Systematic review

Psychotropic drug use in children

PI: Alan R. Ellis, PhD, MSW
Research Assistants: Casey Smith, MSW; Hazel Bright, BA; Mary Byrd Pettenati, BA; Lauren Moore, BS
Librarians: Kristine Alpi, MLS, MPH, AHIP; Jennifer Garrett, MLIS

Prescription drug expenses drive U.S. mental health spending,1 and psychotropic medication use–even in preschool-aged children– has increased dramatically over the past 20 years.1-7  Although psychotropic medication represents standard treatment for many mental disorders, its increasing use among children has raised concern.  Psychotropic use in preschool children,4,8 which often has the purpose of treating attention deficit/hyperactivity disorder (ADHD) or associated symptoms,8-11 is especially concerning.  Psychiatric diagnosis of children is notoriously difficult.12  Also, although ADHD screening instruments are available for children as young as 3 years,13,14 some children receive stimulants without an ADHD diagnosis.11  Even among those with such a diagnosis, treatment varies widely.9,10  Further, although preschool children may be vulnerable to side effects, we lack safety and effectiveness information for this group, particularly with regard to antipsychotics and mood stabilizers.8,15  Correspondingly, much psychotropic medication use among children under 6 is off-label.  Other concerns include polypharmacy,12,16 medication use in the absence of psychosocial treatment or well-child care,9,12 and the fact that most psychotropic medications used by preschoolers are prescribed by primary care physicians,8,11 who may not always be as well-prepared for this responsibility as psychiatrists.12

A preliminary study of psychotropic medication use among North Carolina preschoolers, based on aggregated Medicaid data, found rates high enough to warrant continued attention.17  Findings showed a tenfold difference in rates between areas with the highest and lowest use, and suggested that psychotropic use may be higher in areas with fewer alternatives (e.g., fewer psychiatric and primary care providers).  Combined with the above information, this apparent disparity highlights a pressing need to understand psychotropic use in children, how it varies, and what explains its variation.

We are currently conducting a rigorous, but brief, systematic review (a “scoping review”) to describe the current state of knowledge about psychotropic drug use in U.S. children.  We are examining (a) rates of utilization of psychotropic drugs in U.S. children and (b) factors predicting utilization.  We aim to complete this review in May 2016.  Our findings will support further investigations of the predictors of use and the perceptions of multiple stakeholders about psychotropic medication use in children.

link to current systematic review protocol

link to archive of all protocol versions


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17. Ellis AR. The administration of psychotropic medication to children ages 0–4 in north carolina. NC Med J. 2010;71(1).