Are doctors starting to ease off on prescribing psychotropic drugs to young kids?
This seems to be the conclusion of a new study published in the journal of Pediatrics this week. The study’s design was relatively simple: gather data on 2-to 5-year-olds from national health surveys, and see what trends emerge. The findings? While behavioral diagnoses in young children have increased over the past two decades, prescriptions for psychotropic medications have been cut in half.
Why was there a prescription peak that has now stabilized, and what could explain the drop? I contacted Dr. Tanya Froehlich, a contributing author of the study and associate professor at the University of Cincinnati Department of Pediatrics, to shed some light on this phenomenon. She responded via email.
Dr. Froehlich attributed the decline to two major factors: regulatory controls and increasingly cautious doctors. Specifically, she said, decreasing prescription rates “may be due to physician and public concern about these medications spurred by a number of FDA advisories issued in the mid- to late 2000’s, including the black box warnings on selective serotonin reuptake inhibitors (SSRI) and atomoxetine, and other advisories regarding psychostimulant-associated side effects.”
Froehlich adds, “there is an increasing sense that we should be cautious when prescribing psychoactive medications to very young children. This caution is appropriate given that we haven’t firmly established the long-term effects of these medications on the developing brain.”
Another interesting finding was that young children in families lacking private health insurance were more likely to use psychotropic medications.
As for why, Froehlich notes that “not having private insurance is a marker for having a lower socioeconomic status. Greater use of psychotropic medications by children with lower socioeconomic status may be due to these children having higher rates of mental health issues, which has been shown in a number of prior studies. This may be explained by the fact that children in lower income families have higher exposure to a number of mental health risk factors, such as lead exposure, in-utero tobacco exposure, and psychosocial adversity.”
“An additional reason for the higher rates of psychotropic medication use in lower income children may be that they have diminished access to behavioral interventions,” continues Froehlich. “For example, families with fewer resources may find it difficult to attend on-going behavioral counseling sessions due to lack of transportation, an inflexible work schedule, or inability to find care for their other children while attending the appointments.”
The rate of children receiving at least one behavioral diagnosis was 1.56% across the study period; 35.9% of these children were prescribed psychotropic medication. Stimulants were the most commonly prescribed medication: 57.8% of children with a diagnosis of ADHD and 65.7% of children diagnosed with a mood disorder were prescribed psychotropic medication.
Readers, do you have personal experience with this and what's your take? Are your pediatricians and specialists less likely to prescribe drugs for children's behavioral problems? Or not.
This program aired on October 3, 2013. The audio for this program is not available.