March 20, 2000 (Washington) -- Repeating a recent call for better treatment guidelines for children with psychiatric disorders, First Lady Hillary Rodham Clinton announced Monday that both Federal and private groups will be stepping up their efforts to define appropriate diagnosis, treatment, and observation of these young patients.
Critical steps already are being taken, Clinton said, but throughout 2000, more information will be made available to the people who need it, including parents, teachers, and health care professionals.
First to be released this week is a new fact sheet by the National Institute of Mental Health (NIMH). The resource is intended to help parents understand the treatment options for their children, Clinton said. Also, the Department of Education plans to release a kit to help teachers and parents recognize children with emotional and behavioral problems, and a $5 million NIMH study is getting under way that will assess the use of Ritalin (methylphenidate)in preschool-age children.
The First Lady added that this spring, other information is slated for release, such as new practice guidelines by the American Academy of Pediatrics and new professional education programs by the American Academy of Family Physicians. And in the fall, the Surgeon General will host a public conference to discuss the increased use of medications, she said.
Clinton's announcement follows a recent study published in the Journal of the American Medical Association. Researchers found that between 1991 and 1995, there was a dramatic rise in the use of psychotropic drugs -- or those that affect the mind, emotions and behavior -- in treating preschoolers with behavior problems. Although the increased use of medications may be justified, Clinton said, "I am not a doctor, but I am a parent -- and these findings concerned me."
The findings do raise certain concerns, says Mark Wolraich, MD, who is a professor of pediatrics at Vanderbilt University. For example, he tells WebMD that while there is good evidence and data to evaluate the use of Ritalin in school-age children for attention deficit disorders, there is less known about its use in preschoolers and whether it offers the same benefits and risks for that age group.
In terms of school-age children, "There are clearly some areas where it is being overprescribed and underprescribed," adds Martin Stein, MD, who is a professor of pediatrics at the University of California, San Diego. Developing and discussing new guidelines hopefully will help identify and correct some of those problems, he tells WebMD.
These practice guidelines will be developed from existing literature. But the real key to determine appropriateness may have to wait for the FDA. The agency's efforts to develop pediatric labeling information will play a critical role in ensuring the appropriate use of these medications, Clinton said.
The FDA recently was given the power to require pediatric clinical studies for over 400 medications, including psychotropic drugs, says Dianne Murphy, MD, the FDA's associate director for pediatrics. She tells WebMD that these studies are important because they will help outline efficacy and safety issues, as well as identify the appropriate dosages for when medications are necessary.
While conducting these studies may take some time, the FDA has made significant progress, she adds. Thanks to a provision that makes it more attractive for drugmakers to voluntarily initiate pediatric studies, the FDA already has received 170 proposals and relabeled six products, she says.
The importance of the NIMH study is that it will help answer some of the ethical issues, she says, adding that in terms of Clinton's initiative, "I'm sure that the attention it brings to [the use of psychotropic drugs in children] will help facilitate a timely review."