The use of psychotropic prescription medications to treat
ADHD, mood disorders, anxiety and other mental health disorders in very young
children appears to have leveled off.
A national study of 2- to 5-year-olds, published Sept. 30, 2013, in Pediatrics, shows that overall psychotropic prescription use peaked
in 2002-2005, then leveled off from 2006-2009. The researchers also discovered increased
use of these medications among boys, white children and those without private
health insurance during the 16-year study period, 1994-2009.
“The likelihood of receiving a behavioral diagnosis
increased in 2006 to 2009, but this was not accompanied by an increased
propensity toward psychotropic prescription,” says Tanya Froehlich, MD, a
pediatrician at Cincinnati Children’s and the study’s senior author. “In fact,
the likelihood of psychotropic use in 2006-2009 was half that of the 1994-1997
period among those with a behavioral diagnosis.”
Psychotropic usage decreased from 43 percent of those with
one or more behavioral diagnoses in 1994-1997 to 29 percent in 2006-2009.
Commonly prescribed psychotropic medications fall into
several categories, including both typical and atypical antipsychotics,
antidepressants, antianxiety agents, stimulants and mood stabilizers. The U.S.
Food and Drug Administration has approved few of these medications for the
preschool age group, yet previous studies documented two to three-fold
increases in psychotropic prescriptions for preschool children between 1991 and
The study analyzed data about more than 43,000 children,
drawn from two national surveys that collect information on patient visits to
physician offices and outpatient clinics.
It is likely that psychotropic medication use leveled off
due to numerous warnings issued in recent years. These include a 2004 FDA
“black box” warning regarding suicide risk, a 2005 public health advisory
regarding potential for cardiovascular risks involving amphetamines, and a 2006
FDA Advisory Committee recommendation (later reversed) for a black box warning
on psychostimulants linking these drugs to possible heart problems.
Additional research is needed, Froehlich says, to determine
why boys, white children and those without private health insurance are more
likely to receive these medications and to determine their appropriateness.
findings underscore the need to ensure that doctors of very young children who
are diagnosing ADHD, the most common diagnosis, and prescribing stimulants, the
most common psychotropic medications, are using the most up-to-date and
stringent diagnostic criteria and clinical practice guidelines,” she says.
“Furthermore, given the continued use of psychotropic medications in very young
children and concerns regarding their effects on the developing brain, future
studies on the long-term effects of psychotropic medication use in this age
group are essential.”