The blood pressure drug clonidone may benefit preschool-age children with severe post-traumatic stress disorder symptoms resulting from chronic abuse or neglect, according to a study reported in the September Journal of the American Academy of Child and Adolescent Psychiatry.

Drugs are not the first treatment of choice for PTSD in children, state Robert J. Harmon, M.D., and Paula D. Riggs, M.D., who conducted the study. For very young children with severe symptoms that do not respond to other treatments, however, clonidine may offer the best chance of improvement.

The seven study subjects were preschool-age children, 3 to 6 years old, who met DSM-IV criteria for PTSD. The children's symptoms had not abated with individual, family, and structural/behavioral treatment approaches after at least one month of treatment. Most of the children used a clonidine patch that released small amounts of medication throughout the day.

Harmon and Riggs found that clonidine greatly alleviated many of the children's major symptoms. Aggressive behavior lessened in all of the children, and most had fewer problems with impulsive behavior, overalertness, emotional outbursts and mood swings, anxiety, disobedience and "oppositional" behavior, sleeplessness, and nightmares. The children also got along better with other patients and the staff at the day hospital where they were being treated.

Many parents felt the medication was the most significant aspect of their child's treatment, and both staff and parents noted that the medication was often necessary to enable the children to take advantage of other treatment approaches.

Clonidine had few major side effects, although abrupt blood pressure increases were possible if treatment stopped suddenly.

While these preliminary data are promising, Harmon and Riggs call for larger placebo-controlled trials to determine the drug's efficacy and safety for treating this population of children for severe PTSD symptoms.

Harmon is a professor and head of the division of child psychiatry and director of the Infant Psychiatry and the Kempe Center Therapeutic Preschool at the University of Colorado, and Riggs is an assistant professor and director of psychiatric services for adolescents in the Addiction Research and Treatment Services Program, also at the University of Colorado.

(Psychiatric News, October 18, 1996)