Trends in the prescribing of psychotropic medications to preschoolers.
BACKGROUND
Recent reports on the use of psychotropic medications for preschool-aged children with behavioral and emotional disorders warrant further examination of trends in the type and extent of drug therapy and sociodemographic correlates.


OBJECTIVE
To determine the prevalence of psychotropic medication use in preschool-aged youths and to show utilization trends across a 5-year span.


METHODS
Ambulatory care prescription records from 2 state Medicaid programs and a salaried group-model health maintenance organization (HMO) were used to perform a population-based analysis of three 1-year cross-sectional data sets (for the years 1991, 1993, and 1995).


METHODS
From 1991 to 1995, the number of enrollees aged 2 through 4 years in a Midwestern state Medicaid (MWM) program ranged from 146,369 to 158,060; in a mid-Atlantic state Medicaid (MAM) program, from 34,842 to 54,237; and in an HMO setting in the Northwest, from 19,107 to 19,322.


METHODS
Total, age-specific, and gender-specific utilization prevalences per 1000 enrollees for 3 major psychotropic drug classes (stimulants, antidepressants, and neuroleptics) and 2 leading psychotherapeutic medications (methylphenidate and clonidine); rates of increased use of these drugs from 1991 to 1995, compared across the 3 sites.


RESULTS
The 1995 rank order of total prevalence in preschoolers (per 1000) in the MWM program was: stimulants (12.3), 90% of which represents methylphenidate (11.1); antidepressants (3.2); clonidine (2.3); and neuroleptics (0.9). A similar rank order was observed for the MAM program, while the HMO had nearly 3 times more clonidine than antidepressant use (1.9 vs 0.7). Sizable increases in prevalence were noted between 1991 and 1995 across the 3 sites for clonidine, stimulants, and antidepressants, while neuroleptic use increased only slightly. Methylphenidate prevalence in 2- through 4-year-olds increased at each site: MWM, 3-fold; MAM, 1.7-fold; and HMO, 3.1-fold. Decreases occurred in the relative proportions of previously dominant psychotherapeutic agents in the stimulant and antidepressant classes, while increases occurred for newer, less established agents.


CONCLUSIONS
In all 3 data sources, psychotropic medications prescribed for preschoolers increased dramatically between 1991 and 1995. The predominance of medications with off-label (unlabeled) indications calls for prospective community-based, multidimensional outcome studies.
Zito
J M
JM
School of Pharmacy, University of Maryland, Baltimore 21201, USA. jzito@rx.umaryland.edu
Safer
D J
DJ
dosReis
S
S
Gardner
J F
JF
Boles
M
M
Lynch
F
F
D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D032763:Behavior Control; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002653:Child Behavior Disorders / Q000188:drug therapy*; D002675:Child, Preschool; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008484:Medicaid; D008774:Methylphenidate / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012922:Social Change; D014481:United States / Q000453:epidemiology
D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs; D008774:Methylphenidate