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Thousands of toddlers medicated for ADHD, raising worries

Posted by on May. 18, 2014 at 3:31 PM
  • 74 Replies

I can't imagine anyone putting a 2 year old on Ritalin..

There is also something seriously wrong (with society, not children) when ONE in FIVE boys is being diagnosed with ADHD. 

ATLANTA — More than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Centers for Disease Control and Prevention.

The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young.

The American Academy of Pediatrics standard practice guidelines for A.D.H.D. do not even address the diagnosis in children 3 and younger — let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group. “It’s absolutely shocking, and it shouldn’t be happening,” said Anita Zervigon-Hakes, a children’s mental health consultant to the Carter Center. “People are just feeling around in the dark. We obviously don’t have our act together for little children.”

Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., said in a telephone interview: “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.”

Friday’s report was the latest to raise concerns about A.D.H.D. diagnoses and medications for American children beyond what many experts consider medically justified. Last year, a nationwide C.D.C. survey found that 11 percent of children ages 4 to 17 have received a diagnosis of the disorder, and that about one in five boys will get one during childhood.

A vast majority are put on medications such as methylphenidate (commonly known as Ritalin) or amphetamines like Adderall, which often calm a child’s hyperactivity and impulsivity but also carry risks for growth suppression, insomnia and hallucinations.

Only Adderall is approved by the Food and Drug Administration for children below age 6. However, because off-label use of methylphenidate in preschool children had produced some encouraging results, the most recent American Academy of Pediatrics guidelines authorized it in 4- and 5-year-olds — but only after formal training for parents and teachers to improve the child’s environment were unsuccessful.

Children below age 4 are not covered in those guidelines because hyperactivity and impulsivity are developmentally appropriate for toddlers, several experts said, and more time is needed to see if a disorder is truly present.

Susanna N. Visser, who oversees the C.D.C.’s research on the disorder, compiled Friday’s report through two sources: Medicaid claims in Georgia and claims by privately insured families nationwide kept by MarketScan, a research firm. Her report did not directly present a total number of toddlers 2 and 3 years old nationwide being medicated for the disorder, however her data suggested a number of at least 10,000 and perhaps many more.

Dr. Visser’s analysis of Georgia Medicaid claims found about one in 225 toddlers being medicated for A.D.H.D., or 760 cases in that state alone. Dr. Visser said that nationwide Medicaid data were not yet available, but Georgia’s rates of the disorder are very typical of the United States as a whole.


“If we applied Georgia’s rate to the number of toddlers on Medicaid nationwide, we would expect at least 10,000 of those to be on A.D.H.D. medication,” Dr. Visser said in an interview. She added that MarketScan data suggested that an additional 4,000 toddlers covered by private insurance were being medicated for the disorder.

Dr. Visser said that effective nonpharmacological treatments, such as teaching parents and day care workers to provide more structured environments for such children, were often ignored. “Families of toddlers with behavioral problems are coming to the doctor’s office for help, and the help they’re getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child,” Dr. Visser said. “It puts these children and their developing minds at risk, and their health is at risk.”

Very few scientific studies have examined the use of stimulant medications in young children. A prominent 2006 study found that methylphenidate could mollify A.D.H.D.-like symptoms in preschoolers, but only about a dozen 3-year-olds were included in the study, and no 2-year-olds. Most researchers on that study, sponsored by the National Institute of Mental Health, had significant financial ties to pharmaceutical companies that made A.D.H.D. medications.

Some doctors said in interviews on Friday that they understood the use of stimulant medication in 2- and 3-year-olds under rare circumstances.

Keith Conners, a psychologist and professor emeritus at Duke University who since the 1960s has been one of A.D.H.D.’s most prominent figures, said that he had occasionally recommended it when nothing else would calm a toddler who was a harm to himself or others.

Dr. Doris Greenberg, a behavioral pediatrician in Savannah, Ga., who attended Dr. Visser’s presentation, said that methylphenidate can be a last resort for situations that have become so stressful that the family could be destroyed. She cautioned, however, that there should not be 10,000 such cases in the United States a year.

“Some of these kids are having really legitimate problems,” Dr. Greenberg said. “But you also have overwhelmed parents who can’t cope and the doctor prescribes as a knee-jerk reaction. You have children with depression or anxiety who can present the same way, and these medications can just make those problems worse.”

Dr. Visser said she could offer no firm explanation for why she found toddlers covered by Medicaid to be medicated for the disorder far more often than those covered by private insurance.

Dr. Nancy Rappaport, a child psychiatrist and director of school-based programs at Cambridge Health Alliance outside Boston who specializes in underprivileged youth, said that some home environments can lead to behavior often mistaken for A.D.H.D., particularly in the youngest children.

