- The Washington Times - Sunday, April 2, 2000

Who needs to go out on a limb? Sometimes the meeting of minds is the place to be. Announcing an effort to reverse the startling increase in the number of preschoolers who are prescribed Ritalin, Prozac and other mood-altering drugs, the White House recently outlined a plan welcomed warmly by teachers, psychiatrists, family doctors and drugs companies. In fact, the consensus against doling out these potent drugs to tiny tots was so solid that one has to wonder how this prescription craze came about in the first place.

Psychiatrists point fingers at pediatricians, who blame parents the schools have urged to seek out calming medications to tame junior. The cause? It all starts with a variety of behaviors often hastily diagnosed as Attention Deficit Disorder, a catch-all category of undesirable habits that range from hyperactivity and disorderly conduct, to a stubborn inability to concentrate and work in a school setting. Critics, naturally concerned about drugging children of all ages into a chemically-induced docility, have long doubted that such behaviors always reflect an honest-to-goodness mental or emotional disorder. Sometimes, they believe, bad behavior is exactly that, requiring old-fashioned correction, rather than modern medication.

Of course, the White House initiative doesn't touch on this particularly prickly pediatric controversy that affects school-age children, most of whom happen to be boys. As announced by Hillary Rodham Clinton, the Clinton administration has instead taken its stand against the hasty, practically automatic prescription of psychiatric drugs to troubled toddlers a position about as noncontroversial as it is sensible. As Dr. Joseph T. Coyle, chairman of the psychiatry department at Harvard Medical School wrote in The Journal of the American Medical Association last month, children with behavior problems are "increasingly subjected to quick and inexpensive pharmacologic fixes," although "there is no empirical evidence to support psychotropic drug treatment in very young children." Accordingly, the White House declared (in less than ringing language), "The use of medication is not generally the first option for a preschool child with a psychiatric disorder." What a generally good idea.

White House officials, crediting Mrs. Clinton with this initiative, which she announced in her husband's absence, offered assurances that it had nothing to do with her New York Senate race. Speaking to the New York Times, a federal health official put it, perhaps unintentionally, rather more plainly: "Everything Mrs. Clinton does is related to her campaign, but this initiative has substance, too. We want doctors and parents to think about these issues."

Of course, there is more to the White House plan than a burst of safe and sane publicity. The White House has directed the National Institutes of Mental Health, at a cost of $6 million, to study over the next five years whether Ritalin is effective in treating preschoolers with behavioral problems in other words, whether Ritalin should indeed be prescribed to the very young after all. The White House has also asked the Food and Drug Administration to work with the drug companies to develop "pediatric dosage information" for new labels for these drugs. Maybe this is just a mild hallucination, but such measures, rather than serving to discourage the prescription of these powerful pills to youngsters, would actually seem to be laying the groundwork for making their widespread usage in the future all the more acceptable.


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