THE USE OF PSYCHOTROPIC MEDICATION IN PRESCHOOLERS - INDICATIONS, SAFETY, AND EFFICACY

Objective: To review the indications, safely, and efficacy of psychotr opic medications used in preschoolers. Methods: Proprietary prescripti on-use databases indicate that practitioners are prescribing psychotro pic medications for preschool patients at an increasing rate. A Medlin e search was conducted using drug exposure for children below the age of 6 years to identify efficacy and safety reports of these agents in the preschool age-group. Results: The search yielded 22 reports that m ention exposure to medications, including maternal exposure, accidenta l overdose, and adverse events in preschool children. Safety issues hi ghlight the age-specific vulnerabilities of this age-group, including hepatotoxicity from valproic acid, among others. In addition, the prom inence of adverse-event responses in this age group may be related to polypharmacy not seen in school-age children or adolescents. Less than a dozen controlled efficacy studies of psychotropic agents were ident ified for children in the preschool age-group. These are limited by th e small numbers of subjects in the reports. Only 2 disorders described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) , attention-deficit hyperactivity disorder (ADHD) and autistic disorde r; are mentioned. The Food and Drug Administration (FDA) approved psyc hotropic medications for preschoolers but limited their use to medical purposes, not psychiatric, with the exception of use for ADHD. Conclu sions: Because data about psychotropic drug safety and efficacy in adu lts have not been extended to children, new psychopharmacological rese arch is required before clinicians can use these agents to treat psych iatric disorders in the preschool age-group.