Psychotropic prescriptions in a sample including both healthy and mood and disruptive disordered preschoolers: relationships to diagnosis, impairment, prescriber type, and assessment methods.

OBJECTIVE: Epidemiological data has shown that psychotropic medications are being prescribed to preschoolers at increasing rates. The diagnostic context and functional impairment of these preschoolers remains unknown. This investigation aimed to address these questions in a sample of preschoolers who were either without symptoms (healthy) or with mood and disruptive disorders by assessing them using a structured diagnostic interview and measure of impairment. METHOD: Preschoolers aged 3.0 to 5.11 without symptoms and those with symptoms of mood and disruptive disorders were recruited from primary care and daycare sites in the St. Louis area to participate in a psychiatric evaluation that included information about psychotropic prescriptions from community practitioners. RESULTS: Seven percent of preschoolers (n = 19) out of a total sample of n = 267 were prescribed psychotropic medications. Fifty-two percent of preschoolers in the total sample met criteria for an Axis I psychiatric disorder. Presence of an Axis I disorder was significantly related to psychotropic prescription (p < 0.01). Among preschoolers who met criteria for an Axis I disorder 12% received psychotropics (Dx/Rx group). The Dx/Rx group was more impaired than those with a diagnosis who were not prescribed psychotropics (p < 0.001). Among preschoolers taking psychotropic medications, two failed to meet criteria for any Axis I disorder. CONCLUSION: In this sample, most psychotropic medications were prescribed for impaired preschoolers with an Axis I diagnosis. These findings shed some light on the prescribing trends among mood and disruptive disordered preschoolers.

Risperidone in preschool children with autistic spectrum disorders: an investigation of safety and efficacy.

INTRODUCTION: Early intervention in autism spectrum disorders (ASDs) appears promising and may represent a window of opportunity for more effective treatment. Whereas the safety and efficacy of risperidone have been established for children aged 5 and older, they has not been adequately tested in preschool children. METHODS: A randomized placebo-controlled study of risperidone in preschool children was conducted in a sample of young children, most of whom were also undergoing intensive behavioral treatment. RESULTS: Preschool children tolerated low-dose risperidone well with no serious adverse effects observed over a 6-month treatment period. Weight gain and hypersalivation were the most common side effects reported, and hyperprolactinemia without lactation or related signs was observed. Significant differences between groups found at baseline complicated the analyses; however, controlling for some of these differences revealed that preschoolers on risperidone demonstrated greater improvements in autism severity. The change in autism severity scores from baseline to 6-month follow up for the risperidone group was 8% compared to 3% for the placebo group. Notably, both groups significantly improved over the 6-month treatment period. CONCLUSIONS: Study findings suggest that risperidone is well tolerated in preschoolers over a 6-month period, but that only minimally greater improvement in target symptoms was evident in the risperidone group, possibly due to the differences between groups at baseline or due to the small sample size. Although these findings are not sufficient to direct treatment, they suggest that larger-scale, double-blind, placebo-controlled investigations of risperidone in preschoolers with ASDs should now be conducted.

Preschool depression.

Within the past five years, significant strides have been made in the characterization of preschool (3-6 years of age) depression. Advances in this line of research have been made possible by increasing attention to the impact of developmental stage on symptom manifestation and the development of measures that appropriately assess for the presence of these developmentally specific symptoms. Available empirical evidence demonstrates that preschool depression is characterized by a specific and stable symptom constellation, associated impairment, biologic markers, and family history of similar disorders. This article reviews the relatively new body of evidence supporting the validity of preschool depression.

The contribution of executive functions to emergent mathematic skills in preschool children.

Mathematical ability is related to both activation of the prefrontal cortex in neuroimaging studies of adults and to executive functions in school-age children. The purpose of this study was to determine whether executive functions were related to emergent mathematical proficiency in preschool children. Preschool children (N = 96) were administered an executive function battery that was reduced empirically to working memory (WM), inhibitory control (IC), and shifting abilities by calculating composite scores derived from principal component analysis. Both WM and IC predicted early arithmetic competency, with the observed relations robust after controlling statistically for child age, maternal education, and child vocabulary. Only IC accounted for unique variance in mathematical skills, after the contribution of other executive functions were controlled statistically as well. Specific executive functions are related to emergent mathematical proficiency in this age range. Longitudinal studies using structural equation modeling are necessary to better characterize these ontogenetic relations.

Executive functions in preschool children born preterm: application of cognitive neuroscience paradigms.

Although children born preterm are at risk for neuropsychological impairments at school age and adolescence, including difficulties with visual motor integration, spatial/constructional skills, attention, arithmetic, and nonverbal executive functions, specific neuropsychological outcome has not been investigated adequately in preschoolers. Application of cognitive neuroscience tasks offers the opportunity to characterize early executive functions in young children born preterm. In a preliminary sample of 29 preschool children born preterm (M birth gestational age = 32.4 weeks), executive function outcome was compared to that of fullterm controls by contrasting performance on two prototypic delayed-response-type paradigms, Delayed Alternation and Spatial Reversal. Preschoolers born preterm correctly retrieved the reward on fewer trials on Delayed Alternation than did matched controls. Furthermore, preschool children born preterm used problem-solving strategies that included more perseverative errors than controls. These preliminary findings highlight the utility of cognitive neuroscience paradigms to understand neuropsychological outcome in preschool children born preterm and suggest areas of developmental vulnerability that may include dorsolateral prefrontal circuits.