I see a troubling trend in the pharmacy that has been going on since I started working with a license. And it’s probably no surprise since if you clicked on the link, you already know what I’m going to be discussing today.
I see kids as young as 3-4, yes that’s right, 36-48 months of life, on ADHD medications. That’s quite interesting to me. I’m not going to be discussing the idea that ADHD might not be real. I will discuss the drugs and implications.
The story usually goes something like this:
A child has a lot of energy and can’t focus in school. Parents of said child get a note or call from a teacher about the disruptions, lack of attention, not working on assignments etc. Mom takes a child to doctor and, after performing some routine tests (at least we hope so), mom receives a prescription for some Ritalin, Adderall or other stimulant, goes to the pharmacy and gets to talk to the pharmacist.
This is where more truth comes out because we pharmacist have to disclose more information than a doctor typically would, or would want to. Side effects include; dizziness, sleepiness, decreased appetite, weight loss (that’s why meth addicts are so skinny), high blood pressure, arrhythmias, seizures, priapism, growth suppression, nervousness, insomnia, tachycardia, nausea, headache, palpitations, and visual disturbances.
Truth be told, many people like the effects of stimulants because they get you going, help you feel good, and can hit the pleasure centers of the brain to cause euphoria and if used long enough, or if the effect is strong enough, addiction.
I’ve talked with moms who’ve seen some of these effects in their children. The most common is weight loss and lack of appetite, which go hand in hand. Many also have nausea, compounding the weight loss problem.
What’s worse is that many are getting antipsychotic medications and/or anti-anxiety medications. We’re talking the big guns like benzodiazepines (Xanax, Ativan, Klonopin) and dopamine blockers (Risperdal, Seroquel, Geodon). According to a report from Columbia University, rates of antipsychotics have doubled in children ages 2-5 from 2000-2007. 
What’s worse is that less than half of these children actually had any kind of mental health evaluation, visit with a psychiatrist or have a psychotherapy visit.
One story of an 18 month old, yes 18 months, can be read at the New York Times  about how he was prescribed medications for temper tantrums. His condition got worse until his parents and some good doctors were able to wean him off everything other than some Vyvanse (a stimulant for ADHD). He was overweight and his mother described him as having “blankness” in his eyes by the time he was three.
Part of the problem may be that our public school system is a one size fits all approach to students. We try to fit some square students into a round hole approach. For some children, the public school system works well, especially with good parent involvement. For others, it fails them horribly. I have no data to support the idea that a change in paradigm with public schools’ approach to education might actually curb the rate of prescribing of these medications, but I think it would.
That’s for another post though.
This type of problem solving is analogous to a report I heard on NPR recently about nursing homes and long-term care facilities. A team went to discover if the residents in these types of facilities were really demented and had other mental health problems. Many residents of these types of facilities will yell out and make other types of disturbances during the day and night.
The tea tasked itself with discovering if their really was mental illness or something else going on. In one instance, a woman would yell out at night. Many times in this type of situation, nurses will administer depakote (an anti-seizure medication) or benzodiazepines to calm a patient down.
This team tried to communicate with her. What they found was, after some time and effort, was that she was cold at night. They got her a blanket and she calmed down and slept, all without medications.
Communication: what an amazing concept!
Now I know some people do legitimately have mental illness, there is no doubt about it. Getting a proper diagnoses from the proper channels is important though. Immediately throwing a drug at a problem is a mentality that unfortunately, too many doctors and patients and patient’s moms have. Working through a problem rather than throwing a tablet at it is harder, but can be worth it. Avoiding problems like the story in the New York Times is advisable.
Proper nutrition and activity is generally a good idea, especially for very active kids. Some kids are content to live in their brains more so than others. Others just can’t sit still. They need to move.
A child’s brain is also continuously developing. To address problems like ADHD at 2 or 3, or a temper tantrum at the same age is probably very premature.
My little 3 year old gets frustrated sometimes because she desperately wants to say something. Even when my wife or I is listening intently she’ll get mad or begin to cry. When asked the problem her reply is usually, “I just don’t know how to say it.” Her vocab isn’t quite up to par so her mode of expression goes from words to crying. I certainly don’t fault her for being unable to adequately express in words what’s she’s feeling at the age of 3.
If you think your child may have problems with ADHD and want to take them to a doctor, that’s fine. I don’t disagree with that. But a psychological evaluation by a professional recommended by the doctor is a good place to start. In some cases, if medication is needed on top of a healthy diet and activities, there are alternatives like clonidine which can be prescribed that don’t carry some of the risks of stimulants, or the potential abuse among children or their friends.
1.Olfson, Mark, et al. “Trends in antipsychotic drug use by very young, privately insured children.” Journal of the American Academy of Child & Adolescent Psychiatry 49.1 (2010): 13-23.