“Why stop at four years?” asked Stacy sarcastically. “Why not use it to help toddlers focus on potty training? Or why not use it on infants who have tantrums in public? Here’s a guideline: Give it to kids from their first month of birth so we’ll have zoned out little zombies rather than playful, rambunctious children!”
That’s what my friend Stacy said when she called me right after she read about the new ADHD treatment guidelines from the American Academy of Pediatrics (AAP).
To get an idea of why she’s so upset, consider this: Imagine a four-year-old having suicidal thoughts.
That’s almost impossible to conceive of. But with one of the widely-used ADHD drugs, studies show that four in 1,000 kids may develop suicidal thoughts.
And as you may have already figured out, the new ADHD treatment guidelines have been expanded to include kids as young a four. That’s right — PRESCHOOLERS, medicated to control their high energy and quick attention changes.
Let me back up and tell you how Stacy’s experience brought her to this moment of extreme agitation, courtesy of the AAP.
Ten years ago, when Stacy’s son Jordan was in third grade, she finally gave in to the recommendations of his pediatrician and teachers and agreed to give Ritalin a try.
You can imagine exactly what they told her: Jordan can’t sit still. His mind wanders. He sometimes distracts the other children.
Stacy suspected that this same recommendation was being made to dozens of kids in Jordan’s classes. But she also didn’t want Jordan to fall behind. And as she now says, “That’s the one they get you with. They tell you your child is going to fail. The other kids will go on without him. They put that fear in you. And just the thought of it breaks your heart.”
So Jordan took Ritalin. And Stacy agonized over it — even when his teachers reported that he was better behaved in class. But after just a few weeks of feeling guilty every time she gave her son his morning pill, she decided she’d had enough.
She stopped giving Jordan Ritalin, started giving him fish oil every morning, and made some difficult changes in his diet. (I’m proud to tell you that these were suggestions she’d read about in the e-Alert.)
The dietary change was the hard part. “Unbelievably hard!” as Stacy puts it. An 8-year-old boy who’s used to getting his Happy Meals is anything but happy when the McDonalds pipeline is suddenly shut down.
Still, Stacy persevered and revamped her family’s eating habits. But she continued to tell Jordan’s teachers that he was taking Ritalin, and they continued to tell her how much better he was doing. It’s kind of a shame they never learned the truth, but Stacy just didn’t want to deal with their hardheaded focus on medication.
So that was then, which brings us to now…
Stacy is furious that many first-time parents will innocently walk into situations where preschool teachers and pediatricians may strongly urge them to medicate their children.
And what drugs will they be taking?
Well…here’s where things get weird.
The only ADHD drug with FDA approval for preschoolers is Dexedrine, also known as dextroamphetamine. And as the name implies, it’s a form of amphetamine. But in the new AAP guideline paper, the organization notes that “insufficient evidence” for Dexedrine’s safety in the preschool age group “does not make it possible to recommend at this time.”
And yet it has FDA approval for just that! It’s preposterous!
Meanwhile, Ritalin is not FDA approved for preschoolers, but the AAP says that there is “moderate evidence” that it’s safe.
Is moderate evidence of safety good enough when you’re talking about controlling a preschooler’s behavior? Keep in mind, this isn’t cancer or leukemia we’re fighting here, it’s temperament and mind control.
The teachers might want a calmer class room but it’s not worth one child in a million, let alone four in a thousand, having suicidal thoughts or even one side effect. And especially when adding fish oil and passing on the Happy Meals goes a long way to getting the same result.
Of course, as Stacy learned, the early side effects of that treatment will be an extra tantrum or two. But looking at the calendar, you might want to wait until Wednesday to start cutting back on the sugar.
“ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents” Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, Pediatrics, Published online 10/16/11, pediatrics.aappublications.org
“Should Preschoolers be Given ADHA Meds? Ed Silverman, Pharmalot, 10/17/11, pharmalot.com