Pediatric psychiatry has undergone a lot of changes since the mid 1980s: diagnostic criteria for various psychiatric disorders were refined; new medications came on the market; and managed care exerted its influence.

The result of these changes—according to reports disseminated over the past decade—has been the increased use of psychotropic medications to treat behavioral and emotional problems in children and adolescents. Psychotropic medications are drugs used to treat psychiatric disorders such as depression , or attention deficit/hyperactivity disorder (ADHD). However, the reports of increased use have not been very reliable, or have been based on limited samples.

In an article published in the Archives of Pediatric and Adolescent Medicine , scientists analyzed treatment data on nearly 900,000 children and adolescents across the country and found that in this population, the use of psychotropic medications increased by two to three-fold between 1987 and 1996.

About the Study

Researchers from the University of Maryland, Johns Hopkins University, and the Kaiser Permanente Center for Health Research analyzed treatment data collected between 1987 and 1996 on 900,000 youths aged 20 and younger. The children and teens, who were being treated for psychiatric disorders, were enrolled in either a health maintenance organization (HMO) serving the Northwest US, or in a Medicaid program in a midwestern state or a mid-Atlantic state.

The Findings

Depending on the health care system examined, total prescription use of psychotropic drugs in children and teens increased two to three times between 1987 and 1996. Most of the increase during the study period took place after 1991. In 1996, 6% of the study’s youth had been prescribed at least one psychiatric medication that year. Stimulants, which are used in the treatment of ADHD, were the most widely prescribed psychiatric drug, followed by antidepressants.

The scientists also found that:

  • Youth in Medicaid programs had higher rates of medication use than youth in HMOs for all drug categories except antidepressants and hypnotics.
  • Over the study period, the prevalence of stimulant use increased more in females than males. The opposite was true for antidepressants.
  • By 1996, the 10 to 14-year old age group replaced the 5 to 9-year old group as the largest user of psychotropic drugs in the Medicaid populations. In the HMO group, the 15 to 19-year olds were the largest group of users.

One important limitation of this study is that prescription of medication does not necessarily correlate with actual use of medication. And, as the authors point out, more than five years have passed since the end of the study period, making the information somewhat dated.

How Does This Affect You?

The results of this study suggest that efforts to identify psychiatric disorders in children and teens and to treat them with medications accounted for a large part of the increase in prescription drug use between 1987 and 1996.

But there are other interpretations of the data. For example, the managed care reimbursement structure encourages the use of medical therapy over psychotherapy for the treatment of psychiatric disorders. This implies that physicians were more likely to rely on medications rather than more time intensive psychotherapy or behavioral interventions for reasons of economic expediency rather than clinical outcomes.

Also highlighted by this study is the troubling fact that stimulants were used with equal frequency in the 5 to 9-year old group as they were in the 10 to 14-year old group, suggesting that the need for medication did not diminish with age, which would be a disappointing conclusion.

This study confirms earlier data that prescription drug use for psychiatric disorders by children and teenagers is on the rise. To fully understand the implications of these findings, future studies should focus on the severity of illness, the length of treatment, and how well these children do as they get older.