Feb. 22, 2000 (Minneapolis) -- The number of preschool children receiving Ritalin, Prozac, and other drugs for psychiatric disorders increased dramatically from 1991 to 1995, according to a study in this week's issue of the Journal of the American Medical Association. These medications, called psychotropics, have not been approved for young children, and the potential for harmful effects on them is unknown, the authors write.
"Rapid expansion of medication use for a particular problem raises questions about appropriateness, effectiveness, and long-term safety," researcher Julie Magno Zito, PhD, tells WebMD.
Zito and her colleagues reviewed outpatient prescription records from two state Medicaid programs and one health maintenance organization (HMO). The investigators analyzed these groups for the years 1991, 1993, and 1995.
The researcher found that Ritalin (methylphenidate) was by far the most prescribed psychotropic medication. Ritalin prescriptions among children 2 to 4 years old increased substantially in all three study groups and tripled in two of them.
Antidepressants, such as Prozac (fluoxetine) and Zoloft (sertraline), were the second most common type of psychotropic medication prescribed to preschoolers. During the study period, antidepressant prescriptions doubled in both of the Medicaid groups, and increased in the HMO group as well.
Several factors may have contributed to the trend, says Zito, an associate professor of pharmacy and medicine at the University of Maryland. These include a change in the criteria for diagnosing ADHD, an bigger role for schools in assessing children's emotional and behavioral needs, day care environments that may interfere with children's normal behavioral development, and a more favorable public attitude toward medical treatment of behavioral problems.
"This reported increased use of psychotropic drugs in very young children raises important questions," Joseph T. Coyle, MD, writes in an editorial accompanying the study. He suggests that "behaviorally disturbed children are now increasingly subjected to quick and inexpensive pharmacologic fixes" rather than multidisciplinary approaches that include pediatric, psychiatric, behavioral, and family care. These practices, he says, "suggest a growing crisis in mental health services to children and demand more thorough investigation."
Coyle, who is chair of psychiatry at Harvard Medical School, tells WebMD that if a pediatrician, nurse, or teacher tells a parent that a child needs a psychiatric medication, the child should be assessed by a physician trained in diagnosing emotional or behavioral conditions. A prescription, he says, should not always be the first option.
"Rather than prescribing a medication, sometimes we need to consider the child's perspective and consider stressors that could be causing problematic behaviors," Martin Maldonado, MD, tells WebMD in an interview seeking analysis of the study. These could include a move or a new sibling, which would be highly stressful to a young child, says Maldonado, an infant and child psychiatrist at Menninger Memorial Hospital in Topeka, Kan.
The trend toward prescribing more psychotropic medications may reflect a change in children's mental health, John Dunne, MD, tells WebMD. "Neither the study author nor the editorial author mentioned anecdotal evidence that there is a rising prevalence of psychiatric disorders in very young children," he says. "This trend may be causing physicians to prescribe more psychotropic medication." Dunne is an associate clinical professor of psychiatry at the University of Washington in Seattle, with a private practice in Renton, Wash. He was not involved in the study.
The study was funded by a grant from the National Institute of Mental Health and the George and Leila Mathers Charitable Foundation.
- Researchers report many more children are receiving medications for psychiatric disorders. A study found that prescriptions for Ritalin and antidepressants rose significantly from 1991 to 1995.
- The study's authors and observers alike note the rise in these types of prescriptions could indicate both increased awareness of pediatric mental disorders and a desire to cut costs in treating them.
- Physicians note that questions remain concerning the appropriateness and safety of these medications in children. They stress that often, more than medication is needed to treat these illnesses in young patients.