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Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F. Trends in the Prescribing of Psychotropic Medications to Preschoolers. JAMA. 2000;283(8):1025–1030. doi:10.1001/jama.283.8.1025
Author Affiliations: School of Pharmacy (Drs Zito, dosReis, and Mr Gardner) and School of Medicine (Dr Zito), University of Maryland, and School of Medicine, Johns Hopkins University (Dr Safer), Baltimore, Md; and Center for Health Research, Kaiser Permanente, Portland, Ore (Drs Boles and Lynch).
Context 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.
Objectives To determine the prevalence of psychotropic medication use in preschool-aged
youths and to show utilization trends across a 5-year span.
Design 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).
Setting and Participants 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.
Main Outcome Measures 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.
Results 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
Conclusions 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.
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