Psychotropic Meds Prescribed for Medicaid Preschoolers

Pam Harrison

April 16, 2015

Very young children, up to the age of 4 years, who are enrolled in Medicaid programs in 36 states are receiving psychotropic drugs despite a complete lack of efficacy and safety data supporting their use in preschoolers, new research indicates.

Lauren Garfield, PhD, MPH, currently with Mercy Research in St. Louis, Washington, and colleagues found that 1.19% of Medicaid children up to the age of 4 years received a prescription for any drug for attention-deficit/hyperactivity disorder (ADHD), depression, anxiety, bipolar disorder, or other psychotic illnesses between 2000 and 2003.

Dr Garfield was a postdoctoral research associate at the Brown School at Washington University in St. Louis when the study was conducted.

The study was published in the March issue of the American Journal of Public Health.

Drugs were most commonly prescribed for the treatment of ADHD (0.61% of all children), followed by drugs for depression or anxiety (0.59%) and psychotic illness or bipolar disorder (0.24%).

Boys were 80% more likely than girls to receive a prescription for psychotropic medication.

In addition, children of an unknown race or a race other than white were 75% times more likely to receive a psychotropic drug than white children.

Those with insurance other than fee-for-service only had a 14% higher risk of receiving a psychotropic medication.

Blacks and Hispanic children, on the other hand, were one half to one third as likely to be receiving some sort of psychotropic medication.

Furthermore, 0.17% of infants younger than 1 year and 0.34% of children between the ages of 1 and 2 years were prescribed psychotropic drugs.

"It is possible that some of these children have brain injuries or insults, such as traumatic brain injuries, fetal alcohol syndrome, or the like, for which treatment is being provided," study coauthor Ramesh Raghavan, MD, PhD, Brown School at Washington University in St. Louis, said in a statement.

"But if these medications are being used solely for behavioral control, then it seems clear that we need to better assess these children and see if they might be better served by the use of evidence-based behavioral interventions," he said.

"The fact that any children this small are using psychotropic drugs is very worrisome."

The study was funded by the National Institute of Mental Health; the National Heart, Lung and Blood Institute; the Agency for Healthcare Research and Quality; and the National Institute of Mental Health Office for Research in Disparities and Global Mental Health. The authors report no relevant financial relationships.

Am J Public Health. 2015;105:524-529. Abstract

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