According to background information in the article, increased use of psychotropic medication as treatment for behavioral and emotional problems in American children and adolescents has received widespread attention in the past decade. However, the extent of psychotropic medication treatment for youths receiving care in the community setting has not been reliably reported.

Julie Magno Zito, Ph.D., and colleagues examined changes in psychotropic medication use for youths from 1987 to 1996 by analyzing data from nearly 900,000 youths younger than 20 years who were enrolled in two different regional U.S. health care systems.

The researchers found that the total use of psychotropic medications by youths increased 2- to 3-fold and included most classes of medication. They noted a rapid growth since 1991 in the use of alpha-agonists, neuroleptics, and mood stabilizing anticonvulsants. Stimulants were the single most commonly prescribed medication type, followed by antidepressant medications.

The authors noted that “Most of the temporal change occurred between 1991 and 1996. Medication classes generally showed a proportionally greater prevalence with increasing age, but 10- to 14-year-olds emerged as the Medicaid [publicly funded] age group most likely to receive psychotropic medications while the 15- to 19-year-old group predominated among Health Maintenance Organization [privately funded] medicated youths."

In an accompanying editorial, Michael S. Jellinek, M.D., wrote, "The data reflect somewhat higher utilization rates for younger ages and possibly more serious disorders in Medicaid populations, which could support the hypothesis that mental illness in parents and the stressors of poverty add to the prevalence of child and adolescent psychiatric disorders in this sub-sample. An optimistic clinical perspective suggests that these data reflect a broader awareness of diagnostic criteria, less exclusive reliance on talk therapy, and thoughtful efforts to extrapolate off-label from adult-based evidence to treat children and adolescents with serious mental health needs."

Given the scale of current psychotropic medication utilization, we have a responsibility to know what we are doing and the quality of our efforts. We need to ask... this question: Are we prescribing the right psychotropic medications to the right children using the right treatment plan? Specifically, the work of Zito and colleagues reinforces our obligation to apply a quality assurance and research framework to our current pattern of utilization."