Is low-dose Dexedrine safe for a 4- or 5-year-old?

[bnebert]

ADHD is commonly associated with food allergies. Maybe you should modify her diet to no prepackaged foods, a natural diet, to see if that helps.

 

[Roger&Me]

sorry for the less than advanced reply but 4 year olds are supposed to be "adhd", they are little tiny kids. being hyper and inattentive is the whole point of childhood, its how kids explore their environment and find out who they are.

not trying to start a philosophical discussion here, but there is an element of insanity in giving powerful monoamine releasers to kids that young. especially when the medical necessity of such a decision is dubious at best. intuitively i find it very hard to believe that any child is at risk of suffering serious long term consequences as a result of not being treated for adhd. i find it much easier to believe that exposure to monoamine releasers during early brain development might have a deleterious effects on a child's physical and mental health.

if it were my child, i would look at the doctor like "are you crazy? this is a 4 year old we're talking about here".

 

[Dresden]

IIRC methylphenidate stunts growth in children. I don't know if the same is true for amphetamine or not, but if I had a 4 or 5 year old, I would simply keep their medicine for myself.

 

[Dysphoric]

No that is disgusting! She's too young for something like that. I had a bad experience with doctors putting me on strattera and imipramine (not at once) around the age of 10. Those meds caused me to withdraw and caused hellish depression, and anxiety. I was too afraid to eat because I thought I'd choke and die. That resulted in losing a lot of weight, and I was already skinny. If I would have known that it was the medication I would have never put myself through that hell. I wish a horrible, agonizing death upon that doctor who put me through those two years of hell.

TL;DR I was force fed medication which resulted in severe depression with panic/anxiety all because my ADHD was "too much". Too this day I think it was somewhat of a traumatizing experience. Even from simple observation I've seen countless people I went to highschool with that were on powerful stimulants from early ages that are all socially awkward, very disconnected and quite a few being depressed.

All in all I feel that anyone who would put their children/patient on such meds at such a age that they don't know what they're putting into themselves, especially over something as trivial as childhood ADHD. I wish bad things upon them, lets just leave it at that.

I'll say this before you try and reply to me saying "well that's just your experience". Sure some people may not have a equally traumatizing experience as I had, but that's beside the point. The point is, is that you don't drug someone with something that powerful at the ages that their brains aren't even close to developed. You're going to role the dice with their mental well being just so you don't have to deal with a couple years of a hyperactive child? Sounds like you don't deserve to be a parent then. AFAIK giving people drugs without their consent is very illegal. Oh, but its okay to do it to your child. What a fucked up society.

 

[flyhighk]

^5 year old are too young to decide for themselves if they wanna take the drug or no. That's why parents have to make this decision for their child. Anyways that's not the point of this discussion.
But I agree, giving powerful stims for a 5 year old is a really bad decision.
OP, your brother should learn how to do behavioral therapy. It's doesn't provide immediate improvement, but it's much safer than stimulant drugs, especially for a five year old. If therapy doesn't help, well he can reconsider drugs.

 

[Thorns Have Roses]

My little brother's daughter is 4 years old, and her doctor wants to try her on low-dose Dexedrine.

Parent Training would be a good first line treatment for children this age, it can provide significant improvement without the need to resort to pharmacotherapy, or lead to improved results when used in tandem with pharmaceuticals.^{1 2 3}

sorry for the less than advanced reply but 4 year olds are supposed to be "adhd", they are little tiny kids. being hyper and inattentive is the whole point of childhood, its how kids explore their environment and find out who they are.

There is evidence suggesting that ADHD diagnoses in preschool age children are valid.^{4 5}

 

[Solipsis]

Christ, please allow a child to develop its body and mind before you start meddling with it using psychiatric medications, even if it is relatively non-toxic. Anything you start with super early will often get integrated in the 'system' causing dependency soon enough.
Indeed there are other kinds of therapy to try first, and ADHD is not like a syndrome that is likely that start posing a risk for the child or others in the milieu.

 

[Thorns Have Roses]

But what concerns me even more is the neurotoxicity of amphetamine. But what about 5mg/day, XR? What kind of risks does that hold over time?

I found no evidence that stimulant prescription is associated with long-term cognitive impairment. On the other hand, a significant minority of children with ADHD also have a formal learning disability, in addition to the issues caused by the disorder's inherent inattentiveness.¹

she has one of the worst cases of ADHD that I have ever seen

Parent Training (as the name implies) is gonna help your niece's parents react to, and deal with, her disorder more effectively. ADHD can be trying on the parents as well as the child, everybody could use a lil' help.

please allow a child to develop its body and mind before you start meddling with it using psychiatric medication....ADHD is not like a syndrome that is likely that start posing a risk for the child or others in the milieu

That's kinda completely untrue.² Pharmacotherapy should not be taken off the table, though we must keep in mind there is a chance of misdiagnosis at this age, it depends on how the child reacts to behavioral therapy.

