BEHAVIORAL DRUGS: Use in Toddlers Spikes
Use of stimulants, antidepressants and antipscyhotic drugs in children ages 2-4 has doubled or maybe even tripled from 1991 to 1995, "despite the fact that none of the most commonly used of these drugs has been approved for children under 6," according to a new study in the Journal of the American Medical Association. Specifically, the study analyzed data from two state Medicaid programs and an HMO, finding that up to 1.5% of children between the ages of 2 and 4 were receiving stimulants, antidepressants and antipsychotic drugs. Those findings suggest that nationwide, up to 150,000 children in that age group were taking such medicines in 1995, up from 100,000 in 1991. The Washington Post reports that in addition to lacking FDA approval, "little research has been done on the medicines' effects on children so young." Dr. Julie Magno Zito, the study's principal author, said, "There's no dosing information for these children. ... Are we satisfied that it's appropriate?" While the study did not specify what conditions the children were being treated for or whether pediatricians, family practitioners or psychiatrists were prescribing the drugs, Zito and her colleagues suggested that the trend is "undoubtedly related to a recent national increase in the use of such drugs to treat attention deficit hyperactivity disorder (ADHD)." Stimulants such as Ritalin have been tested in preschoolers and determined safe (Okie, 2/23).
A Legal Practice
While prescribing drugs for non-FDA approved uses -- off-label prescribing -- is legal and common, Zito said parents "should be aware that they are entering an area of uncertainty" (Goode, New York Times, 2/23). Zito added, "We need to find out what is the validity of the use of medication in these children, and did they deserve the medication they got?" She added, "What is 'abnormally inattentive' in a two-year-old? ADHD is a disorder of school-age children, and somehow we've gotten it down to preschool children" (Harris, Wall Street Journal, 2/23). Marsha Rappley of Michigan State University's College of Human Medicine speculated that the "inadequacy of mental health services available to many children with severe psychiatric or developmental problems" is also responsible for the trend. She said, "Many insurance companies will not pay for a physician and a psychologist on the same day. As a profession, we need to do more about finding better ways to help these families" (Washington Post, 2/23).