PSYCHOTROPIC DRUG USE AMONG CHILDREN
Psychotropic drug use among children has received a great deal of media attention in the past year due to increases in both costs and usage. According to the 2002 Medco Drug Trend survey, prescription drug spending on children increased by 85 percent during the past several years. Yet, even more surprising, spending on treatment of attention deficit-hyperactivity disorder (ADHD) increased by 122 percent.
Research released in January 2003 indicates that the number of children who are taking psychotropic medications more than doubled from 1987 to 1996. Researchers examined the rate of use by children in two states' Medicaid programs and a large, private HMO. They found that, in 1987, approximately 2.5 percent of children were taking at least one psychiatric medication, while in 1996, the rate jumped to 6.2 percent. In addition, boys were more likely than girls to be prescribed psychotropic drugs, and children on Medicaid were more likely than children in private HMOs to receive antipsychotics and mood stabilizers.
These findings pose a new set of questions for researchers, policymakers, prescribers and parents-why have the rates more than doubled, and is this good or bad? Several explanations are possible. On the positive side, it seems likely that the stigma against mental illness has decreased, and it is more acceptable for children to be treated for their mental health problems. In addition, research has exploded in the area of psychotropic medications. Practitioners now know more about how to treat children and have more medications in their arsenal. On the negative side, however, increasing prescriptions may be due to aggressive marketing by pharmaceutical companies that entices parents to request medications and encourages physicians to prescribe them, or we may be seeing a move by insurers to save money by promoting medication at the expense of therapy.
Whatever the reason for the increase, it is important to ensure that children that are being treated safely and effectively. Because ADHD and depression are the two most common illnesses that lead physicians to prescribe psychotropics for children, it follows that stimulants and antidepressants are the most commonly prescribed medications for children. However, there is a great deal of concern about the effects of psychotropic use by children, since few of these drugs actually have been tested on children. In an attempt to address these concerns, the Department of Health and Human Services (HHS) has required testing of some commonly prescribed drugs for children. Earlier this year, Prozac was approved by the Food and Drug Administration (FDA) to treat depression and obsessive compulsive disorder in children between the ages of 7 and 17. Prozac is the first selective serotonin reuptake inhibitor to receive approval for treatment of depression in children.
State legislatures have been actively addressing public concerns about psychotropic drug use by children. In recent years, states have commissioned studies, organized advisory councils, and even authorized courts to order medication for children. One of the most active and controversial areas of legislative activity is the issue of who can recommend psychotropic medications in school. Most often, legislation is focused on who can recommend the use of stimulants to treat ADHD. Some states have barred school personnel from recommending medication but still allow personnel to suggest an evaluation by a medical practitioner.
Parents are concerned that treating ADHD with Ritalin and other stimulants may lead to drug abuse and addiction later in life. However, two recent studies offer evidence that children treated with stimulants for ADHD actually appear to be less likely to abuse drugs as they get older. Yet, some advocacy groups continue to remain concerned about children's safety. The Citizens Commission on Human Rights-founded by the Church of Scientology-is a very vocal supporter of banning medications in schools and believes that ADHD is not an illness.
The American Academy of Child and Adolescent Psychiatrists (AACAP) believes that medication can be a useful part of treatment for some child psychiatric disorders, but they stress that it should be part of a comprehensive treatment plan. The plan should include ongoing medical assessment and, in most cases, psychotherapy as well. AACAP further believes that a physician who recommends psychotropic medication should be experienced in treating psychiatric illnesses in children and should fully explain why medication is being recommended, what the potential benefits and dangers are, and what other treatment alternatives exist.
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