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Study: 1.5% of Preschoolers on Mood-Altering Drugs Feb. 23, 2000

Adam Marcus
HealthSCOUT

As many as 1.5 percent of preschoolers take some form of mood-altering medication, new research shows.

An analysis of prescribing records from two state Medicaid programs and a large Western HMO shows that the use of antidepressants, tranquilizers and stimulants like Ritalin increased significantly between 1991 and 1995, researchers say.

Yet many of these drugs aren't approved for -- and haven't been tested on -- very young children.

"Is it good news or bad news? We need to know," says Julie Magno Zito, a pharmacist at the University of Maryland in Baltimore and lead author of the study.

"We better be able to justify it because it's hard to understand how preschool-aged children can meet the criteria for ADHD [attention deficit hyperactivity disorder] and depression." A report on the findings appears in the Feb. 23 issue of the Journal of the American Medical Association.

Zito and her colleagues looked at three one-year snapshots of medication use among children ages 2 to 4. The kids were enrolled in two Medicaid programs -- one in the Midwest and one in the mid-Atlantic -- and an HMO in the Pacific Northwest.

Sharp rise in stimulant use
Between 1991 and 1995, the number of young children taking psychotropic medicines rose steadily, Zito's group found. Stimulant use tripled, thanks largely to Ritalin, the most popular treatment for ADHD. The prevalence of clonidine, another drug to control hyperactivity and anxiety, rose more than 28-fold during the period. Antidepressant use also increased, but less significantly, the researchers say.

Children in the HMO were less likely to get the mood-altering drugs than those in the two Medicaid programs, which serve low-income families. Yet Zito says the HMO sample included a high proportion of Asian children, who are less likely than other ethnic groups to take stimulants.

The researchers didn't track patients by diagnosis, so they could not determine why the children were receiving which drugs. But Zito says the increasing awareness of ADHD is certainly driving the higher rates of stimulant and clonidine use.

Studies have shown that Ritalin improves academic performance and social functioning in older children and adolescents, she says, but those results can't be extended to preschoolers. Then there's the more vexing question, as any parent of a toddler knows: "How do you diagnose hyperactivity in a 2- or 3-year old?" she asks.

Zito says more work is needed to learn the long-term effects of psychotropic drugs on children. They may be effective, she says, "but are they safe?"

Dr. Joseph Coyle, a Harvard University psychiatrist, calls the latest results "troubling." Thanks to limited coverage of psychiatric care, particularly in many state Medicaid programs, "behaviorally disturbed children are now increasingly subjected to quick and inexpensive pharmacologic fixes" instead of comprehensive treatment, writes Coyle in an editorial accompanying the journal article.

"These disturbing prescription practices suggest a growing crisis in mental health services to children and demand more thorough investigation," he writes.

But other experts say the findings are encouraging.

"This is good news, as far as I'm concerned," says Dr. Maria Lymberis, a psychiatrist at the University of California at Los Angeles and treasurer of the American Psychiatric Association. Psychotropic medications in general are underused, says Lymberis, and most emotional disorders that affect children go undiagnosed for at least 10 years.

"We shouldn't be surprised that young children need medications." Arguing that they don't is tantamount to putting serious childhood emotional problems in the " 'they'll-outgrow-it' basket," she says.

What To Do
Experts estimate that between 3 percent and 5 percent of American school children have ADHD. The condition can persist into adulthood if untreated. To learn more about ADHD, visit the Children and Adults with Attention-Deficit/Hyperactivity Disorder Web site.

For more on other emotional trouble that affects young children, try the American Academy of Child and Adolescent Psychiatry.

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SOURCES: Interviews with Julie Magno Zito, Ph.D., associate professor of pharmacy and medicine, University of Maryland School of Pharmacy, Baltimore, and Maria Lymberis, M.D., clinical professor of psychiatry, University of California at Los Angeles and treasurer, American Psychiatric Association; Feb. 23, 2000 Journal of the American Medical Association

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