Recent reports on the use of psychotropic medications for preschool-aged children
with behavioral and emotional disorders warrant further examination of trends in the
type and extent of drug therapy and sociodemographic correlates.
To determine the prevalence of psychotropic medication use in preschool-aged youths
and to show utilization trends across a 5-year span.
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 data sets (for the years 1991, 1993, and
1995).
From 1991 to 1995, the number of enrollees aged 2 through 4 years in a Midwestern
state Medicaid (MWM) program ranged from 146,369 to 158,060; in a mid-Atlantic state
Medicaid (MAM) program, from 34,842 to 54,237; and in an HMO setting in the Northwest,
from 19,107 to 19,322.
Total, age-specific, and gender-specific utilization prevalences per 1000 enrollees
for 3 major psychotropic drug classes (stimulants, antidepressants, and neuroleptics)
and 2 leading psychotherapeutic medications (methylphenidate and clonidine); rates
of increased use of these drugs from 1991 to 1995, compared across the 3 sites.
The 1995 rank order of total prevalence in preschoolers (per 1000) in the MWM program
was: stimulants (12.3), 90% of which represents methylphenidate (11.1); antidepressants
(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). Sizable 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-olds
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 psychotherapeutic agents in the
stimulant and antidepressant classes, while increases occurred for newer, less established
agents.
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 prospective community-based, multidimensional outcome
studies.