Trends in the Prescribing of Psychotropic Medications to Preschoolers

OF PSYCHOtropic medication treatment for children and adolescents with emotional and behavioral disorders has significantly increased in the United States during the last few decades, particularly in the last 15 years.Specifically, the 5-through 14-yearold age group has experienced a great increase in stimulant treatment for attention-deficit/hyperactivity disorder (ADHD), and the 15-through 19-yearold age group has had sizable increases in the use of antidepressant medications. 1,2pproved and unapproved indications for psychotropic medications in young children are not extensive.These include: short-term use of analgesics and sedatives/hypnotics for pain relief; hydroxyzine for situational anxiety associated with medical, presurgical, and dental procedures; tricyclic antidepressants for nocturnal enuresis (6-year-olds and older); and amphetamines for ADHD in those 3 years old and older. 3][6] Concern about this age group relates to off-label (unlabeled) use, ie, for treatment indications with little or no proven efficacy and lacking product package insert labeling information approved by the US Food and Drug Administration (FDA). 7One psychiatric newsletter, citing FDA-compiled marketing data, reported that 3000 prescriptions for fluoxetine hydrochloride were written for children aged younger than 1 year in 1994. 8In a 1998 professional meeting report, 5 pediat-ric researchers noted that 57% of 223 Michigan Medicaid enrollees aged younger than 4 years with a diagnosis