More Preschoolers Taking Psychotropic Drugs

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Doctors are prescribing anti-depressants, stimulants, and other psychotropic drugs to preschoolers at increasing rates, according to a study published last week. But it is unknown what long-term effects those drugs may have on children , experts say.

The study, reported in the Feb. 23 issue of the Journal of the American Medical Association, ("Trends in the Prescribing of Psychotropic Medications to Preschoolers"), found that prescriptions for 2- to 4-year-olds for such stimulants as methylphenidate, the generic form of Ritalin, increased threefold, while prescriptions for such anti-depressants as Prozac doubled between 1991 and 1995.

Psychotropic medical treatment for children and teenagers with emotional and behavioral disorders, notably attention deficit/hyperactivity disorder, has significantly increased in the United States in the past few decades, the researchers write.

"More children are being diagnosed with behavior disorders, and more medication is being prescribed across the board, not just for preschoolers," Dr. Daniel Safer, a co-author of the study and an associate professor of psychiatry and pediatrics at Johns Hopkins University in Baltimore, said in an interview.

According to the study, such treatment for children younger than 5 has not received much professional attention until recently.

"There is legitimate concern about long-term use" of such drugs by children, said Robert J. Resnick, a professor of psychology at Randolph Macon College in Ashland, Va., and a former president of the American Psychological Association.There may be a rush to use pharmacological remedies rather than behavioral intervention, he said.

'A Growing Crisis'

Dr. Joseph T. Coyle, the chairman of the department of psychiatry at Harvard University Medical School, writes in an editorial accompanying the study that a basis for concern exists, "given that there is no empirical evidence to support psychotropic drug treatment in very young children and that there are valid concerns that such treatment could have deleterious effects on the developing brain.

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

Some movement to research the use of stimulants and anti-depressants in preschool children has occurred, Dr. Safer, said. Some medications may affect growth but do not impair learning abilities in school-age children, he said. But it is unknown what the adverse effects may be for preschoolers, he acknowledged.

Dr. Safer and other researchers monitored the prescriptions of more than 200,000 2- to 4-year olds in two state Medicaid programs and a health-maintenance organization to determine the prevalence of psychotropic-medication use in preschool-aged youngsters.

Very young children were prescribed psychotropic drugs at a relatively lower rate than older youths, according to the researchers, citing data from a previous report. The earlier study called for further review.

FDA Infractions?

With the exception of methylphenidate, none of the drugs examined in the study is approved by the U.S. Food and Drug Administration for use by preschoolers or for the conditions for which they were prescribed. For example, the researchers found that clonidine, which is used to treat high blood pressure, was prescribed for ADHD.

"Because children's responses to medications are not necessarily similar to those of adults, systematic and careful research specially needs to be for them," the study says.

Vol. 19, Issue 25, Page 10

Published in Print: March 1, 2000, as More Preschoolers Taking Psychotropic Drugs
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