A new study finds that 1.2 percent of American preschool children on Medicaid are using antidepressants, mood stabilizers, medications for attention-deficit disorder and other psychotropic drugs.

Researchers at the Brown School at Washington University in St. Louis and at Washington University School of Medicine in St. Louis found preschoolers are being given these medications despite limited evidence supporting safety or efficacy. The study results are published in the March issue of the American Journal of Public Health.

“All of the children in our study are very young, four years of age or less,” said Derek Brown in an interview with the Standard-Examiner.

Brown, assistant professor of public health at the Brown School and one of the authors of the study, also said in general, psychotropic drugs are not recommended for use among children of these ages.

“Although the rates are fairly low in percentage terms, we know little about the safety and efficacy of such medications in this population. If evidence-based, behavioral interventions were being followed, and children’s mental health needs were being properly assessed, we would expect to find rates of use near zero,” Brown said.

Brown said the findings of the study indicate unnecessary costs and potentially harmful or ineffective prescribing. These resources could instead be directed to effective, safer interventions.

“We do not expect to see zero, since a few children may have rare conditions for which use at these ages could be indicated. Unfortunately we do not have the medical charts or full information to separate out indicated cases,” Brown said.

Jim Bird, a psychologist and emeritus professor in child and family studies at Weber State University, said he believes this is a much-needed topic for discussion.

“My opinion is if the child needs it, it’s appropriate. The bigger question is how do you determine if the child needs it? That’s the big issue,” Bird said. “Has the ADHD been diagnosed properly? Is medication prescribed in a way that is effective? Is it carefully monitored? It takes more than just a doctor’s visit and it takes time for things to be done correctly. Sadly, there has been an explosion of kids being put on ADHD medication since 1990.”

Bird said in 1960, approximately 50,000 children were on ADHD medication. Today, over five million kids are being medicated for ADHD. But he said it’s not just the fault of the doctor.

“When a person goes to see their doctor, many times they are expecting the doctor to give them a prescription and if they don’t, they think they haven’t been properly treated,” Bird said. “There are also some medications that are given to children for off label purposes and they haven’t been tested on children. That’s a concern.”

Bird also said because the brain of a child is developing and maturing and is a very active organ, introducing medication that affects the brain should not be taken lightly.

According to the U.S. Centers for Disease Control, data from a national sample of children with special health care needs, ages four to 17 years, collected in 2009 and 2010, showed that most children with ADHD received either medication treatment or behavioral therapy. However, many were not receiving treatment as described in the best practice guidelines from 2011.

Less than one in three children with ADHD received both medication treatment and behavioral therapy, the preferred treatment approach for children ages six and older. Only half of preschoolers, ages four to five, with ADHD received behavioral therapy, which is now the recommended first-line treatment for this group. About half of preschoolers with ADHD were taking medication for ADHD, and about one in four were treated only with medication.

The CDC report also showed that between 2009 and 2010, 66 percent of Utah children with ADHD took medication and 42 percent received behavioral treatment. Only 30 percent of those kids received a combination of medication and behavioral therapy.

Bird said treatment for ADHD, when properly diagnosed and treated, is very beneficial and can help the child tremendously. But he also said there are two types of attention – active and reactive. Active attention is designed to protect us from harm. Reactive attention is where a child learns to focus their attention, and Bird said he believes society needs to work a little harder at teaching children reaction attention.

“I was at a party the other day. There was a person feeding their baby. They had the bottle propped up in the baby’s mouth while they were looking at their iPhone,” Bird said. “I see parents watching more than two hours of television each day but they don’t spend 10 minutes reading to their child. They think Baby Einstein will increase their child’s intelligence but they don’t think This Little Piggy or Pat-A-Cake will do it.”

Bird said parents need to go back to playing Peek-A-Boo with their children and taking time every night to read to them.

“We need to work on teaching them how to focus their attention,” Bird said. “Our society has gotten to the point of entertaining ourselves and our children to death with all of these devices. My biggest concern is that we tend to give a child a classification of ADHD or bipolar when in fact it’s the environment. When you bring a child in who has never been required to really pay attention, but they’ve been entertained their whole life, you get a diagnosis of ADHD. Well, what have you done here? You’ve transferred the problem of the environment to the child.”

Brown said he hopes the study will raise awareness of the inappropriate use of psychotropics among all very young children as well as those who are on Medicaid.

“While medication is an important potential treatment among older ages, we would like to see expanded use of evidence-based, behavioral interventions for very young children,” Brown said. “State Medicaid programs could consider greater monitoring of inappropriate use through medication safety or review programs, and improved provider education about evidence-based therapies for very young children.”