Medicaid-insured children receive substantial psychiatric services and thus may have prolonged exposure to psychotropic medications in the early years of life, according to research published in JAMA Pediatrics.

Researchers assessed the longitudinal patterns of psychotropic medication use in a cohort of 35,244 Medicaid-insured children. Investigators captured the cumulative incidence of first psychiatric diagnosis and psychotropic medication use from birth through age 7and stratified results by sex. Researchers also investigated the annual duration of medication use. Of the total cohort, 17,267 (49%) were girls and 17,977 (51%) were boys.

During the study period, 4550 children received a psychiatric diagnosis by age 8. Of these diagnoses, 2624 (57.7%) were behavioral. Girls were more likely than boys to receive a diagnosis of adjustment disorder or anxiety disorder (both P <.001), with incidence rates 7.7% and 3.0% higher, respectively, compared with boys. By age 8, 2196 (10.2%) children had received psychotropic medication, among whom 1763 (80.5%) received monotherapy, 343 (16.4%) received 2 medication classes concomitantly, and 90 (4.3%) received 3 or more medication classes concomitantly for 60 days or more. The annual median number of days of psychotropic use increased with age, reaching 210 of 365 days for children aged 7. Among children aged 7, the median number of days of use of an antipsychotic (193 days), stimulant (183 days), or α-agonist (199 days) medication exceeded half the year, a figure researchers considered significant, prolonged exposure.

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Based on these results, researchers emphasized the need for outcomes research in pediatric populations to elucidate the long-term effects of early and sustained psychotropic medication exposure. Clarifying the potential risks of childhood psychotropic medication use could assist clinicians in offering safe, targeted treatment to young patients with psychiatric disorders.


Pennap D, Zito JM, Santosh PJ, Tom SE, Onukwugha E, Magder LS. Patterns of early mental health diagnosis and medication treatment in a Medicaid-insured birth cohort [published online April 30, 2018]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2018.0240