Trends in the prescribing of psychotropic medications to preschoolers

Context Recent reports on the use of psychotropic medications for preschool -aged children with behavioral and emotional disorders warrant further exam ination of trends in the type and extent of drug therapy and sociodemograph ic correlates. Objectives To determine the prevalence of psychotropic medication use in pr eschool-aged youths and to show utilization trends across a 5-year span. Design 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 da ta sets (for the years 1991, 1993, and 1995). Setting and Participants From 1991 to 1995, the number of enrollees aged 2 through 4 years in a Midwestern state Medicaid (MWM) program ranged from 14 6 369 to 158 060; in a mid-Atlantic state Medicaid (MAM) program, from 34 8 42 to 54 237; and in an HMO setting in the Northwest, from 19 107 to 19 322 . Main Outcome Measures Total, age-specific, and gender-specific utilization prevalences per 1000 enrollees for 3 major psychotropic drug classes (stimu lants, antidepressants, and neuroleptics) and 2 leading psychotherapeutic m edications (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 methylph enidate (11.1); anti depressants (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), Siz able 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-o lds 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 psych otherapeutic agents in the stimulant and antidepressant classes, while incr eases 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 prospectiv e community-based, multidimensional outcome studies.