142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

306665
Psychotropic prescribing in children under age 4 in Medicaid

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 1:10 PM - 1:30 PM

Lauren Garfield, PhD, MPH , Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
Derek Brown, PhD , Brown School, Washington University in St. Louis, St. Louis, MO
Benjamin Allaire, MS , RTI International
Raven Ross, MSW , Brown School Washington University
Stacey McCrary, MSW , Brown School Washington University
Ramesh Raghavan, MD, PhD , Brown School; and Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO

Following 1997 expansion of children’s health coverage, increased demand for services may have increased risk of prescribing psychotropics in young children.  The use of psychotropic drugs in children under age 4 years is highly controversial; few medications have been tested and FDA approved for children in this age range and short- and long-term side effects are virtually unknown.  We followed two cohorts of children (born in 1999 and 2000) up to age 4, to determine prevalence of psychotropic prescribing and indications for prescribing. All children were enrolled within Medicaid programs in 36 states. We modeled odds of receiving any prescription for three indications: attention deficit/hyperactivity disorder, depression/anxiety, and psychotic illness/bipolar disorder. A total of .78% of children received at least one psychotropic drug across both cohorts. Among the three index disorders, greatest prescribing was seen for children with a claims diagnosis of depression/anxiety (.34%). A larger proportion of children aged 3-4 years received drugs compared to those aged 0-1 year (1.81% vs .15%).  Males and those with FFS-only Medicaid had higher odds of receiving a prescription (ORs 1.90, 1.50 respectively), while Black and Hispanic children had lower odds (ORs .50, .35 respectively).  Our finding that children under age 4 are being prescribed psychotropics is concerning; there is not evidence to support the safety or efficacy in this population.  Future research should focus on finding ways to implement medication use practice parameters in infant and toddler clinics, and to expand use of psychosocial interventions for young children with behavioral problems.

Learning Areas:

Clinical medicine applied in public health

Learning Objectives:
Identify potential inappropriate psychotropic prescribing in children less than age 4 in Medicaid data and describe why this prescribing is problematic.

Keyword(s): Child/Adolescent Mental Health, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working in the area of mental health and pharmacoepidemiology of psychotropics in administrative data since beginning of my dissertation research, in 2007. I have authored and co-authored multiple peer-reviewed papers in these areas and am working with a highly qualified research team on this project. My postdoctoral work has focused on Medicaid data in the childhood population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.