1. Pediatric Psychopharmacology in Preschoolers: A Research Perspective Mark A. Riddle, M.D.

2. Age/Developmental Groupings Infant/Toddler 0 - 2 Preschool3 - 5 School - Age6 - 12 Adolescent12 - 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 IADHD> 3 DextroamphetamineADHD> 3

6. FDA “Approved” Drugs: Neuroleptics Chlorpromazinebehavior problems> 1 HA (short-term) Haloperidolbehavior problems > ? HA (short-term) after non-neuroleptic Thioridazine“black box” > ? behavior problems & HA

7. FDA “Approved” Drugs: Benzodiazapines Diazepam anxiety > 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 ADHDmethylphenidate (small n) aggressionnone disorganizationnone anxietynone mood labilitynone

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