Baltimore, MD—Psychiatric services are increasingly being used in the pediatric population in the United States, and questions are being raised about whether psychotropic medications are appropriately prescribed to very young children.
A study in JAMA Pediatrics assessed the longitudinal patterns of psychotropic medication use in association with diagnosis and duration of use in children insured by Medicaid. Included were Medicaid administrative claims data for 35,244 children born in a mid-Atlantic state in 2007 and followed up for up to 96 months through December 31, 2014.
A large part of the concern, according to the study, was the greater use of off-label prescriptions in young children, even though the short- and long-term effects of early exposure are generally unknown.
The focus was on the mental-health treatments they received from birth through age 7 years, with University of Maryland researchers analyzing psychiatric diagnoses and psychotropic medication use—monotherapy or concomitant use of psychotropic medications.
Results indicate that, by the age of 8 years, 19.7% of the children had received a psychiatric diagnosis, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes 290-319. Most diagnoses—57.7%—were behavioral (codes 312, 313, or 314).
Researchers determined that girls were more likely than boys to receive an incident psychiatric diagnosis of adjustment disorder (22.2%) versus (14.5%) or anxiety disorder, (7.1% versus 4.1%).
Also, by age 8 years, 10.2% of the children had received a psychotropic medication, with most of those—80.5%—receiving monotherapy. Yet 16.4% were prescribed two medication classes concomitantly, while 4.3% received three or more medication classes concomitantly for 60 days or more.
The study calculated that the annual median number of days of psychotropic medication use among medicated children increased with age, reaching 210 of 365 days for children 7 years of age. In fact, among the children aged 7 years, the median number of days of use of an antipsychotic (193 days [interquartile range, 60-266 days]), stimulant (183 days [interquartile range, 86-295 days]), or alpha-agonist (199 days [interquartile range, 85-305 days]) was greater than half of the year.
“Medicaid-insured children received substantial mental health services and had prolonged exposure to psychotropic medications in the early years of life,” study authors concluded. “These findings highlight the need for outcomes research in pediatric populations.”
A study in JAMA Pediatrics assessed the longitudinal patterns of psychotropic medication use in association with diagnosis and duration of use in children insured by Medicaid. Included were Medicaid administrative claims data for 35,244 children born in a mid-Atlantic state in 2007 and followed up for up to 96 months through December 31, 2014.
A large part of the concern, according to the study, was the greater use of off-label prescriptions in young children, even though the short- and long-term effects of early exposure are generally unknown.
The focus was on the mental-health treatments they received from birth through age 7 years, with University of Maryland researchers analyzing psychiatric diagnoses and psychotropic medication use—monotherapy or concomitant use of psychotropic medications.
Results indicate that, by the age of 8 years, 19.7% of the children had received a psychiatric diagnosis, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes 290-319. Most diagnoses—57.7%—were behavioral (codes 312, 313, or 314).
Researchers determined that girls were more likely than boys to receive an incident psychiatric diagnosis of adjustment disorder (22.2%) versus (14.5%) or anxiety disorder, (7.1% versus 4.1%).
Also, by age 8 years, 10.2% of the children had received a psychotropic medication, with most of those—80.5%—receiving monotherapy. Yet 16.4% were prescribed two medication classes concomitantly, while 4.3% received three or more medication classes concomitantly for 60 days or more.
The study calculated that the annual median number of days of psychotropic medication use among medicated children increased with age, reaching 210 of 365 days for children 7 years of age. In fact, among the children aged 7 years, the median number of days of use of an antipsychotic (193 days [interquartile range, 60-266 days]), stimulant (183 days [interquartile range, 86-295 days]), or alpha-agonist (199 days [interquartile range, 85-305 days]) was greater than half of the year.
“Medicaid-insured children received substantial mental health services and had prolonged exposure to psychotropic medications in the early years of life,” study authors concluded. “These findings highlight the need for outcomes research in pediatric populations.”
