Trends in the prescribing of psychotropic medications to preschoolers

JAMA. 2000 Feb 23;283(8):1025-30. doi: 10.1001/jama.283.8.1025.


Context: Recent reports on the use of psychotropic medications for preschool-aged children with behavioral and emotional disorders warrant further examination of trends in the type and extent of drug therapy and sociodemographic correlates.

Objectives: To determine the prevalence of psychotropic medication use in preschool-aged youths and to show utilization trends across a 5-year span.

Design: Ambulatory care prescription records from 2 state Medicaid programs and a salaried group-model health maintenance organization (HMO) were used to perform a population-based analysis of three 1-year cross-sectional data sets (for the years 1991, 1993, and 1995).

Setting and participants: From 1991 to 1995, the number of enrollees aged 2 through 4 years in a Midwestern state Medicaid (MWM) program ranged from 146,369 to 158,060; in a mid-Atlantic state Medicaid (MAM) program, from 34,842 to 54,237; and in an HMO setting in the Northwest, from 19,107 to 19,322.

Main outcome measures: Total, age-specific, and gender-specific utilization prevalences per 1000 enrollees for 3 major psychotropic drug classes (stimulants, antidepressants, and neuroleptics) and 2 leading psychotherapeutic medications (methylphenidate and clonidine); rates of increased use of these drugs from 1991 to 1995, compared across the 3 sites.

Results: The 1995 rank order of total prevalence in preschoolers (per 1000) in the MWM program was: stimulants (12.3), 90% of which represents methylphenidate (11.1); antidepressants (3.2); clonidine (2.3); and neuroleptics (0.9). A similar rank order was observed for the MAM program, while the HMO had nearly 3 times more clonidine than antidepressant use (1.9 vs 0.7). Sizable increases in prevalence were noted between 1991 and 1995 across the 3 sites for clonidine, stimulants, and antidepressants, while neuroleptic use increased only slightly. Methylphenidate prevalence in 2- through 4-year-olds increased at each site: MWM, 3-fold; MAM, 1.7-fold; and HMO, 3.1-fold. Decreases occurred in the relative proportions of previously dominant psychotherapeutic agents in the stimulant and antidepressant classes, while increases occurred for newer, less established agents.

Conclusions: In all 3 data sources, psychotropic medications prescribed for preschoolers increased dramatically between 1991 and 1995. The predominance of medications with off-label (unlabeled) indications calls for prospective community-based, multidimensional outcome studies.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Behavior Control*
  • Central Nervous System Stimulants / therapeutic use
  • Child Behavior Disorders / drug therapy*
  • Child, Preschool
  • Drug Utilization / trends
  • Female
  • Health Maintenance Organizations
  • Humans
  • Male
  • Medicaid
  • Methylphenidate / therapeutic use
  • Practice Patterns, Physicians' / trends*
  • Prevalence
  • Psychotropic Drugs / therapeutic use*
  • Social Change*
  • United States / epidemiology


  • Central Nervous System Stimulants
  • Psychotropic Drugs
  • Methylphenidate