Preschoolers put on ‘adult’ medication

Study: 246 kids in Oregon Health Plan use drugs not tested for childen

By Peter Korn

The Portland Tribune, Apr 14, 2006, Updated Oct 30, 2009

A new study directed by an Oregon Health & Science University professor has found that 246 preschool children covered by the state-sponsored Oregon Health Plan are receiving antipsychotic or antidepressant medications that have never been studied for use in children.

And while the study’s lead researcher admits the figure might seem alarming, mental health experts caution that the prescriptions might have been justified and may be a result of Oregon’s insufficient mental health resources.

The study, a collaboration between the state’s department of human services, its Medicaid program and the Oregon State University College of Pharmacy, was headed by OHSU psychiatry professor David Pollack. Pollack said he understands that at first glance, the prospect of children age 5 and under receiving psychiatric medication intended for adults can be startling.

“There’s an element of alarm,” he said. “But it leads us to say we need to answer more questions. It doesn’t mean it’s inappropriate.”

Pollack noted that the 246 children represent less than one-half of 1 percent of the 86,828 Oregon Health Plan children whose records were reviewed. The Oregon Health Plan is an insurance program for low-income Oregonians funded through Medicaid.

“The problem is there’s very little data to direct the use of pharmacological agents in preschool children,” said Joan Luby, associate professor of child psychiatry at Washington University School of Medicine in St. Louis. “There’s just not much known. That doesn’t mean these drugs aren’t effective. We just don’t have the studies to show whether they are safe and effective.”

Still, Luby, who has spent a decade studying children under 6 years of age, said that mental illnesses such as depression occur in the very young more frequently than most people realize. “I wouldn’t say I’m surprised, but the public is surprised,” she said. “Depression is a disorder that’s a good example of a combination of biological and psychological risk factors. It’s a complicated equation.”

A third of kids were abused

The Oregon study, first reported in a monthly publication called Oregon Health News, looked at Medicaid pharmacy prescription records from Oregon Health Plan claims. Among its findings: 41 percent of the children given psychiatric medication had an attention deficit disorder (though the prescribed medications were not those usually recommended for children with the disorder), and 33 percent were diagnosed victims of child abuse.

But the study, Pollack said, poses as many questions as answers. Among them: Whether the children were adequately assessed before being medicated, and whether the prescriptions were accompanied by appropriate therapy. Pollack said he thinks data showing 82 of the 246 children given the drugs had suffered some form of abuse might be particularly revealing.

“I know enough about clinical practice to know that it’s really hard to make diagnoses in children, and there’s a lot of pressure,” Pollack said. “You have some very complex cases where children might have some combination of illnesses, developmental disabilities and autism.”

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