摘要：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], 1.87 [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. Psychotropic medication use in children has been increasing over the past several decades. 1–4 It is disconcerting that there is evidence that at least part of this increase is attributable to the prescribing of psychotropic drugs among preschool children. Yet, national estimates of the magnitude of such prescribing for infants and toddlers, and the indications for such prescribing, are largely unavailable. Although there are several large, national studies of psychotropic prescribing in privately insured children, 2,5 these studies make it difficult to look at prescribing specifically in very young children. For example, one study excludes children aged younger than 2 years 2 and the other aggregates data from all children aged 0 to 13 years. 5 There are also other limitations to the existing literature on utilization of psychotropics in preschool children. First, most often the prevalence of psychotropic medication use among this population comes from studies of young children aged 2 to 4 years, from only one 6–10 or a few states, 11,12 making it difficult to determine whether reported prevalence is generalizable nationally; there is significant geographic variation in health care delivery and utilization. 13,14 Others have focused on only 1 class of medication such as antipsychotics 6,12,15,16 or on only 1 diagnosis, such as autism. 7 Although the literature is not consistent in the populations that are studied, several important consistencies in findings have emerged. The prevalence of psychotropic prescriptions increases as children age 1,3,6 and has increased with time. 1,2 Boys are consistently more likely to receive prescriptions than are girls 1,3,11 and White children are more likely than minority children to receive medications. 1,3,11 Although existing studies provide important information about psychotropic utilization, we still lack a national perspective on utilization in the youngest age group. Most psychotropic prescribing in young children is off-label, meaning that the medication has not been tested and approved by the Food and Drug Administration for use in this age group. 17,18 This is understood and accepted practice as these medications are not routinely tested in young children; however, close clinical monitoring of children receiving these drugs is warranted until clinical trials establish their safety and effectiveness in this population. 18 This dearth of studies including young children has made it necessary to look to other sources of data to understand how psychotropics are being used in this population. Very young children can be more sensitive to medication side effects than adolescents or adults. 19–21 Currently, we have limited knowledge of the long-term effects of antipsychotics on the developing brain and nervous system 22 and there are multiple public health consequences of prescribing psychotropics to preschool children. The first 3 years of life are a period of rapid neurodevelopment, and the effect of exposure to psychotropic medications is still largely unknown. 22 Metabolic side effects are one important set of side effects that can result from psychotropic exposure. Overweight and obesity are a significant problem for children, with 12% of kindergarteners already obese and 14.9% classified as overweight; these children are more likely to be overweight or obese as adults. 23 In children with chronic mental illness the prevalence of overweight and obesity is greater than in the general pediatric population. 24 There is also evidence of metabolic dysfunction, as significant weight gain and incidence of diabetes is significantly greater in antipsychotic- and psychotropic-exposed children. 25–27 Therefore, understanding prescribing in young children is a first step to preventing or ameliorating serious side effects that could affect children’s health into adulthood. In the current study, we examined utilization of the most commonly used psychotropic medications among children aged 4 years and younger in Medicaid programs from 36 states. Children in Medicaid are large consumers of these drugs and these prescriptions account for significant expenditures for the Medicaid program. 28,29 We looked at all children aged younger than 5 years (up to age 4 years, 364 days) in calendar years 2000 through 2003 in 36 states to determine the prevalence of psychotropic medication use and indications for such use among preschool children enrolled in Medicaid programs.
