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May 8, 1996

Identifying Substance Abusers at Preschool Age

JAMA. 1996;275(18):1391-1392. doi:10.1001/jama.1996.03530420019012

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SOME CAN BE spotted when they're only 4 or 5 years old: children with a "high potential" for substance abuse in adolescence.

Consider "Billy," a hypothetical case patient based on the clinical experience of Richard B. Heyman, MD, chair of the American Academy of Pediatrics' Committee on Substance Abuse. The child "had been an irritable infant, tough to console," Heyman recalled. "As Billy grew, he slept little, obeyed less, and generally consumed most of his parents' waking hours to keep him safe."

Because the child was disruptive, easily distracted, and often hostile, he was evaluated for attention-deficit hyperactivity disorder (ADHD) at a very early age. After a battery of tests, ADHD was diagnosed. He was treated and seemed to perform a little better in school.

"Certainly no child is locked into substance abuse at this age," cautioned George C. Comerci, MD, professor of pediatrics at the University of Arizona College