Psychotherapeutic Medication Prevalence in Medicaid-Insured Preschoolers

Abstract

Preschool psychotherapeutic medication use increased across ages 2 to 4 for stimulants, antipsychotics, and antidepressants, reflecting use for psychiatric/behavioral disorders. However, the use of anxiolytic/sedative/hypnotics and anticonvulsants was more stable across these years, suggesting medical usage. Additional research to assess the benefits and risks of psychotherapeutic drugs is needed, particularly when such usage is off-label for both psychiatric and nonpsychiatric conditions.

Who Are the New Users of Antipsychotic Medications?

“…However, during the sample period, more information became available on the negative health effects of some second-generation antipsychotic medications, leading the FDA in 2003 to issue a warning regarding the risk of hyperglycemia and diabetes mellitus based on several studies which were published during our study period (31). In addition, the remarkable increases in the rates of use for off-label conditions and use in children (5,19,25,32,33) may lead to lower dosing.…”

“…It is unknown which is driving the current growth in antipsychotic medications, although one recent study using MEPS data notes that just over a third of the increase in the larger class of psychotropic medication was due to new users whereas twothirds of the increase was due to greater spending per user (6). In addition, much of our knowledge about antipsychotic medication use comes from Medicaid populations (2,19) with little information available on trends in the use of antipsychotics from privately insured and uninsured populations.…”

Factors Influencing Female Caregivers' Appraisals of Their Preschoolers' Behaviors

“…In the United States, the prevalence of children with behavioral problems has increased markedly in the last 15 years (Buitelaar et al, 2006;Cooper et al, 2006;Egger & Angold, 2006;Zito et al, 2003;Zito et al, 2008). Prescriptions for psychotherapeutic medications directed toward reducing behavioral problems in the school aged child increased two to three fold in the early 1990"s (Zito et al, 2007) and from the mid 1990"s to 2002 rates for these medications increased from 8.6 per 1000 children to 39.4 per 1000 children (Cooper et al, 2006).…”

“…Preschool children also had marked increases in psychotropic medication usage as estimates now indicate 2.3% to 7% of preschoolers receive one or more prescriptions for these medications (Luby, Stalets, & Belden, 2007;Raghavan et al, 2005;Zito et al, 2007). In the 2007 National Survey of Children"s Health, 40% of parents of preschool children had concerns about their child"s physical, social, and emotional development and 17.5% of the preschooler"s parents had concerns with how well their child got along with other preschoolers (CAHMI, 2007).…”

“…The marked increase in the number of psychotropic medications being prescribed to this age group in the last 15 years seems to indicate that normal, typical behaviors are being thought of as abnormal and clinically significant (Egger & Angold, 2006;McClellan & Speltz, 2003;Zito et al, 2007). Diagnosing a preschool child with a behavioral disorder can affect the child"s perception of himself as well as the perceptions of those dealing with the child on a daily basis (Egger & Angold, 2006).…”