Pediatric Psychopharmacology in Preschoolers: A Research Perspective

1
Pediatric Psychopharmacologyin PreschoolersA
Research Perspective

• Mark A. Riddle, M.D.

2
Age/Developmental Groupings

• Infant/Toddler 0 - 2
• Preschool 3 - 5
• School - Age 6 - 12
• Adolescent 12 - 17

3
Current Classifications

• DSM
• DC 0 - 3
• SOYP

4
Current Clinical Practice

• sedation prn
• sedation ongoing
• behavioral organization

5
FDA Approved Drugs Stimulants

• Amphetamine salts I ADHD gt 3
• Dextroamphetamine ADHD gt 3

6
FDA Approved DrugsNeuroleptics

• Chlorpromazine behavior problems gt 1
• HA (short-term)
• Haloperidol behavior problems gt ?
• HA (short-term)
• after non-neuroleptic
• Thioridazine black box gt ?
• behavior problems HA

7
FDA Approved DrugsBenzodiazapines

• Diazepam anxiety gt 6 months
• muscle spasm
• adjunct anticonvulsant

8
Other Commonly Used Drugs

• diphenhydramine/hydroxyzine
• clonidine
• phenobarbital

9
Symptoms Medication-Responsive?

• hyperactivity, impulsivity, distractibility
  
• (ADHD)
• aggression
• behavioral disorganization
• anxiety
• mood lability

10
Controlled Psychotropic Treatment Data

• ADHD methylphenidate (small n)
• aggression none
• disorganization none
• anxiety none
• mood lability none

11
Can Symptom Severity Be Assessed?External
Symptoms (PATS)

• ADHD/Aggression
• parent report
• teacher report
• simulated classroom?

12
Can Symptom Severity Be Assessed?External and
Internal Symptoms

• Disorganization
• parent report
• teacher report
• expert clinician assessment?

13
Can Symptom Severity Be Assessed?Internal
Symptoms

• Anxiety/Mood
• parent report?
• expert clinician assessment?

14
Recommendations

• Stop unsupported indications
• Look at PATS (ADHD) experience
• Listen to more expert opinions
• Go for more research