(RxWiki News) Diagnosing very young children with behavioral conditions can be challenging. Deciding how to treat them, and whether to use medication, is a challenge as well.
But after a brief increase in the mid-2000s, it does not appear that the use of mental health medications has changed much for very young children.
A recent study found that psychotropic medication prescription use for preschool children slightly increased until 2005, but then decreased through 2009.
"Discuss treatment options for your children with their doctors."
The study, led by Vilawan Chirdkiatgumchai, MD, of the Department of Pediatrics at Cincinnati Children's Hospital Medical Center, looked at the use of psychotropic medication in preschool-aged children from 1994 through 2009.
The researchers used data from the National Ambulatory and National Hospital Ambulatory Medical Care Surveys conducted between 1994 and 2009.
These include data on psychotropic prescription rates for 43,598 children, aged 2 to 5, in four-year blocks (1994–1997, 1998–2001, 2002–2005, and 2006–2009).
The researchers found that prescription rates generally peaked in 2005 after a gradual rise and then began to drop again.
The prescription rates were 0.98 percent from 1994 to 1997 and 0.83 percent from 1998 to 2001.
They increased to 1.45 percent in 2002 to 2005 and then decreased to 1 percent from 2006 to 2009.
The researchers found that the likelihood of a child being prescribed a psychotropic medication in 2006-2009 was about the same as the likelihood in 1994-1997 and 1998-2001.
In the mid-2000s, more warnings and advisories about psychotropic drugs for children were released, including warnings from the FDA in 2005.
It's not clear if these warnings influenced use for this age group. Yet the decrease after 2005 in psychotropic medication prescriptions did not appear to be a result of fewer diagnoses.
The researchers found that the likelihood of being diagnosed with a behavioral disorder increased over the same time period for children in this age group.
Meanwhile, those diagnosed with behavioral conditions were less likely to be prescribed the medications over time.
While 43 percent of children with a behavioral diagnosis received a psychotropic medication prescription from 1994 to 1997, only 29 percent of these children received one from 2006 to 2009.
"Our findings underscore the need to ensure that doctors of very young children who are diagnosing ADHD, the most common diagnosis, and prescribing stimulants, the most common psychotropic medications, are using the most up-to-date and stringent diagnostic criteria and clinical practice guidelines," the researchers wrote.
The researchers also looked at which groups were most likely to receive prescriptions for psychotropic medications.
The odds of boys receiving a prescription were 1.6 times more likely than the odds for girls, and the odds for white children were 1.4 times more likely than the odds for children of other races.
The odds for children aged 4 and 5 were nearly four times greater than the odds for children aged 2 and 3.
The odds for children without private health insurance were 2.4 times greater than the odds for children with private health insurance.
"Further study is needed to discern why psychotropic use in very young children stabilized in 2006–2009, as well as reasons for increased use in boys, white children, and those lacking private health insurance," the researchers wrote.
Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences, said both doctors and parents have been concerned about behavior-related medications that have not been well studied in children aged 5 and younger.
"For several years, surveys suggested a low absolute use rate but worrisome relative increase," Dr. Elliott said. "This study concludes that, after a spike in 2003-2005, use of such medications has declined."
But the issue merits continued study, Dr. Elliott suggested.
"Absolute changes, though, remain relatively small, so it will continue to be important for pediatricians and parents alike to assess under what circumstances use of such medications should be considered in very young children and to ensure that other reasonable alternatives have been exhausted,” he said.
The study was published September 30 in the journal Pediatrics. The research was funded by the Cincinnati Children’s Hospital Medical Center Division of Developmental and Behavioral Pediatrics and the National Institute of Mental Health. The authors declared no conflicts of interest.