The issue of children and psychotropic medications received national media attention when the Journal of the American Medical Association (JAMA) ran an article in the February 23 issue reporting dramatic increases in prescribing psychotropic medications for preschoolers.

APA’s Division of Public Affairs played an important role in countering potential antipsychiatry messages by having expert child psychiatrists available for interviews with several broadcast and print media outlets.

David Fassler, M.D., chair of APA’s Council on Children, Adolescents, and Their Families, told Psychiatric News, "I am concerned that the media reaction to these types of studies may scare some parents away from getting treatment for their children. So I take every opportunity I can to educate writers and producers about the fact that children have mental illnesses that are highly treatable."

Fassler was interviewed by the British Broadcasting Company for a radio program, the Associated Press, the Oregonian newspaper, and Time magazine. He also provided background information to the writers and producers of ABC’s "Nightline," who focused primarily on the controversy over prescribing methylphenidate for attention-deficit/hyperactivity disorder (ADHD).

"I emphasized to the media that a comprehensive and accurate psychiatric assessment should be conducted prior to using medication. Some children can benefit from medication, but it should be part of a comprehensive treatment plan," said Fassler.

He emphasized as well that parents need to make informed decisions about psychotropic medications by working with the child’s physician to learn about the diagnosis and all treatment options.

"I also discussed the findings from the JAMA article with the media," said Fassler. The authors reported significant increases in the last decade among preschoolers prescribed stimulants (primarily methylphenidate), antidepressants, and clonidine. The sample consisted of approximately 200,000 children aged 2 to 4 years in an HMO in the Northwest, a Medicaid program in the mid-Atlantic region, and a Medicaid program in the Midwest between 1991 and 1995, according to the article.

"I stressed that the article is provocative and raises more questions than it answers. We don’t know who prescribed the medications, what diagnoses the children had, and whether a psychiatric consultation was available through a behavioral health carveout," said Fassler.

"We also don’t know if the results represent practice patterns across the country. Although it appears that physicians are prescribing medications for younger children, I have not seen a significant increase where I practice in Burlington, Vermont," said Fassler.

Joseph Coyle, M.D., a psychiatrist at Harvard Medical School in Boston, made a similar observation in an editorial accompanying the JAMA article. His survey of 48 physicians on the editorial board of the Journal of Child and Adolescent Psychiatry showed that they prescribed medications to preschoolers rarely or never.

Fassler noted that the media tended to focus their questions on the potential risks of using psychiatric medications in young children. "I think that is reasonable because we don’t know a lot about the effects of using medications in children so young," he observed.

The authors of the JAMA article noted that only methylphenidate has been studied extensively in children and that its adverse effects are more pronounced in preschoolers than in older children.

He added that the National Institute of Mental Health and the Food and Drug Administration plan to conduct more research on the effects of psychiatric medications in children.