Psychotropic Medication in Children: A Study From The Netherlands

Abstract

ABSTRACT. Objective. Although there is a global concern about the increased use of psychotropic agents in children, most research literature originates in the United States and is based on figures from the first half of the 1990s. Also, few studies document the use of various types of psychotropic agents. The objective of this study was to investigate the use of psychotropic medication in children in the Netherlands and to determine whether this corresponds with previously reported figures from the United States.Methods. A drug utilization study based on computerized pharmacy dispensing records was conducted from 1995 to 1999 for children aged 0 to 19 years in the north of the Netherlands.Results. Stimulants were the most widely used psychotropic agents among 0-to 19-year-olds (prevalence: 7.4/1000 in 1999), followed by hypnotics/anxiolytics (6.9/ 1000) and antidepressants (4.4/1000). Prevalence rates of stimulants increased from 1.5/1000 in 1995 to 7.4/1000 in 1999. Incidence rates, proportion of girls, and duration of stimulant treatment increased as well. Changes in prevalence rates of other psychotropic agents were much smaller than those of stimulants. Finally, the vast majority of children who were treated with psychotropic agents used only 1 agent at a time.Conclusion. The prevalence of stimulant use in the Netherlands is much lower than reported previously (28/ 1000 children in 1995) from the United States, and differences also existed with regard to the use of other psychotropic agents and combinations of psychotropic agents. However, the increase in Dutch stimulant use agrees with the previously reported 2.5-fold increase in the United States and shows that the increased use of stimulants is not limited to the United States. Pediatrics 2001; 108(2). URL: http://www.pediatrics.org/cgi/content/full/ 108/2/e25; child, pediatrics, psychotropic drugs, drug utilization study, pharmacoepidemiology.ABBREVIATIONS. ATC, Anatomic Therapeutic Chemical.

Trends in the prescribing of stimulant medication for the treatment of Attention Deficit Hyperactivity Disorder in children and adolescents in NSW

“…58 In The Netherlands, Schirm et al (2001) reported a five-fold increase in the use of stimulant medication among 0-19 years from 1995 to 1999. 59 The sharpest increases in NSW occurred in the mid-1990s. There are many factors that may have contributed to this, including: an increased public and clinician awareness and acceptance of ADHD as a disorder; a broadening of the diagnostic criteria for ADHD; a greater knowledge of the course of the disorder; an increase in the availability of ADHDspecific services, particularly paediatric and child psychiatric services; an increase in knowledge about the use and effectiveness of stimulant medication; fewer interruptions in treatment because of reduced concerns about growth retardation; lengthier periods of treatment; and an increase in the use of stimulant medication for the treatment of adults.…”

“…An increase in the number and proportion of girls on medication has been observed overseas. 55,59 As a greater understanding and acceptance of ADHD has occurred over time, a greater number of girls may have been recognised as having the disorder and referred for treatment. The disproportionate growth in girls on psychostimulant therapy is likely to continue in the future if it is accepted that the prevalence rate of ADHD for girls in Australia is about half of that for boys.…”

“…[55][56][57][58][59] Numerous reasons for this increase have been suggested, including increased duration of treatment; more girls, adolescents, and inattentive youths on medication; and an improved public image of the medication treatment. 56,59 Safer and Malever (2000) recently examined the prevalence of medications administered in public schools (elementary, middle and high schools) in Maryland, US. 60 They estimated that 3.65 per cent of students were treated with medication for ADHD.…”

“…Children aged 5-9 years had the highest rate (13.9 per 1,000), followed by 10-14 year olds (10.0 per 1,000), 15-19 year olds (2.5 per 1,000) and then 0-4 year olds (2.3 per 1,000). 59 Rates of prescribing appear to differ across regions. 58,60-62 Valentine et al (1996), for example, found wide variation in the rate of use when they compared the states and territories of Australia in 1993.…”

Trends in Psychostimulant and Antidepressant Use by Children in 2 Canadian Provinces

“…2 Second, the trend of increased psychotropic use has been observed among children less than 6 years old, 15,16 although others suggest that treatment in this age group is initiated only in conjunction with psychosocial services in children with predisposing risk factors. 17 More recent studies have demonstrated a continued rise in the use of psychotropics among children and adolescents both in the United States [3][4][5]18,19 and in Europe, 20,21 and these trends are seen for psychostimulants 3,4 and ADs. 5,19,20 However, there is much less data among Canadian children.…”