Study: More Kids on Prescribed Drugs

Source: Associated Press, Chicago

22nd Feb 2000

ASSOCIATED PRESS CHICAGO (AP) -- The number of 2- to 4-year-olds taking psychiatric drugs like Ritalin and Prozac soared 50 percent between 1991 and 1995, according to a new study that experts said reveals a troubling and growing trend.

Doctors said the effects of such drugs are largely unknown in children so young and they worry the drugs could affect the development of young minds. More than 200,000 preschool-aged children around the country were studied for the report in today's Journal of the American Medical Association.

"These are substantial increases with little or no data supporting their use. I think that's the message that should go out," said Julie Magno Zito, the lead author and an assistant professor of pharmacy and medicine at the University of Maryland.

The researchers suggest the increase is due to a growing acceptance of such drugs and because more and more children are attending day-care and are being pressured to conform to school standards of good behavior. Michele Barker, a Hot Springs, Ark., mother of three, learned firsthand about psychiatric drug use in small children before her son, Heath, started kindergarten.

Nicknamed "the red tornado" for his auburn hair and wild ways, Heath's penchant for tearing things up and plunging off furniture worried his parents, so they had him tested. A pediatrician diagnosed an attention deficit disorder and prescribed the stimulant drug Ritalin in the early 1990s. Heath was 4 years old.

Heath's mother has anecdotal evidence suggesting -- as the authors do -- that the increases are continuing. Through her involvement in several Internet support groups for parents of children with behavior problems, she said she's hearing of "more and more 3- and 4-year-olds" being put on drugs like Prozac.

"It's become a quick fix," said Barker, 39.

Dr. Joseph Coyle of Harvard Medical School's psychiatry department said the study reveals a troubling trend. He said "there is no empirical evidence to support psychotropic drug treatment in very young children" -- and there are valid concerns that such treatment could harm brain development.

"These disturbing prescription practices suggest a growing crisis in mental health services to children and demand more thorough investigation," Coyle wrote in a JAMA editorial.

The authors reviewed Medicaid prescription records from 1991, 1993 and 1995 for preschoolers from a Midwestern state and a mid-Atlantic state; and for those in an HMO in the Northwest. The states were not identified.

Use of stimulants, anti-depressants, anti-psychotics and clonidine -- a drug used in adults to treat high blood pressure and increasingly for insomnia in hyperactive children -- were examined. Substantial increases were seen in every category except anti-psychotics, though in some cases the actual number of prescriptions was quite small.

The number of children getting any of the drugs totaled about 100,000 in 1991, and jumped to 150,000 in 1995. That year, 60 percent of the youngsters on drugs were age 4, 30 percent were 3 and 10 percent were 2-year-olds. The use of clonidine skyrocketed in all three groups. Although the numbers were small, the researchers said the clonidine increases were particularly remarkable because its use for attention disorders is "new and largely uncharted." They noted that slowed heart beat and fainting have been reported in children who use clonidine with other medications for attention disorders.

Dr. David Fassler, chairman of the American Psychiatric Association's council on adolescents and their families, said the medications studied "can be extremely helpful for some children, even quite young children." But he said they should be prescribed only after a comprehensive evaluation and in conjunction with other therapy.

Their use is increasing in part because doctors are getting better at diagnosing behavior disorders at an early age, Fassler said.

However, because their effects on younger children and their development aren't known, Fassler said, the Food and Drug Administration has recently instructed pharmaceutical companies to study the connection.

Barker said Ritalin calmed her son and helped him do well in school. But it also stole his bubbly personality, so she took him off it after four years.

"He started becoming the so-called zombie," she said. The family altered his diet and tried nutritional supplements instead.

Now almost 12 and drug-free for nearly four years, Heath is repeating fifth grade and has some learning difficulties. But his mother said he seems happier, and so is she.

"I don't care if he's not an honor roll student," she said, "because he's healthy."

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