ARTICLES
National Trends in the Use of Psychotropic Medications by Children

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ABSTRACT

Objectives

Little information exists on national trends in the use of psychotropic medication by children and adolescents. The objective of this report is to compare patterns and predictors of psychotropic medication use by children and adolescents in the United States in 1987 and 1996.

Method

An analysis of medication use data is presented from two nationally representative surveys of the general population focusing on children 18 years of age and younger who used one or more prescribed psychotropic medication during the survey years. Rates of stimulant, antidepressant, and other psychotropic medication use are reported.

Results

The overall annual rate of psychotropic medication use by children increased from 1.4 per 100 persons in 1987 to 3.9 in 1996 (p < .0001). Significant increases were found in the rate of stimulant use (0.6 per 100 persons to 2.4 per 100 persons), antidepressant use (0.3 per 100 persons to 1.0 per 100 persons), other psychotropic medications (0.6 per 100 persons to 1.2 per 100 persons), and coprescription of different classes of psychotropic medications (0.03 per 100 persons to 0.23 per 100 persons), especially antidepressants and stimulants. Rates of antipsychotic and benzodiazepine use remained stable. In 1996, stimulant use was especially common in children aged 6 to 14 years (4.1 per 100), and antidepressant use was common in children aged 15 to 18 years (2.1 per 100 persons).

Conclusion

Between 1987 and 1996, there was a marked expansion in use of psychotropic medications by children, especially stimulants and antidepressants.

Section snippets

Sources of Data

Data were drawn from the household component of the 1987 National Medical Expenditure Survey (NMES) (Edwards and Berlin, 1989) and the 1996 Medical Expenditure Panel Survey (MEPS) (Cohen, 1997a). Both surveys were sponsored by the Agency for Healthcare Research and Quality to provide national estimates of the use, expenditures, and financing of health services. The NMES and MEPS surveys were conducted as national probability samples of the U.S. civilian, noninstitutionalized population.

Study Samples

The 1987

Background Characteristics

Table 1 presents the background characteristics of the study samples. Between 1987 and 1996, there was a substantial increase in the proportions of children who were Hispanic, publicly insured, and between 6 and 14 years of age.

Psychotropic Medications

During the study period, the overall rate of psychotropic medication use increased from 1.4 to 3.9 per 100 children and adolescents (Fig. 1). Significant increases were evident across all geographic regions and all age, race/ethnicity, sex, and insurance groups examined.

DISCUSSION

During the late 1980s and early 1990s, there was a dramatic increase in the use of psychotropic medications by children in the United States. The increase cut across age, racial/ethnic, geographic, gender, and insurance groups and included stimulants, antidepressants, and other psychotropic medications.

Growth in the use of stimulants, which are almost exclusively prescribed for ADHD (Safer and Krager, 1994), may reflect increasing public acceptance of these medications. An early public survey

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