Chemical Kids ; A Boom in Drug Therapy for Children Is Spurring a Debate within the Medical Community. Are Psychotropic Drugs Being Overprescribed?

Article excerpt

Throughout the 1990s, family physicians and psychiatrists in the US would compare notes in clinic hallways and at conferences: The scuttlebutt was about a perceived boom in prescriptions for drugs designed to treat a range of mental conditions - for kids.

Recently, researchers have been putting hard numbers to the trend, confirming a dramatic rise - as much as a threefold increase - in the share of young patients treated with stimulants, antidepressants, "mood stabilizing" anticonvulsants, and other psychotropic drugs that previously had been prescribed primarily for adults.

The rise has been so steep and so sudden that the medical community is itself

debating with new vigor whether such drugs are being overprescribed. For some researchers, the new studies raise other fundamental questions such as whether young people taking drugs such as Ritalin and Prozac are being properly diagnosed and whether the dosages - and even the medications themselves - are appropriate.

Increasingly, doctors see conditions such as attention deficit hyperactivity disorder (ADHD) as "lifetime disorders," says Julie Zito, an associate professor of pharmacy at the University of Maryland at Baltimore. "If that means that you can start a child on a stimulant at the age of three and tell him he's going to take it for the rest of his life, we are into a very new world."

One key difficulty, researchers say, is that healthcare professionals prescribing these medications have at their disposal little data on how the compounds may affect the still-growing mind and body of a young person in the long term. It's a tough debate, with physicians on the front lines trying to balance their desire to help a youngster and family in distress by prescribing such drugs with their uncertainty about the risk to the child in the long term.

"A lot of kids we see are in terrible shape and can use whatever tools we have to help them get their lives back together again. Sometimes pharmacological tools are quite helpful," says James Leckman, a professor of child psychiatry and pediatrics at Yale University in New Haven, Conn. But "there's a lot we don't know about how these medications work, and it may be that we're putting a few children at risk for problems down the road."

In January, Dr. Zito and colleagues from two other institutions published what many say is the most comprehensive study yet of trends in psychotropic drug treatment for people under the age of 20. From 1987 to 1996, the proportion of young patients treated with psychotropic drugs in three large healthcare programs doubled, and in some cases, more than tripled. The study covered nine classes of medication and nearly 900,000 young people.

"This increase in use is really dramatic," Zito says, especially over such a relatively short period.

Another study, published last spring, looked at the prevalence of psychotropic treatments for groups of more than 500,000 young people who were in employer-insured healthcare programs. It found that the number of young people being treated with any of four classes of psychotropic medication rose from 38 per 1,000 in 1995 to 52 per 1,000 by 1999.

Zito says her own study prompts two questions: "Why have these numbers increased so rapidly and dramatically, and how appropriate is this increase in use?"

Some powerful forces drive the trend

Explanations for the increase are numerous - and mostly conjectural.

Some researchers cite an explosion of research during the 1980s and 1990s on how the brain functions. Those findings led the medical community to tend to attribute kids' behavior problems more often to physiological causes. For instance, a child who seems unable to stay in his seat during class is now more likely to be treated for a chemical imbalance in his brain rather than trained to change his behavior. This new emphasis on neurological diagnoses has been followed automatically by a growth in pharmaceutical treatments. …