More Preschoolers Receiving Psychiatric Medications
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
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.