Henrietta Leonard, M.D.

Putting psychotropic drugs and preschoolers in perspective

Henrietta Leonard, M.D., a practicing child and adolescent psychiatrist, is a professor of psychiatry and human behavior in the Brown University School of Medicine. Leonard has talked and written extensively on scientific and ethical issues in prescribing medications for preschoolers and other children.

PROVIDENCE, R.I. — The seemingly dramatic increase in the prescribing of psychotropic medications for preschool children is a red flag for the community, says Henrietta Leonard, M.D. The findings from a recent study published in the Journal of the American Medical Association did not include reasons for the increase or for regional differences in prescriptions. Most of the medications were not labeled for use among preschoolers.

There is an urgent need for more research on psychotropic drug use in very young children, said Leonard, who runs research trials of medications in children and adolescents.

“We don’t know if the preschoolers in the study are receiving adequate assessments and treatments, but we can guess that they probably are not,” she said. “And if there are assessments and treatments, who is doing them?

“It used to be that an experienced multidisciplinary team would carefully and thoughtfully evaluate the child. You want someone who is well trained and if that individual is prescribing medications, that they are specifically trained in that expertise, such as someone who has trained in child psychiatry.

“There are occasional times when it is appropriate to use psychotropic medications to treat 2- to 4-year-olds but only after psychotherapies have been tried, are ongoing, and have been assessed. The fear is that this is not occurring and that psychosocial stresses in the homes of these children, which may underlie or complicate these cases, are not being addressed.”

In fact, no research results support psychotropic drug treatment in preschoolers. Moreover, “we have little information to know what the effects may be on the developing brain,” said Leonard, who is a member of the scientific committee of the federally funded Research Units in Pediatric Psychopharmacology.

The JAMA findings also suggest a crisis in mental health services for children, Leonard said. Budget cuts for health care can ration psychotherapy and force a focus on the quick fix. The trend among third-party payers is to deny reimbursement for psychotherapy and for combined psychotherapy and drug treatments. This increases the chances that only drugs will be used.

“There have been dramatic changes in the health care world, such as severe time restrictions imposed on taking care of patients, which affects how we do a comprehensive evaluation and provide appropriate treatment.

“I have to write a 12-page treatment plan on why I want to talk with a child and family members or caretakers for 45 minutes. But if I put that child on medication, I can see him or her for a 15-minute follow-up, and I don’t have to jump through hoops.”

Leonard serves on the editorial board of the Journal of Child and Adolescent Psychopharmacology. She is also editor of the Brown University Child and Adolescent Psychopharmacology Update, a monthly publication for psychiatrists and pediatricians. The April 1 issue of the Update contains a feature article by Leonard titled “Are Psychotropic Drugs Being Overprescribed in Preschoolers?”

To speak with Leonard, contact Scott Turner at 863-2476 (Scott_Turner@brown.edu).