The use of psychotropic prescription medications to treat ADHD, mood disorders, anxiety and other mental health disorders in young children seems to have leveled off, according to a new study from The Cincinnati Children’s Hospital.

A national study that included two to five year olds showed that psychotropic medication use peaked from 2002 to 2005, then leveled off from 2006 to 2009. Researchers also discovered an increase in the use of these medications in boys, white children and those that did not have private health insurance during the 16-year study period from 1994 to 2009.

“The likelihood of receiving a behavioral diagnosis increased in 2006 to 2009, but this was not accompanied by an increased propensity toward psychotropic prescription,” says Tanya Froehlich, MD, a pediatrician at Cincinnati Children’s Hospital and the study’s senior author. “In fact, the likelihood of psychotropic use in 2006-2009 was half that of the 1994-1997 period among those with a behavioral diagnosis.”

Psychotropic medication use decreased from 43 percent in those with one or more behavioral diagnoses between 1994 and 1997 to 29 percent between 2006 and 2009.

Commonly prescribed psychotropic medications fall into several categories, including typical and atypical anti-psychotics, antidepressants, anti-anxiety, stimulants and mood stabilizers. The U.S. Food and Drug Administration has approved several of these medications for preschool children, but previous studies have documented two to threefold increases in psychotropic prescriptions for preschool children between 1991 and 2001.

The researchers also discovered that the likelihood of being diagnosed with a behavioral disorder increased over the same time period for children in this age group. According to a prior study on the prevalence of early childhood emotional and behavior disorders, estimations on the number of children who suffer from these conditions varies depending on which study is cited.

Researchers studied data from two national surveys that collect information on patient visits to office-based physician practices and hospital-based outpatient clinics throughout the United States. The researchers studied data on more than 43,000 young children.

It is possible that psychotropic medication use leveled off due to the numerous warnings issued in the mid to late 2000s. These include a 2004 FDA black box warning regarding suicide risk, a 2005 public health advisory regarding cardiovascular risks involving amphetamines, and a 2006 FDA Advisory Committee recommendation for a black box warning on psychostimulants, which was later reversed.

Dr. Froehlich says additional research is needed to determine why boys, white children and those without private health insurance are more likely to receive these medications.

“Our findings underscore the need to ensure that doctors of very young children who are diagnosing ADHD, the most common diagnosis, and prescribing stimulants, the most common psychotropic medications, are using the most up-to-date and stringent diagnostic criteria and clinical practice guidelines,” says Dr. Froehlich. “Furthermore, given the continued use of psychotropic medications in very young children and concerns regarding their effects on the developing brain, future studies on the long-term effects of psychotropic medication use in this age group are essential.”

The Cincinnati Children’s Hospital Medical Center study is published online in the journal Pediatrics.