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Side Effects of Methylphenidate in Preschool Children
This study appeared in the Journal of Child and Adolescent Psychopharmacology (1998, Vol. 8 13-25). The focus of this study was to evaluate the side effects of methylphenidate in preschool children. This is important, because there has been relatively little research conducted in which the effects of stimulant medication on young children have been examined.
The children in this study were 27 boys and five girls with an average age of four years and 10 months. These children participated in a double-blind placebo-controlled crossover drug study to assess the side effects of methylphenidate. In this type of design, children received medication for period of time and a placebo for period of time. Side effects were monitored by their parents using a rating scale specifically designed for medication studies. Neither the child nor the parent was aware of when medication was being received and when the child with receiving a placebo.
Of 17 childhood behaviors that are usually associated with side effects, eight behaviors showed significant changes when the child was on a higher does of methylphenidate. Although this appeared somewhat higher than what is usually reported in populations of school-age children, very few parents reported the side effects as being severe. In fact, severe side effects were reported by less than 10 percent of the sample, and as many reports of severe side effects occurred when the child was on a placebo as when the child was receiving medication.
The authors suggest that these results indicate that methylphenidate is generally tolerated quite well by preschool children, although they are cautious to note that their study only evaluated potential side effects over a short-term. They also make the important point that what parents may sometimes assume to be side effects of medication, do not actually result from the medication at all (recall that the number of severe "side effects" that were reported when the child was receiving medication were no greater than when the child was getting the placebo.)
This study is important in that it provides additional evidence to suggest that stimulant medication may be a reasonable treatment approach in preschool children with ADHD. My own feeling about this, however, is that it is always appropriate to try other types of interventions with preschoolers before using medication, and that medication should be considered if these other approaches are not effective. This is consistent with treatment guidelines recently published by the American Academy of Child and Adolescent Psychiatry, who regarded stimulant medication as a second line treatment for preschoolers with ADHD to be used after other approaches were not successful.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.