Anything you start with super early will often get integrated in the 'system' causing dependency soon enough.

I don't even know what you're talking about.

 

[flyhighk]

^I guess soli meant that using stims at a young age will cause permanent dependence.
Which isn't true if that's what we wanted to say.

 

[Solipsis]

If we are talking about starting with a 4 or 5 year old and administering a pharmaceutical that alters levels of neurotransmitters... I would assume it would have to be a case so severe that there are no hopes any time soon that you can discontinue... if that child has most of it's essential physical and mental development yet to come, how does the brain not start relying on this state of affairs between the 4th/5th and 18-25th year of life?
It would surprise me if it didn't since I heard that early starting of drug use caused similar 'pervasive assimilation' of drug use with expected consequences for the rest of life. Are you saying that is entirely psychological, like conditioning?

NKB, I have close friends and acquaintances with ADD but it was diagnosed at a later age and I don't find it surprising that it was hard to do it any time sooner. Maybe it was the possibility of misdiagnosis I was most worried about. Children are so playful and a lapse in attention should not be mistaken for ADD nor should general high activity be mistaken for ADHD. The problems would have to already be so severe that medication becomes the lesser of two evils. Then I would agree.

I guess any outrage would be painted against the background of disturbing levels of diagnosis which the US is known for most. The pressure to fit in and succeed in life despite competition is so great that people finetune children from a small age. I think Louis Theroux investigated that, though obviously he showed extreme cases which might not necessarily be representative. But additional evidence may show it is to some extent.
Again yes: if rather than merely "difficult", children are impossible and grossly dysfunctional even at the low levels of having to be functional and responsible, then it may be a better choice to do something more rigorous about it. Even if dexedrine (or why stop there, give them Desoxyn ) is not really safe, accepting those levels of risks might be worth avoiding disaster.

But that would make this discussion unfair, the way I interpret this question is if it would be alright to give a child dexedrine to combat moderate symptoms because 'it couldn't hurt'. That would be the interesting ethical question, if we skew it to only cover children who are at a last resort then the matter slowly becomes more self-evident. Hence my previous reaction. Then again technically the question was if it would be safe, not if it would be the right thing to do.

(thanks for the sourcy)

 

[CSM25]

Hi. Not to parrot what others have said.

I think it is a dangerous idea. As someone who questions whether ADHD exists (yet seriously suffers from the "time-blindness", executive function, and organizational issues),
I firmly believe using psycho-stims and psyche meds for the most part is BAD news at such a young age, maybe even at 18.

I have self-medicated for years with other stimulants and they have really made me dependent. Getting clean of everything including alcohol, for a couple of years and then using these,
I see that they are very strong at times and can have serious side effects. If I didn't like or feel that I "perform better" (who doesn't though?) on stimulants, then I would never use them.

I used SNRI's when I was younger and those caused INSANE and what I can hope are not permanent side effects. And I was 19-20 at the time. Not the exact same thing, but something affecting serotonin, norepinephrine as well. I mean major personality changes, impaired judgement, and more. I never did any drugs at all until then (except coffee and a rare smoke, tiny bit of drinking).

Dexedrine not only slows reuptake of norepinephrine and dopamine (like "clogging the faucet") but also boosts their level (like "turning on the water full blast"). *

*I mean, if a sink with running water represents neurotransmitters of norepinephrine and dopamine (and others), then the skin being clogged and water staying in the sink without draining, is like the synapse still full of such chemicals. The water running, at a higher intensity is like more dopamine etc flooding the synapse.

I got screwed up personally on the reuptake... I am sure that constant boosting at a young age would be bad too (although worse/ better, who knows?)

I hope I made sense.

 

[Seppi]

Hi. Not to parrot what others have said.

I think it is a dangerous idea. As someone who questions whether ADHD exists (yet seriously suffers from the "time-blindness", executive function, and organizational issues),
I firmly believe using psycho-stims and psyche meds for the most part is BAD news at such a young age, maybe even at 18.

I have self-medicated for years with other stimulants and they have really made me dependent. Getting clean of everything including alcohol, for a couple of years and then using these,
I see that they are very strong at times and can have serious side effects. If I didn't like or feel that I "perform better" (who doesn't though?) on stimulants, then I would never use them.

