EBD Blog

Sometimes I just don’t get it.

The following abstract (from PubMed) describes research on use of medications as a treatment for preschoolers with attention deficit hyperactivity disorder, disruptive behavior disorder, and posttraumatic stress disorder. I suspect that the article reports on prior interventions that have been tried in most of the cases described in the study, but I have to wonder whether those interventions were well-conceived and -executed. Afterall, preschoolers are little kids. Most all of them are very susceptible to differential reinforcement. Did anyone test a carefully implemented time-out program with these kids (and I don’t mean one of the bogus take-time-to-get-yourself-together practices that are often labeled “time out”)?

There are surely a few preschoolers who will not respond to effective behavior management practices, and for those children and their families we must turn to additional means of therapy. But, I hope professionals concerned with Emotional and Behavioral Disorders among young children are using well-documented behavior modification procedures as a much earlier line of therapy.

Prog Neuropsychopharmacol Biol Psychiatry. 2006 Sep 26; [Epub ahead of print] Related Articles, Links

Psychopharmacologic treatment of aggressive preschoolers: A chart review.

Staller JA.

Division of Child and Adolescent Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.

Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in a university child psychiatry outpatient clinic from 2001-2004. The most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD), Disruptive Behavior Disorder and Posttraumatic Stress Disorder (PTSD). Medication was prescribed for a majority of the children with prominent aggression; atypical antipsychotics were prescribed with the greatest frequency, followed by stimulants and then alpha agonists-treatment response ratings indicated moderate to marked improved in a majority of the preschoolers who received one or a combination of these medications. Findings support the need for controlled trials of medication in preschoolers with severe aggression.