Trends in the prescribing of psychotropic medications to preschoolers

The use of psychotropic medications to treat emotional and behavioral disorders in preschool-aged children has increased sharply in recent years, prompting concern about the safety and effectiveness of such treatments in this age group. The authors systematically identified patterns of use of psychotropic medications in preschoolers, pooling prescription records for the years 1991, 1993, and 1995 from 2 state Medicaid programs and 1 health maintenance organization (HMO) serving over 200,000 2- to 4-year-old children. Specifically, the authors calculated the prevalence of the use of 3 classes of medications (stimulants, antidepressants, and neuroleptics) and of the individual medications methylphenidate and clonidine. In 1995, the prevalence per 1000 enrollees in the 2 Medicaid programs was highest for stimulants (12.3 and 8.9), followed by antidepressants (3.2 and 1.6), clonidine (2.3 and 1.4), and neuroleptics (0.9 and 0.5). For enrollees in the HMO, the prevalence of clonidine use in 1995 was approximately 3 times greater than that for antidepressant use. Although the use of stimulants, antidepressants, and clonidine increased markedly from 1991 to 1995, only a slight increase occurred in the use of neuroleptic medications. The use of methylphenidate increased in all 3 groups between 1991 and 1995: 3-fold and 1.7-fold for the 2 Medicaid groups, 3.1-fold for the HMO enrollees. Although the authors found a decrease in the proportions of older stimulants and antidepressants used in this age group, the use of newer, less-established agents increased. Given the rise in the prescription of psychotropic medications in preschoolers noted in this study and the widespread use of these medications for off-label indications, the authors recommend systematic, prospective study of this phenomenon.