Spike in ADHD Meds, Antidepressants in Kids

Kate Johnson

February 27, 2014

An increase in prescription drug use among US children and teens, particularly psychostimulants and antidepressants, as well as growing teen admission rates for mental health issues and substance abuse are among the top findings in a new report from the Health Care Cost Institute (HCCI), a Washington-based nonprofit, nonpartisan research group.

"The trend of rising use of prescriptions among children is particularly notable," David Newman, PhD, JD, HCCI's executive director, said in a written statement. "We, and others, need to focus on the mental health needs of our children."

The report, Children’s Health Spending: 2009-2012, examined employer-sponsored health insurance (ESI) coverage for children by analyzing fee-for-service claims for about 10.5 million ESI children per year between 2009 and 2012.

It showed that health spending per child rose by 5.5% per year and out-of-pocket spending rose by 6.6% per year, with spending increases seen across sexes, regions of the country, and service categories.

The rise in central nervous system (CNS) drug use was driven by increases in generic drug use, although prescription CNS drug use declined, noted Amanda Frost, PhD, coauthor of the report.

"We saw double digit increases in generic CNS drug use for the younger children, preteens, and teenagers in 2011 - 2012 compared to 2009 - 2010 ― a really big increase in the use of CNS drugs," she told Medscape Medical News, adding that even with a concurrent drop in brand name drug use, the net effect remained an overall increase in prescription CNS agents.

"The high rise in use of CNS drugs begins with the younger boys, ages 4 to 8, but for the girls, it mainly happens in the preteens, ages 9 to 13," she said.

Table. Increased Generic CNS Drug Use

  % Change, 2009 - 2010 % Change, 2010 - 2011 % Change, 2011 - 2012
Ages 4 - 8 3.5% 20.2% 12.5%
No. filled days per 1000 pts 5253 6315 7101
Ages 9 - 13 0.5% 24.7% 20.4%
No. filled days per 1000 pts 12,563 15,669 18,865
Ages 14 - 18 4.5% 15.4% 19.4%
No. filled days per 1000 pts 20,235 23,357 27,891


Sex Differences

The report showed that teenaged boys and girls differed in the types of CNS drugs they used in 2012. For boys, drugs to treat attention-deficit/hyperactivity disorder (ADHD) and similar conditions were the most commonly used; those drugs included amphetamines and miscellaneous anorexigenics, respiratory drugs, and cerebral stimulants. The 2 most commonly prescribed ADHD drugs were mixed amphetamine salts and methylphenidates.

On the other hand, girls were about half as likely as boys to use these medications (8.84 filled prescription days per teenaged girl in 2012 vs 16.62 days for boys), and they were more likely to use antidepressants (13.27 filled days vs 8.80 for boys).

The study also shows a rise in the number of teens being admitted to hospital for mental health issues or substance use (MHSU) treatment.

"In all of the years of the study, girls had more MHSU admissions than boys, but these numbers were rising at approximately the same rate," said Dr. Frost.

For girls, MHSU admissions rose from 9 per 1000 teenaged girls in 2010 to 11 in 2012, whereas for boys, they rose from 7 per 1000 boys to 9.

Although the study set out to look at spending patterns, it ended up revealing some more interesting findings, said Dr. Frost.

"We started out looking for where the dollars were being spent, but what we learned is that the really interesting trends are happening not in spending, because increases in spending are being driven mainly by increases in prices, which is not really a new idea. The more interesting story is really happening in youth trends: what services are kids using, do they differ by age group, and is this changing over time?"

And although the findings shed little light on reasons for these trends, they point to areas where future research should focus, explained the study's other coauthor, Carolina-Nicole S. Herrera.

"In some ways, we're laying the groundwork for doing ACA [Affordable Care Act]–related analysis to see how all these new healthcare policy changes are going to affect our children."

HCCI and the study authors report no relevant financial relationships.


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