I used SNRI's when I was younger and those caused INSANE and what I can hope are not permanent side effects. And I was 19-20 at the time. Not the exact same thing, but something affecting serotonin, norepinephrine as well. I mean major personality changes, impaired judgement, and more. I never did any drugs at all until then (except coffee and a rare smoke, tiny bit of drinking).

Dexedrine not only slows reuptake of norepinephrine and dopamine (like "clogging the faucet") but also boosts their level (like "turning on the water full blast"). *

*I mean, if a sink with running water represents neurotransmitters of norepinephrine and dopamine (and others), then the skin being clogged and water staying in the sink without draining, is like the synapse still full of such chemicals. The water running, at a higher intensity is like more dopamine etc flooding the synapse.

I got screwed up personally on the reuptake... I am sure that constant boosting at a young age would be bad too (although worse/ better, who knows?)

I hope I made sense.

TAAR1 agonists are pretty different than classical reuptake inhibitors.

 

[sekio]

I would rather see kids on low-ish doses of amphetamine or methylphenidate PRN for attention span purposes, than on broad spectrum, daily, antipsychotics or SNRIs.

Certainly it needs to be paired with parent training, diet, enriched environments (children are not meant to sit for hours on end) and the like, but I think the consensus is that low-moderate doses of amphetamine/MPH are pretty physically benign in school age children. Not saying that they can tolerate them psychologically though. Especially if they're self-administered. We all know how that story ends.

 

[CSM25]

Very true Sekkio and Sepi.Thanks for the like.

I learn something new everyday. I wholeheartedly agree that global psyche meds would be more dangerous.

There are side effects that can be quite troubling that don't hit everyone though.

 

[pofacedhoe]

I would almost guarantee that the child's diet is in need of remediation and if you augment that, than the child will benefit greatly. Holy crap do not give a 4 year old fucking amphetamines. A young mind is still developing such important synaptic connections and this will have life long implications. CHANGE THE DIET DON'T GIVE THEM STIMULANTS

yes. does she eat any omega 3 at all?

adhd is sometimes bad but honestly speed is brain rot from my experience as an adult with it

 

[piller97]

IMO 5mg/day of XR would be safe, and as long as she doesn't develop problems with tolerance, theres no reason she couldn't be on that dose for a long time without it needing to be raised.
If it were IR i may be concerned as 5mg being released at once I could see perhaps leading to complications....but with the time release of XR i think it should be ok...

The most important thing to remember is to frequently meet with and update the prescribing doc(ideally a psychiatrist, preferably specializing in children) as they should be your first line of defence against any negative effects.

Also, if you feel like this may be iffy and aren't completely comfortable, you are 100% justified in getting a second opinion, sometimes it takes a few trys to find a doctor who understands your nieces unique needs and is able to proceed accordingly.

Im surprised that the doc didn't go with a non-stimulant medication as a first attempt......its been my experience that amphetamines are used as a last resort.
The only reason I can think of is that perhaps the non-stimulant medications aren't available in such a low dose, other than that I don't see why adderall (or ritilan) would be a first choice.

Best of luck!
-p

 

[ebola?]

IMO 5mg/day of XR would be safe, and as long as she doesn't develop problems with tolerance, theres no reason she couldn't be on that dose for a long time without it needing to be raised. If it were IR i may be concerned as 5mg being released at once I could see perhaps leading to complications....but with the time release of XR i think it should be ok...

It's "safe", for a four to five year old kid, where the brain is drastically more plastic than an adult's? I also don't see why daily dosing would not induce significant tolerance, even with low dosages. I really don't see why we're not erring on the side of caution when the long-term consequences of this type of practice are so poorly understood.
...
For me, this is actually an ethical issue: if I child is too young to hold the capacity to decide whether to take a psychoactive medication, that child probably should not be taking that medication at all (unless he or she poses some sort of physical threat to him/herself or others); I'm skeptical of whether parents should hold this type of authority over their children.

ebola

 

[Thorns Have Roses]

as long as she doesn't develop problems with tolerance, theres no reason she couldn't be on that dose for a long time without it needing to be raised.

I've been wondering about this myself, it is unclear how much of a problem tolerance represents.^{1 2 3} One could always cycle between medications if it's an issue.

Im surprised that the doc didn't go with a non-stimulant medication as a first attempt......its been my experience that amphetamines are used as a last resort.

I was under the impression that stimulants are the first-line treatment.^{4 5} Bupropion, gaunfacine, and atomoxetine seem like decent options though.^{6 7 8}

if I child is too young to hold the capacity to decide whether to take a psychoactive medication, that child probably should not be taking that medication at all

Why should psychiatric medication be viewed differently than medication for physical ailment?

