for self-awareness or personal reflection quite yet.
The medication decision is tough for any parent to make.
Niksmom
Dec 4, 2007 at 10:40 am
Perhaps a controversial reply…wouldn’t it be wonderful if SPD (sensory processinf disorder) were recognized in the DSM and we could try NON-pharma approaches to helping our littlest kids by giving their bodies the sensory input they need instead of altering their pathways? We are not yet in a position where we will have to make the pharma decision but will put it off as long as possible. I see tremendous changes in Nik when he gets significant and appropriate amounts and types of sensory input. Of course, getting schools to take on the added burden of providing necessary training to teachers and additional OT’s…well, sure, drugs are much cheaper for the schools! Sigh. It’s a tangled skein…
Niksmom
Dec 4, 2007 at 10:41 am
oops…meant processing…
Marla
Dec 4, 2007 at 11:11 am
And how exactly do they do psycotherapy with a toddler? We have had our daughter on medications since she was three. She has always done better, been able to focus, reduction in aggressive behaviors, sleeps better and has less anxiety and of course her seizures are under control when she is on medications for them. It was certainly not my wish to medicate her but I do believe her life has been made better through use of medications. We have tried weaning her off of certain medications many times and it is always obvious that she needs the medications. She is at the point now where she can communicate about her medications and recently said about her Strattera, “I need that med. Don’t make it stop.” That was the first time she fought us on stopping a medication. I could not believe it.
Autismville
Dec 4, 2007 at 12:15 pm
No meds as of yet, but I’ve learned to never say never. Jack is just four, but all the therapy in the world doesn’t seem to help overcome the stereotypical, self-stimulatory behavior. We attempt to intervene, but his drive to engage in the behavior seems relentless at times…
Addressing his sensory needs does seem to help, but only a little. Thankfully he hasn’t been self-injurious yet. Hopefully by the time we may need meds, even better options will be available.
KimJ
Dec 4, 2007 at 1:10 pm
We’ve never put Pop on meds, heck, we can’t get him to take antibiotics or vitamins.
But I do apply Niksmom’s theory, promoting sensory outlet and avoidance to help control his SID. When he wasn’t speaking (well enough to make his needs/wants known) we did all sorts of sensory exercises with him. Now he can do them alone.
Dr. Temple Grandin discusses the use of psychotherapy in her own early childhood (albeit under vastly different circumstances) and says Speech Therapy would have benefited her much more. If you’re not talking yet and have significant receptive language delay, psychotherapy isn’t going to make much impact.
Never say never is right, and we’re fully aware that Pop’s needs may drastically change when puberty sets in.
Kristina Chew, PhD
Dec 4, 2007 at 1:55 pm
Regan, thanks for those links—-both Jim and I were trained in ABA when Charlie started doing ABA in the fall of 1999. I’ve also had VB training and lots of 1:1 coaching from in-home consultants—-so yes, I do think I’ve in essence done some of the therapies you mention. Deciding to give Charlie medication (he was 6) was a decision reached only after much discernment, self-scrutiny, and behavior plans. Once we started the medication, there were more behavior plans—-it’s a back and forth.
Kristina Chew, PhD
Dec 4, 2007 at 1:56 pm
And here is Autism Speaks hosting a Symposium on the Development of Novel Neuropharmacological Therapeutics for Autism at the Annual Meeting of the American College of Neuropsychopharmacology on December 14, 2007 in Boca Raton, Fla.
Regan
Dec 4, 2007 at 2:18 pm
Kristina,
Your and Jim’s experience in training probably parallel’s ours here pretty closely, that’s why I thought that the PMT and PCIT might look quite familiar…and not what is commonly thought of as “psychotherapy” (not a couch in sight). I put up the links so others might have a chance to see what the structure of the recommendations are.
I’m sure you guys deliberated and observed a lot before deciding on meds. If they make it better, they make it better.
Have an opinion? Leave a comment: