CLONIDINE FOR POSTTRAUMATIC-STRESS-DISORDER IN PRESCHOOL-CHILDREN

Posttraumatic stress disorder (PTSD) in severely and chronically abuse d and neglected preschool children often results in extreme and disabl ing symptoms that cannot be managed outside of a highly structured pro gram, e.g., in a psychiatric day hospital. Even when the milieu treatm ent is supplemented with individual, group, behavioral management, and family therapies, some children remain difficult to manage, both in t he therapeutic program and at home, without the use of psychotropic me dication. Although one hesitates to use medication with this age group , the severity of the symptoms and the difficulties in managing the be havior of these children, even during psychiatric day treatment, neces sitated our considering that the benefits of such treatment might outw eigh the risks associated with psychopharmacological intervention. Giv en the recent suggestion that clonidine, a presynaptic alpha(2)-adrene rgic agonist, is useful in the treatment of adult PTSD (Friedman, 1988 ; Rosenberg et al., 1994) and that some clinicians are also using it t o treat childhood PTSD (Marmar et al., 1993), we initiated a limited o pen clinical trial using clonidine with the 3- to 6-year-old preschool children entering our program. We considered clonidine only in those children who met DSM-IV criteria for PTSD (American Psychiatric Associ ation, 1994), when their PTSD symptoms of hyperarousal, impulsivity, a nd aggression remained severe and had not abated with individual, fami ly, and structural/behavioral treatment approaches after at least 1 mo nth in treatment.