| Prescriptions for psychotropic medications for preschoolers rose substantially WESTPORT, Feb 23 (Reuters Health) - Prescriptions for psychotropic medications for preschoolers rose substantially during the first half of the 1990s, according to study findings published in the February 23rd issue of The Journal of the American Medical Association. Since the effects of these medications on such young children are largely unknown, both epidemiological and clinical studies are needed, researchers report. In the study, Dr. Julie Mango Zito, of the University of Maryland at Baltimore, and colleagues analyzed the use of stimulants, antidepressants and neuroleptics in children ages 2 to 4 years. Subjects were drawn from Medicaid programs in a Midwestern state and a mid-Atlantic state and from a health maintenance organization in the Northwest. Between 1991 and 1995, prescription rates for stimulants and antidepressants, but not neuroleptics, increased substantially, the researchers report. They detected considerable variation in prescription patterns when the data were stratified by gender, age, geography and healthcare system. "These findings are remarkable in light of the limited knowledge base that underlies psychotropic medication use in very young children," the researchers write. Overall, the use of stimulants increased about 3-fold. The majority of stimulant prescriptions were for methylphenidate, but "there was a modest but consistent decrease in the proportion of methylphenidate use relative to other stimulants across the three time periods," the authors write. There was a "dramatic" increase in prescriptions for clonidine during the study period. This finding is "notable because its increased prescribing is occurring without the benefit of rigorous data to support it as a safe and effective treatment for attentional disorders," Dr. Zito and colleagues state. "It appears that behaviorally disturbed children are now increasingly subjected to quick and inexpensive pharmacologic fixes as opposed to informed multimodal therapy associated with optimal outcomes," Dr. Joseph T. Coyle, of Harvard Medical School in Boston, Massachusetts, writes in an editorial that accompanies the study. "These disturbing prescription practices suggest a growing crisis in mental health services to children and demand more thorough investigation," he concludes. Dr. Harold S. Koplewicz, a child psychiatrist who directs the New York University Child Study Center, noted in an interview with Reuters Health that psychiatric illnesses in children often go undiagnosed. Of the estimated 10 million children and adolescents who have psychiatric problems, only about 1 in 5 receive treatment, he said. The apparent increase in prescriptions for children raises several questions, according to Dr. Koplewicz, including whether more children are being diagnosed and treated properly or whether children are given medications because HMOs refuse to pay for other treatments, such as play therapy. The only way to answer this and other questions, in particular questions about the safety and effectiveness of medications, is to fund more research, he said. JAMA 2000;283:1025-1030,1059-1060. |
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