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
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
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. …