HealthDay News — For children aged 4 to 18 years, mental health diagnoses and psychotropic medication prescribing vary across practices in the United States, according to a review published online April 1 in Pediatrics.

Stephanie L. Mayne, MHS, from the Children’s Hospital of Philadelphia, and colleagues conducted a retrospective review of electronic health records from 43 US primary care practices serving children aged 4 to 18 years. Variability in diagnosis and psychotropic medication prescribing was examined.

The researchers found that 15% of 294 748 children received a mental health diagnosis and 14% were prescribed psychotropic medications. The most commonly diagnosed disorder was attention-deficit/hyperactivity disorder (1% to 16% per practice). Across practices there was variation in the proportion of children receiving any psychotropic medication (4% to 26%) and the proportion receiving 2 or more medication classes (1% to 12%). Variability was also seen in specific medication classes (stimulants, 3% to 18%; antidepressants, 1% to 12%; α-agonists, 0% to 8%; and second-generation antipsychotics, 0% to 5%). Community availability of psychiatrists partially accounted for variability.

“The prevalence of mental health diagnosis and psychotropic medication prescribing varies substantially across practices and is only partially explained by psychiatrist availability,” the authors wrote. “Research is needed to better define the causes of variable practice-level diagnosis and prescribing and implications for child mental health outcomes.”

One author disclosed financial ties to Pfizer.


Mayne SL, Ross ME, Song L, et al. Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices. Pediatrics. 2016; doi:10.1542/peds.2015-2974.