In Brief

At a March 20 meeting at the White House, APA Recording Secretary Ronald F. Levant, EdD, underscored the need for young children to receive psychosocial interventions, even if medications are prescribed. He emphasized the importance of understanding the parameters of normal child development to validly diagnose mental disorders in young children.

"Psychological and pharmacological interventions for children need equal attention," Levant said during a roundtable discussion with First Lady Hillary Rodham Clinton, Secretary of Health and Human Services Donna Shalala, Surgeon General David Satcher, MD, National Institute of Mental Health Director Steven Hyman, MD, Food and Drug Administrator Jane Henney, Assistant Secretary of Education Judith Huemann and representatives from 14 major mental health, health-care, educational and consumer organizations.

"While pharmacotherapy has been an effective treatment for many children, psychological interventions also have demonstrated efficacy," said Levant, dean at the Center for Psychological Studies at Nova Southeastern University in Florida.

Levant also emphasized the need for more research on the short- and long-term effects of medication, psychological interventions and combination therapy on children. At issue is the fact that while the psychotropic medications prescribed for ADHD are approved by the FDA for older children and adults, their safety and effectiveness has not been proven for pre-school children. Little is known about the degree to which gains made while taking medications are sustained after they are discontinued.

At the meeting, the White House announced its initiative to help ensure that children with emotional and behavioral conditions are appropriately diagnosed, treated, monitored and managed by qualified health-care professionals. It includes:

  • Funding a $5 million five-year study by the National Institute of Mental Health to investigate whether Ritalin is safe and effective in treating preschoolers. In the study, hundreds of boys and girls will receive Ritalin, behavioral therapy or some combination of both.

  • Creating a new process at the U.S. Food and Drug Administration to improve pediatric labeling for young children.

  • Sponsoring a national conference through the Surgeon General's Office this fall on treating children with behavioral and mental disorders.

  • Releasing a fact sheet for parents about treating children with emotional and behavioral conditions.

"There appeared to be consensus at the meeting that proper diagnosis by qualified professionals is essential," says Levant. "Most of the psychoactive drugs prescribed to children are prescribed by primary-care generalists with minimal specific training in mental health and treatment and too often based on brief interviews with minimal follow-up and sometimes pressured by harried teachers and frustrated parents."

Insurance and managed-care companies too often favor psychotropic medications over appropriate behavioral interventions, he says.

The Clinton administration called the meeting in response to the a study in the Feb. 23 Journal of the American Medical Association, which found that the amount of psychotropic medications prescribed for preschoolers, including Ritalin and Prozac, increased dramatically from 1991 to 1995--even though there is little research on their effectiveness in children under age six.

In the study that sparked this debate, researcher Julie Magno Zito, PhD, and her colleagues studied data from Medicaid populations and a health-maintenance organization to determine psychotropic usage among children, ages 2 to 4, between 1991 and 1995. More than 200,000 preschoolers enrolled in these programs.

The study found that stimulants, such as Ritalin, were the leading treatment among preschoolers who received Medicaid services in a Midwestern state, followed by antidepressants, such as Prozac. Clonidine, which is typically used to treat insomnia associated with attention-deficit hyperactivity disorder, was the third leading treatment, followed by neuroleptics, such as Haldol or Mellaril. Preschoolers in the mid-Atlantic Medicaid program were prescribed these medications at a similar rate.