(unless he or she poses some sort of physical threat to him/herself or others)

Would increased risk of physical injury, and future development of substance abuse disorders count?^{9 10} I suppose the child's mental health and social functioning are insignificant, as well as the greater likelihood of parental depression, 'cause that stuff isn't physical.^{11 12}

I really don't see why we're not erring on the side of caution when the long-term consequences of this type of practice are so poorly understood.

Indeed, psychostimulant therapy is simply not the best option at this point.^{13 14(not to beat a dead horse)} However, there is no reason to remove that option from the table, given the undesirable long-term consequences associated with the disorder.¹⁵ Granted, startin'em on stimulants in childhood is merely correlated with positive long-term outcomes. ¹⁶

 

[ebola?]

Why should psychiatric medication be viewed differently than medication for physical ailment?

Basically, the questions of how to interpret illness of the mind, define and diagnose disorders, and choose among treatments is more controversial within the scientific community. Indeed, the prevailing typology of 'syndromes' we have is subject to social construction and ambiguous in its ontological and epistemological standing, diagnoses and treatments are far less reliable, and are more likely to have detrimental consequences in their application. Basically, because the mind is so important, it becomes crucial that one decides what is to be done with it him or herself.

Would increased risk of physical injury, and future development of substance abuse disorders count?

The latter seems like a grey area to me, but adolescents often approach having sufficient capacity to decide about their own medications. This is a tricky issues that families will have to navigate.

I suppose the child's mental health and social functioning are insignificant, as well as the greater likelihood of parental depression, 'cause that stuff isn't physical.

No one has implied that in this discussion.

However, there is no reason to remove that option from the table, given the undesirable long-term consequences associated with the disorder.

I think that the pros and cons are both rather significant, hence the importance of the individual deciding for him or herself.

Granted, startin'em on stimulants in childhood is merely correlated with positive long-term outcomes.

Yes, within that particular study, which fails to address all potential drawbacks.

I'm going crazy with the references due to my lack of ADD qualifications, FYI.

No, they're useful--thanks. Incidentally, while I don't have a bunch of references handy, I did research in undergrad examining the presentation of AD(H)D (and hold a degree in psychology with focus in cognitive neuroscience...not bragging, but demonstrating I'm not talking out my ass ), and our lab came to the conclusion that it's an alternate attentional style, with its own pros and cons, but unfortunately one that doesn't 'fit' with our severely underfunded primary education
...
I think that the 'cult' of delivery of psychiatric medication tables key institutional pathologies in education in the US and unwarrantedly 'crowds out' non-pharmacological methods of intervention. Eg, in France, you see a mere fraction of stimulant prescriptions and far more common use of alternate treatments.


ebola

 

[Thorns Have Roses]

I did research in undergrad examining the presentation of AD(H)D

Dang, I'm glad my references weren't evidence of idiotic misinterpretation of data on my part.

Basically, the questions of how to interpret illness of the mind, define and diagnose disorders, and choose among treatments is more controversial within the scientific community. Indeed, the prevailing typology of 'syndromes' we have is subject to social construction and ambiguous in its ontological and epistemological standing, diagnoses and treatments are far less reliable, and are more likely to have detrimental consequences in their application. Basically, because the mind is so important, it becomes crucial that one decides what is to be done with it him or herself.

You're right, you're right, I admit that I am biased, and think a psychiatrist's diagnosis is just as valid as your typical M.D.'s. I'm coming at this from the perspective of somebody whose life fell to pieces due to undiagnosed/untreated mental illness (plus time in PD staff has got me in the habit of defending the DSM and mainstream pharmaceutical treatment from knee-jerk emotional rejection by hippie types).

came to the conclusion that it's an alternate attentional style, with its own pros and cons, but unfortunately one that doesn't 'fit' with our severely underfunded primary education

I do not disagree, it's all relative, these conditions "exist" because they cause functional impairment, or decreased subjective quality of life, within our current socio-economic system.

I think that the 'cult' of delivery of psychiatric medication tables key institutional pathologies in education in the US and unwarrantedly 'crowds out' non-pharmacological methods of intervention.

Indubitably. My pet theory is that the high rates of pharmacotherapy for any medical complaint in the US is a byproduct of our healthcare system. Folks pay so much for access to medicine that they expect a medication for every little thing, or else they feel they're being ripped off, and are liable to switch to a different provider due to perceived neglect. I have no evidence to support this, of course, just IMO.