Children and mental health medication is a common issue in pediatric health care. The belief by many is that there is a problem of overmedication and over-prescribing of psychotropic medicines for children.
A study released recently by Columbia University Irving Medical Center (CUIMC) refutes that belief and their analysis suggests that the opposite is true. Looking at prevalence of childhood neurological and mental health conditions and the rate of prescriptions for psychiatric medications, the results indicate that in some cases there could be a problem of under-prescribing medication for some of these conditions.
Ryan Sultan, MD, a child psychiatrist, and researcher at CUIMC who led the study explained, "Over the last several years, there has been widespread public and professional concern over reports that psychiatric medications are being overprescribed to children and adolescents in the United States. We were interested in better understanding this concern."
So how did they come to this conclusion? There were some big bits of data and some serious number crunching. Records contained in a national prescription database were accessed, and the researchers look at how many prescriptions a year were issues for three classes of psychiatric medications: stimulants, antidepressants, and antipsychotics. In total there were approximately 6.3 million children between the ages of 3 and 24 years old.
Prescription rates don't tell the whole story, however. The team looked at the patterns of prescriptions and compared them to the prevalence of attention deficit-hyperactivity disorder (ADHD), anxiety disorders, and depression in several age groups including young children (3 to 5 years), older children (6 to 12 years), adolescents (13 to 18 years) as well as young adults (19 to 24 years).
Depression is a problem in pediatrics, especially in children in the teen years. Estimates from the CDC are that 1 in 8 teens has experienced a depressive episode and one in twelve children will show some symptoms of ADHD. However, during the period the Columbia team looked at, there were fewer than 1 in 30 teens that were given a prescription for antidepressants. In the case of stimulant medications for ADHD, the rate was about 1 in 20 who were placed on drugs for attentional issues.
When the two sets of numbers are compared side by side (prescription rates and prevalence), the figures just do not indicate a problem with overuse of mental health medications. Dr. Sultan stated, "Our results show that, at a population level, prescriptions of stimulants and antidepressant medications for children and adolescents do not appear to be prescribed at rates higher than the known rates for psychiatric conditions they are designed to treat. These findings are inconsistent with the perception that children and adolescents are being overprescribed."
Rates of prescription varied according to age, with the highest number of orders being issued in the age group of young adults (19-24). It was also found that the age of the children at the time they were prescribed stimulants or antidepressants fell in line nicely with the average age of onset for the conditions (ADHD, depression, anxiety) they are meant to treat, however with antipsychotic medications the picture was less than clear. Dr. Mark Olfson, a senior author on the paper, explained that treating psychiatric disorders is difficult, saying, "However, the situation with antipsychotic medications is less clear-cut. Given the clinical uncertainty over their appropriate indications, it is unclear whether their annual use rates, which ranged from 0.1 percent in younger children to 1 percent in adolescents, are above or below the rates of the psychiatric disorders they aim to treat."
In the UK, the NHS recently recognized Children's Mental Health Week. The Duchess of Cambridge, Kate Middleton, has taken on the cause of children's mental health and in the video below talks about efforts there to understand and better serve children with mental health issues.
Sources: Columbia, Journal of Child and Adolescent Psychiatry, Pharmacist.com
