Tracking use of drugs for psychiatric disorders for the period 1987 through 1996, the researchers found that prescriptions had doubled -- and in some cases tripled -- among children under the age of 20.
The study, analyzing data from approximately 900,000 children younger than 20, found that doctors were prescribing more drugs not only for attention deficit hyperactivity disorder (ADHD), but also for more serious psychiatric problems, such as depression, anxiety and psychotic disorders, says Julie Magno Zito, the lead author of the study."I was surprised at the extent of use of all the medications," says Zito, an associate professor of pharmacy and medicine at the University of Maryland."For instance, there is an increase in the use of neuroleptics (used in the treatment of severe psychosis). The concern is that we don't see that there is an increase in psychotic rates. So, are we using the drugs for behavorial problems and if so, what are the benefits and risks of that?"
The results of the study appear in the January Archives of Pediatrics and Adolescent Medicine. The research was funded by the National Institute of Mental Health, and the G. Harold and Leila Y. Mathers Foundation.
For the study, Zito and her colleagues looked at the enrollment and prescription records of children covered by Medicaid and health maintenance organizations (HMOs) from 1987 to 1996.
They found that the average number of prescriptions for psychiatric drugs in that period increased two-to-three-fold. For example, the percentage of children receiving at least one drug climbed from 2.5 percent in 1987 to 6.2 percent in 1996.
"That figure is not surprising given the time frame. Prozac was just coming into use, as well as the stimulants for use in treating ADDs," says Dr. Jerry Rushton, an assistant professor of pediatrics at the University of Michigan who studies depression in children.
The study found the use of psychiatric drugs by children covered by Medicaid almost always exceeded the rates of youths enrolled in HMOs by large margins, Zito says, particularly drugs that treat more serious disorders. This is largely due to the populations served by Medicaid, which include children in foster care, who often have serious social dysfunction problems, and disabled children who require considerable mental and physical care, she says.
By 1996, the 10- to 14-year-old group had replaced the five-to-nine-year-old group as the largest segment taking psychiatric medication in the Medicaid populations. Meanwhile, 15- to 19-year-olds were the biggest users of the drugs among those covered by HMOs in 1996.
Particularly notable, Zito says, was the increase in drugs to treat ADHD.
"The data," says Zito, "suggests that for a very large proportion of children with ADHD, medication is playing a significant role in treatment, whereas in the past we would be looking at the environment and the family of the child in assessing the problem."
"There are real problems that parents are having managing their children, and to suggest that we're taking care of the problem by simply giving people access to medication is not sufficient," she adds.
Not that medication is bad, she emphasizes.
"I don't want to paint this between pro-drug and anti-drug, because there's a proportion of children who clearly need the medication. But we need to spend more time assessing the outcomes so that we are figuring out who's benefiting and who's not with this treatment," she says.
Such assessments are hard to come by, Zito adds, because research lags in this area. While there is a lot of money spent to find a cure for disorders, as well as what causes them, not enough money is spent researching the effects of medication, she says.
"We need a serious research agenda to reassure us that the medications are being used appropriately," she says.
Rushton says that assessing children and prescribing the right medications is a delicate balancing act.
"It's a matter of having realistic goals. If you want your child to be happier and get along with others, those problems are not going to be solved by medication," he says.
Instead, he tells parents and their children exactly what symptoms the medication will help, like aiding in focusing and helping children stop fidgeting, and he also explains the potential side effects.
More informationThe National Institutes of Health has an informative site on ADHD. The National Institute of Mental Health has information about therapies to treat ADHD.