When I think about using drugs with young children, I always think about Michael.

I loved teaching four-year-old Michael. He came in every morning with a great smile on his face, a beautiful laugh and a great big hug for his teachers. Michael loved to sing songs, play running games and build great big buildings out of blocks.

But he had a hard time sitting still. After about five minutes of circle time, he would invariably throw himself onto the floor or wiggle around in his chair so that the chair would fall backwards. During individual work-time, I felt successful if I helped him to sit for more than two minutes at a time. If for even one second I turned away from him, he would be gone and his project would be on the floor.

We worked on a behavior modification program for six months. Then, we turned to his parents with our suggestion - treatment with a drug called Ritalin. It was a hard decision for us and for his parents, but we felt that Michael's difficulties were preventing him from learning and that we needed to try something new.

At the time, over ten years ago, this suggestion was considered unique and risky. I remember how hard we had to fight to convince his doctors and his parents that this was a risk worth taking.

TIMES HAVE CHANGED

While ten years ago, the suggestion to use drug treatment with a young child was considered unique and drastic, today drug treatment for young children with behavioral or emotional problems is becoming more and more common. According to a study published in the February 23rd Journal of the American Medical Association (JAMA), more than 150,000 pre-school children in the United States are currently taking psychotropic drugs, such as Ritalin and Prozac in order to treat emotional or behavioral disorders.

Here are some other facts that were discovered as part of this study:

• Between the years 1991-1995, the number of pre-school children taking psychotropic medication doubled.
• 60 percent of the youngsters receiving these drugs were four-years-old, 30 percent were three-years-old and 10 percent were only two-years-old.
• 1.5 percent of the children who participated in the study were taking some form of psychiatric drug.

GOVERNMENT RESPONSE

In response to this study, the United States Government has committed to investing money into informing parents and teachers about the risks of psychotropic drugs. In addition, the Food and Drug Administration is developing new drug labels that will give more accurate information about the appropriateness of each drug for use in young children and the National Institute of Health is beginning a nationwide study of Ritalin use in young children. Clearly, the results of this study concern a large number of people.

WHY IS THIS HAPPENING?

Dr. Israel Strous, a psychiatrist involved in researching psychotropic medications, explains that more children are using psychotropic drugs, because researchers have succeeded in developing more effective medications. Today, psychotropic (psychiatric) medications work better, quicker and have fewer side effects than ever before. In addition, physicians and parents are now more aware that there are medications that can help difficulties in young children.

While of course it is great that more children are getting the treatment that they need, there is a risk that parents and doctors will use medications before first trying other methods of treatment.

"In today's world we are always looking for a "quick fix," says Strous. Medications are often the quickest way to improve behavioral difficulties or emotional problems. Yet in some cases, the same results can be achieved through behavioral therapy, without the risk of side effects involved in taking medications.

SHOULD PRE-SCHOOL CHILDREN BE TAKING PSYCHIATRIC MEDICATIONS?

"The answer to this question," states Strous, "must be taken on a case by case basis. It is irresponsible to make a blanket statement about whether or not psychotropic drugs are safe for children. Instead, each child's difficulties must be evaluated on an individual basis." The key is to balance the positive effects of taking the medication with the possible side effects.

Dr. Strous stresses that, "When a physician prescribes medication unnecessarily, he is being negligent. When, however, a child needs the required medication and his parents or physician are not willing to consider the option, then denying the child this medication is equally negligent."

ALWAYS CONSIDER THE PROS AND THE CONS

When a young child starts taking a psychotropic drug to improve his emotional or behavioral difficulties, there are almost always pluses and minuses. On the plus side, when a medication is appropriately prescribed, it is usually effective in improving a child's attention span and/or emotional well-being. The negative side, however, involves physical side effects and the uncertainty about potential long-term effects.

This was certainly the case for Michael. We saw the changes in Michael from the first week. He no longer rolled his seat back and forth or threw himself to the ground during circle time. Suddenly, he could sit without difficulty for up 15 minutes at a time.

Michael started learning. He sat and listened to stories and asked and answered questions. He matched and labeled pictures, identified colors, strung beads into necklaces and drew actual pictures instead of squiggly lines.

But although Michael was learning more, he was now smiling less. He would stroll in each morning, now without the smile, the laugh or the boundless energy. During snack time, instead of gulping down his sandwich, he would sit and play with his food and complain that he wasn't hungry. Towards the end of the day, he would sometimes get headaches and we would hold him as he cried that his head hurt.

We couldn't put our fingers on it, but somehow he was different and while he was learning more and behaving better, we missed the old Michael.

I am happy to say that over the course of the past ten years, strides have been made in drug research, that have greatly reduced the side effects of psychotropic drugs on children like Michael. But despite this improvement, the risks of short and long-term side effects are definitely still there.

SOME PERSONAL CONCLUSIONS...

As a parent and a pre-school special education teacher, I look at the fact that more children are taking medication to improve behavioral and emotional difficulties, as a mixed blessing. I am happy that many young children who in previous years were unable to manage their difficulties are now receiving appropriate treatment. On the other hand, I know that the decisions that we must make, as parents and educators, are now more difficult.

So if your child has behavior or emotional difficulties, don't despair. Know that there are several options of treatment available. Carefully weigh your child's options, knowing that your decision may be difficult, but your child's life can be richer.