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Psychotropic drug use among preschool children in the Medicaid program from 36 states
Lauren D Garfield1, Derek S Brown, Benjamin T Allaire
1Lauren D. Garfield, Derek S. Brown, Raven E. Ross, Ginger E. Nicol, and Ramesh Raghavan are with Washington University, St Louis, MO. Benjamin T. Allaire is with RTI International, Research Triangle Park, NC.
Insights
Preschool children in Medicaid are receiving psychotropic medications, primarily for attention-deficit disorders. This study highlights the need for more research on the safety and efficacy of these drugs in young children.
Area of Science:
- Pediatric pharmacology
- Public health
- Child psychiatry
Background:
- Psychotropic medication use in preschool-aged children is a growing concern.
- Limited evidence exists regarding the safety and efficacy of these medications in young children.
- Understanding prescribing patterns is crucial for improving child health outcomes.
Purpose of the Study:
- To determine the prevalence of psychotropic medication use among preschool children enrolled in Medicaid.
- To identify the specific indications for which these medications are prescribed.
- To analyze demographic and insurance-related factors associated with psychotropic medication prescription.
Main Methods:
- Utilized Medicaid Analytic Extract data from 36 states (2000-2003).
- Followed two cohorts of children (born 1999 and 2000) up to age 4.
- Employed logistic regression to model the odds of receiving medications for ADHD, depression/anxiety, and psychotic/bipolar disorders.
Main Results:
- 1.19% of preschool children received at least one psychotropic medication.
- Attention-deficit disorder/attention-deficit hyperactivity disorder (ADHD) medications were most common (0.61%).
- Boys, children of other/unknown race, and those with other insurance types showed higher odds of prescription; Black and Hispanic children had lower odds.
Conclusions:
- Psychotropic medications are being prescribed to preschoolers despite insufficient evidence of safety or efficacy.
- There is a need to implement medication use practice parameters in early childhood clinics.
- Expanding psychosocial interventions for young children with behavioral issues is recommended.
Objectives:
We determined the prevalence of and indications for psychotropic medication among preschool children in Medicaid.
Methods:
We obtained 2000 to 2003 Medicaid Analytic Extract data from 36 states. We followed children in 2 cohorts, born in 1999 and 2000, up to age 4 years. We used logistic regression to model odds of receiving medications for (1) attention-deficit disorder/attention-deficit hyperactivity disorder, (2) depression or anxiety, and (3) psychotic illness or bipolar.
Results:
Overall, 1.19% of children received at least 1 psychotropic drug. Medications for attention-deficit disorder/attention-deficit hyperactivity disorder treatment were most common (0.61% of all children), followed by depression or anxiety (0.59%) and psychotic illness or bipolar (0.24%). Among children, boys, those of other or unknown race compared with White, and those with other insurance compared with fee for service-only had higher odds of receiving a prescription (odds ratio [OR]=1.80 [95% confidence interval (CI)=1.74, 1.86], 1.75 [corrected] [1.66, 1.85], and 1.14 [1.01, 1.28], respectively), whereas Black and Hispanic children had lower odds (OR=0.51 [95% CI=0.48, 0.53] and 0.37 [0.34, 0.39], respectively).
Conclusions:
Preschoolers are receiving psychotropic medications despite limited evidence supporting safety or efficacy. Future research should focus on implementing medication use practice parameters in infant and toddler clinics, and expanding psychosocial interventions for young children with behavioral problems.
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