Clonidine for posttraumatic stress disorder in preschool children

Posttraumatic stress disorder (PTSD) in severely and chronically abused and neglected preschool children often results in extreme and disabling symptoms that cannot be managed outside of a highly structured program, e.g., in a psychiatric day hospital. Even when the milieu treatment is supplemented with individual, group, behavioral management, and family therapies, some children remain difficult to manage, both in the therapeutic program and at home, without the use of psychotropic medication. Although one hesitates to use medication with this age group, the severity of the symptoms and the difficulties in managing the behavior of these children, even during psychiatric day treatment, necessitated our considering that the benefits of such treatment might outweigh the risks associated with psychopharmacological intervention. Given the recent suggestion that clonidine, a presynaptic alpha(2)-adrenergic agonist, is useful in the treatment of adult PTSD (Friedman, 1988; Rosenberg et al., 1994) and that some clinicians are also using it to treat childhood PTSD (Marmar et al., 1993), we initiated a limited open 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 Association, 1994), when their PTSD symptoms of hyperarousal, impulsivity, and aggression remained severe and had not abated with individual, family, and structural/behavioral treatment approaches after at least 1 month in treatment.