“In acting out and being hard to control, they’re signaling the chaos in their environment,” Dr. Rappaport said. “Of course only some homes are like this — but if you have a family with domestic violence, drug or alcohol abuse, or a parent neglecting a 2-year-old, the kid might look impulsive or aggressive. And the parent might just want a quick fix, and the easiest thing to do is medicate. It’s a travesty.”


Source: http://www.nytimes.com/2014/05/17/us/among-experts-scrutiny-of-attention-disorder-diagnoses-in-2-and-3-year-olds.html?_r=0

by on May. 18, 2014 at 3:31 PM
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Replies (1-10):
FromAtoZ
by AllieCat on May. 18, 2014 at 3:50 PM
1 mom liked this

I don't like this at all.  I've always been very leery of such things.  It seems every other child, regardless of age, has been diagnosed with some disorder, is on medication for such disorder.

I know two boys, older than this, aged 14, who are both ADHD.  It isn't easy but the meds, or trying to find the right medication and dosage, is harder on them than any thing else.

I have no first hand personal experience.  I will not pretend I do.  I can only go on who I know and what I know from others.

My ex husband's fiance's 9 year old daughter, and her 12 year old daughter, have both been 'diagnosed' with ADHD and PTSD.  Both are on Prozac. They say their issues stem from her recent separation and divorce from their father.  

I can't comprehend that.  My 14 year old has been through hell and back the past 3.5 years since my divorce.  Medicating her, diagnosing her with anything outside anxiety has never been mentioned. 

Yes, I realize we are all different, as are our situations.

I may be far off but I really am beginning to think our children are diagnosed not only FAR too early, as evidenced in this article, but far too often.

LDavis33
by Bronze Member on May. 18, 2014 at 3:53 PM
6 moms liked this

Sad but not all that shocking.  I suspect that if I had gone to the "right" doctor and pushed just hard enough, I could have had a diagnoses of ADHD for my 4 year old as early as the age of 2.  Did I?  Nope, because 2 year olds are supposed to be high-strung.  Hell, so are 4,5 and 6 year olds (I could go on, but you get the point).

I think the problem not only lies in doctors who are too quick to whip out the prescription pad, but also in the parents who either aren't aware of the normal developmental stages for children (which vary widely for each child)or who just can't (or rather don't want to) handle the typical craziness of a toddler or young child.  Maybe it's the parents who need some medicating rather than these poor kids who have done nothing wrong other than being normal, carefree, rambunctious children?

EDITED TO CLARIFY:  After reading my post, I realized that the way in which it was written may have made it sound as though my 4 year old has been diagnosed with ADHD.  That is not the case.  He is a happy, energetic, rambunctious, imaginative, exhausting, wonderful 4 year old.

purpleducky
by Silver Member on May. 18, 2014 at 5:24 PM
I couldn't get past the ages. ADHD isn't supposed to be diagnosed before the age of 6. Those doctors are stupid.
bluerooffarm
by Bronze Member on May. 18, 2014 at 5:38 PM

My doctor asked me if my youngest needed medication.  That was 2 years ago and he is just 5 now.  It is way over-diagnosed.  As a teacher I saw children who really had ADHD and I saw others who did not but were medicated for it.  It's very sad.

Karmahappens
by Bronze Member on May. 18, 2014 at 5:41 PM

Hwere is the thing. ALL of these drugs (except for intuniv) are STIMULINTS.  If you give a stimulant to a child who does not have the brain chemistry of someone with ADHD-the effect you get is of a child that is MORE hyper.  So for example if my child who is NOT hyperactive took ritilin it would make him bounce off of the walls.

lwalker270
by Bronze Member on May. 18, 2014 at 5:46 PM


Quoting Karmahappens:

Hwere is the thing. ALL of these drugs (except for intuniv) are STIMULINTS.  If you give a stimulant to a child who does not have the brain chemistry of someone with ADHD-the effect you get is of a child that is MORE hyper.  So for example if my child who is NOT hyperactive took ritilin it would make him bounce off of the walls.

I agree.

My son has Aspergers and ADHD, but his doctors wouldn't discuss medicating him until first grade when he was finally diagnosed.  We held off for another year until we had exhausted all non-pharmaceutical alternatives.  For my son, the medication made a tremendously positive difference.

I think toddlers are WAY too young to be on medication, but that's just me.




The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.

