The idea of medicating children to change or control their behavior is an inherently uncomfortable thought. A new study showing a sharp increase in both use of and spending on behavioral drugs for children is sure to make many adults uneasy. But viewed in a balanced light, the study should be the source of both caution and optimism.

The study by Medco Health Solutions Inc., reported in Monday's Enquirer, showed a 23 percent increase in use of behavioral medication for all children, including a 49 percent increase in attention deficit/hyperactivity disorder drugs by children under 5. Now Americans spend more on drugs for ADHD and depression than they do on antibiotics, or asthma or allergy medications for children.

More drugs for more kids triggers gut-level questions - why the increase, are they necessary, what are the side effects? But many physicians - including the chair of the American Academy of Pediatrics' drug committee - say the increase is a sign of the drugs' effectiveness.

Locally, Dr. Michael Sorter of Children's Hospital Medical Center says that, in particular, medicines used in the treatment of ADHD - such as Ritalin and Dexadrine - have solid track records, and many children who use them show significant improvements in attention span and impulse control. Their success has meant improved relationships, behavior and learning for millions of children.

But many doctors admit that other behavioral medications are not as well studied or as reliable. Recent studies on the use of antidepressants for children show that, although their use has skyrocketed, most clinical trials have failed to prove that they're effective. Britain has banned antidepressants except Prozac for children. Other medications, such as those used with schizophrenia and bipolar disease, have been tested primarily on adults, so their effects on children are not as clear.

Certainly, the best approach with these medications is caution. Parents and physicians should balance risk against benefit and, if drugs are prescribed, their effects should be carefully monitored. It's essential that families, teachers and caregivers have good information on these medications - but they don't always get it. That is inexcusable.

A second major caution is the huge growth in prescriptions to very young children. Physically, emotionally and developmentally, children under 6 are different than older children. Parents, child-care centers and physicians should use wide definitions for "normal behavior" and leave lots of room for development before turning to drug solutions.

Finally, some of the most important results of this survey have nothing to do with drugs. All good treatment plans for children with behavioral or attention problems insist on a holistic approach. Social skills training, academic intervention and family support are essential to achieving good results. Reaching for a pill alone is never the full answer. And the better prenatal and early care children receive at home, at school and in society, the less medication they may end up needing.