1. Rates of psychotropic use among children with behavioral diagnoses has decreased from 43.4% in 1994-1997 to 29.2% in 2006-2009.
2. The rates of having at least one behavioral diagnosis increased by 56% from the first study interval (1994-1998) to the last (2005-2009), while the rates the psychotropic prescriptions peaked in 2002-2005 and have since declined significantly.
Evidence Rating Level: 2 (Good)
Study Rundown: Mental health problems, particularly behavioral disorders, which require treatment with psychotropic medication may occur in preschool-aged children. While previous studies have examined trends of preschool psychotropic use, the data may have been demographically limited. The current study examined trends of psychotropic medication use in preschool children in a US nationally representative sample of outpatient visits. Results from this study indicate that the rates of psychotropic use among children with behavioral diagnoses has decreased from 43.4% to 29.2% between the first study interval (1994-1997) and the last (2006-2009). Furthermore, although the rates of having at least one behavioral diagnosis increased by 56% during the study period, psychotropic medication has remained stable, with the exception of a peak in 2002-2005. This study is limited by the relatively small number of preschool-aged children receiving psychotropic medications. Nonetheless, these trends may be a result of US FDA warnings on psychotropic medications in the mid-to-late 2000s and highlight the importance of ensuring that these medications are prescribed using the strongest, evidence-based clinical practice guidelines.
In-Depth [prospective cohort study]: A total of 43,598 children ages 2 to 5 years were examined for their psychotropic medication use over a 15-year study period, from 1994 to 2009. Psychotropic medications fell into the following six classes: 1) anxiolytics, sedatives, and hypnotics; 2) central nervous system stimulants; 3) antidepressants; 4) antipsychotics; 5) antiadrenergic agents; and 6) mood stabilizers. A psychotropic medication was prescribed at 1.07% of all office-based medical visits for preschool-aged children between 1994-2009. Stimulants were the most commonly prescribed psychotropic medication and ADHD was the most common diagnosis (0.78%). Boys, older children (4 to 5 years), white children, and those lacking private health insurance were more likely to have use psychotropic medication and have behavioral diagnoses. Although the rates of having at least one behavioral diagnosis increased by 56% during the study period, psychotropic prescriptions remained stable before and after a peak in 2002-2005. Furthermore, the rates of psychotropic use among those children with behavioral diagnoses decreased from 43.4% to 29.2% between the first study interval (1994-1997) and the last (2006-2009).
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