~ F. Scott Fitzgerald



FromAtoZ
by AllieCat on May. 18, 2014 at 5:47 PM


Quoting Karmahappens:

Hwere is the thing. ALL of these drugs (except for intuniv) are STIMULINTS.  If you give a stimulant to a child who does not have the brain chemistry of someone with ADHD-the effect you get is of a child that is MORE hyper.  So for example if my child who is NOT hyperactive took ritilin it would make him bounce off of the walls.

Like I've said, I have no first hand experience with this but I have noticed, with the boys who are often at my house........if they take their meds (no idea what the meds are, can't recall the name) they lose their appetites, they are rather sluggish, have issues sleeping and concentrating.  Sure, they aren't bouncing off the walls and they are more subdued in class.  They won't take their meds on days they have games (they play football, baseball, basketball and they wrestle) because it slows them down to much.  

I wish I could remember the name of the medication they take. 

Karmahappens
by Bronze Member on May. 18, 2014 at 5:52 PM

 

Quoting FromAtoZ:

Quoting Karmahappens:

Hwere is the thing. ALL of these drugs (except for intuniv) are STIMULINTS.  If you give a stimulant to a child who does not have the brain chemistry of someone with ADHD-the effect you get is of a child that is MORE hyper.  So for example if my child who is NOT hyperactive took ritilin it would make him bounce off of the walls.

Like I've said, I have no first hand experience with this but I have noticed, with the boys who are often at my house........if they take their meds (no idea what the meds are, can't recall the name) they lose their appetites, they are rather sluggish, have issues sleeping and concentrating.  Sure, they aren't bouncing off the walls and they are more subdued in class.  They won't take their meds on days they have games (they play football, baseball, basketball and they wrestle) because it slows them down to much.  

I wish I could remember the name of the medication they take. 

 Then they are not neurotypical. Give stimulants to a neuro typical child-and they will have the loss of appetite, and the insomnia-but they will be hyper and peppy. NOT slow and sluggish.

purpleducky
by Silver Member on May. 18, 2014 at 5:57 PM


Quoting FromAtoZ:

Quoting Karmahappens:

Hwere is the thing. ALL of these drugs (except for intuniv) are STIMULINTS.  If you give a stimulant to a child who does not have the brain chemistry of someone with ADHD-the effect you get is of a child that is MORE hyper.  So for example if my child who is NOT hyperactive took ritilin it would make him bounce off of the walls.

Like I've said, I have no first hand experience with this but I have noticed, with the boys who are often at my house........if they take their meds (no idea what the meds are, can't recall the name) they lose their appetites, they are rather sluggish, have issues sleeping and concentrating.  Sure, they aren't bouncing off the walls and they are more subdued in class.  They won't take their meds on days they have games (they play football, baseball, basketball and they wrestle) because it slows them down to much.  

I wish I could remember the name of the medication they take. 

Intuniv or Kapvay or Strattera? They are non stimulants. Or could be an anitdepressant?

FromAtoZ
by AllieCat on May. 18, 2014 at 5:57 PM


Quoting Karmahappens:


Quoting FromAtoZ:

Quoting Karmahappens:

Hwere is the thing. ALL of these drugs (except for intuniv) are STIMULINTS.  If you give a stimulant to a child who does not have the brain chemistry of someone with ADHD-the effect you get is of a child that is MORE hyper.  So for example if my child who is NOT hyperactive took ritilin it would make him bounce off of the walls.

Like I've said, I have no first hand experience with this but I have noticed, with the boys who are often at my house........if they take their meds (no idea what the meds are, can't recall the name) they lose their appetites, they are rather sluggish, have issues sleeping and concentrating.  Sure, they aren't bouncing off the walls and they are more subdued in class.  They won't take their meds on days they have games (they play football, baseball, basketball and they wrestle) because it slows them down to much.  

I wish I could remember the name of the medication they take. 

 Then they are not neurotypical. Give stimulants to a neuro typical child-and they will have the loss of appetite, and the insomnia-but they will be hyper and peppy. NOT slow and sluggish.

I'm not sure what that means but I am going to look in to it.

I only know what the boys share with me and they share quite a bit.  They don't care for the majority of the medications they have had to try.  They don't like the way they feel and have even said some seem to take the 'color' out of the day.  They can be far moodier than any girl.

I did ask if they were ever in any type of counseling.  They used to be, until they stopped and no idea why.  

Just from the outside looking in..........knowing their family history, I truly hope some one is able to get these boys the correct help they need, emotionally and otherwise.  They are such wonderful boys with huge hearts.  But I know they used to be pretty intolreable at times and can act out.  They see that but they say themselves, sometimes it is hard to control their actions but they have come far and are learning how.  They don't expect anything from anyone based on their diagnosis, they cannot use that as a crutch.  For me, that speaks volumes about their character.

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