In a population of children on Medicaid, 19.7% received a psychiatric diagnosis and 10.2% received psychotropic medication by age 8 years, raising concerns for long-term safety and the need for greater research on the use of psychotropics in young children. These findings were published in JAMA Pediatrics.
Dinci Pennap, MPH, from the Department of Pharmaceutical Health Services Research at the University of Maryland in Baltimore, and colleagues used computerized Medicaid administrative claims data covering 35,244 children born in 2007 in a mid-Atlantic state. They followed these children for up to 96 months, through December 31, 2014. The main outcomes were the first psychiatric diagnosis, use of psychotropic medication from birth to age 7 years, use of psychosocial services, and the annual duration of psychotropic medication use.
The investigators found that 4550 children had a psychiatric diagnosis (19.7%) by the age of 8 years, and that 57.7% of these diagnoses were behavioral. Girls had a greater probability than boys of receiving a psychiatric diagnosis of adjustment disorder (22.2% vs 14.5%; P <.001) or anxiety disorder (7.1% vs 4.1%; P <.001).
By age 8 years, 2196 or 10.2% of these children had received psychotropic medication. Most of these (80.5%) received monotherapy, but 16.4% received 2 medication classes concomitantly and 4.3% received 3 or more classes for 60 days or more. Use of this medication was substantial and increased with age. The annual median number of days of psychotropic medication use was 210 days for children aged 7 years.
Attention-deficit/hyperactivity disorder was the most common psychiatric diagnosis, occurring in 9.4% of this population, followed by learning disorder (5.3%). More than 80% of learning disorder cases were identified by age 3 years; this is an important observation, as early intervention is crucial to preventing long-term consequences. However, only 17.5% of these children received psychotherapy, indicating the need for improvement in this area.
Among the limitations of this study is the use of Medicaid data from a single state, which may limit the generalizability to other Medicaid populations or those who are privately insured. Another limitation was that the study accounted for dispensing of medication, but not consumption.
The authors concluded that these data underscore the need for safety and efficacy research on the use of psychotropic medications in young children, including outcomes for metabolic imbalance, weight gain, and sleep disturbance.
Pennap D, Zito JM, Santosh PJ, Tom SE, Onukwugha E, Magder LS. Patterns of early mental health diagnosis and medication treatment in a Medicaid-insured birth cohort [published online April 30, 2018]. JAMA Pediatrics. doi: 10.1001/jamapediatrics.2018.0240