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What Is the Prevalence of Psychotropics Prescribed for Preschoolers?

An increased number of reports have indicated that use of psychotropic drugs by very young children is rising. Using records from 1991 to 1995 in two Medicaid programs in Midwest and mid-Atlantic states and one HMO outpatient facility in the Northwest, researchers compared the prevalence of psychotropic drug use among more than 231,000 children aged 2 to 4 years, with use among children ages 5 to 9, 10 to 14, and 15 to 19 years (over 965,000 individuals were under age 20). The study covered 3 classes of medication (stimulants, antidepressants, and neuroleptics) and, due to their widespread increased use during the study, 2 individual medications (methylphenidate and clonidine).

Although the prevalence of psychotropic use varied among the 3 sites, similar trends were observed over 5 years. The greatest increases over time for preschoolers at individual centers ranged from 28-fold for clonidine, 3-fold for stimulants and methylphenidate, and 2-fold for antidepressants. For preschoolers, 1995 prevalence rates (at one Medicaid site) were 12/1000 for stimulants, 11/1000 for methylphenidate, 3/1000 for antidepressants (largely TCAs), 2/1000 for clonidine, and 0.9/1000 for neuroleptics.

Comment: As noted in other research (see p. 32 of this issue), various exogenous agents may have deleterious effects on brain maturation. Therefore, the effects of commonly prescribed psychotropic medications in preschool children deserve serious study in light of progressively greater clinical use. Also, controlled studies do not support widespread use of clonidine, which may be associated with increasingly high rates of adverse effects (see JW Psychiatry, Nov 1999, p. 92).

— B Geller

Published in Journal Watch Psychiatry April 1, 2000

Citation(s):

Zito JM et al. Trends in the prescribing of psychotropic medications to preschoolers. JAMA 2000 Feb 23 283 1025-1030.

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Coyle JT. Psychotropic drug use in very young children. JAMA 2000 Feb 23 283 1059-1060.

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• Medline abstract (Free)