NCSL LegisBrief
Briefing Papers On the Important Issues of the Day
Psychotropic Medication and Children
By Tracy Delaney
October 2000
Volume 8, Number 40
During the past decade the number of American children receiving medication for behavioral and emotional disorders has increased dramatically, adding fuel to the fire in the emerging controversy over the administration of such medications to children. Although most prescriptions for so-called psychotropic drugs are for stimulants designed to remedy the increasingly common diagnosis of attention deficit hyperactivity disorder (ADHD), there is also a growing trend for children to receive medications for depression and other behavioral and mental health conditions.
A startling report in the Journal of the American Medical Association indicates that the rate of prescribing psychotropic medications for preschool children rose threefold between 1991 and 1995. Among possible reasons for the increase, according to the report, are: 1) the larger pool of eligible youngsters because of expanded diagnosis criteria for ADHD since the 1980s; 2) more girls are being treated for ADHD; 3) greater acceptance of biological treatments for behavioral disorders; and 4) the larger role of school health personnel in identifying medical needs.
Opponents of the use of psychotropics express concern that there is not enough information about the drugs' effect on children's development or on their long-term side effects. They are also concerned that psychotropic medications are being overused on children.
On the other side of the argument are groups, such as the National Mental Health Association, that argue that children sometimes need medication to combat mental illnesses. According to the association, however, children should not be medicated unless a qualified clinician decides that such a course is in their best interest and medication is used in conjunction with other types of treatment, such as therapy, social skills training, emotional and educational support, and parent and teacher mental health training programs.
State Action
Heightened awareness of the issue at the national level has prompted action by some state legislatures. Last year, for example, Colorado began looking into the issue in the wake of the painful Columbine High School tragedy. Lawmakers there explored the possible relationship between prescription drugs and school violence after hearing that one of the Columbine shooters was taking a psychotropic medication. In response, the Colorado Board of Education approved a resolution aimed at promoting classroom management solutions for behavioral problems rather than relying on prescription medications. The resolution does not have the power to eliminate the use of certain medications in schools. It says "...psychiatric prescription drugs have been utilized for what are essentially problems of discipline...". The resolution further stipulates "that the state board of education encourages greater communication and education among educators and medical professionals about the effects of psychotropic drugs on student achievement and our ability to provide a safe and civil learning environment."
This year, 11 states introduced legislation related to children and psychotropic drugs. Six (Georgia, Hawaii, Maryland, Oklahoma, Tennessee and Washington) enacted laws. Most of the laws are broad-based, addressing various aspects of mental health for children, but two specifically relate to psychotropic medication use.
In Georgia, a resolution creates the Commission on Psychiatric Medication of School-Age Children and directs it to investigate the use of psychiatric medications and their effects on school-age children. It provides recommendations for improved oversight of the prescribed use of narcotics among Georgia's youth.
In Washington state, the law requires a study of children on psychotropic medication who are receiving state services. The intent of the study is to determine: the number of children who were prescribed medication during out-of-home care; the medical diagnosis of all children on prescribed medications; the number, types and frequency of medications prescribed to children; the number of children receiving multiple medications; the number of children prescribed Ritalin (most commonly used to treat ADHD); and the total number of children in out-of-home care exceeding 90 days during FY 1999 and the number of those children receiving medication. The report is due to the Legislature on Dec. 15.
Federal Action
The federal government is also looking into this issue. A fact sheet on treating children with psychiatric problems was released by the National Institute of Mental Health for a March 2000, White House conference on mental health. The fact sheet includes detailed information about psychotropic medications that are often prescribed for children. The institute intends to invest more than $5 million in research on the use of medication to treat attention deficit disorder in preschool children. The Clinton administration also announced its intention to step up efforts to reduce the use of psychotropic medications by preschoolers.
Selected References
National Institute of Mental Health. Treatment of Young Children with Mental Conditions. Washington, D.C., March 2000. http://www.nimh.nih.gov/publicat/whmedchild.cfm
Zito, Julie M., et al., Trends in the Prescribing of Psychotropic Medications to Preschoolers. Journal of the American Medical Association 283, no. 8 (February 23, 2000). http://jama.ama-assn.org/issues/v283n8/full/joc91250.html
Contacts for More Information
Children & Families Program
NCSL-Denver
(303) 364-7700
Gretchen B. LeFever
Center for Pediatric Research
(757) 668-6497
GLefever@CHKD.com
National Institute of Mental Health
(301) 443-4513
www.nimh.nih.gov
National Mental Health Association
(703) 684-7722
www.nmha.org
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