are toddlers on medicaid being put on anti-anxiety drugs in large numbers

“we call it medicine: the mass psychiatric drugging of poor children”

a clinical psychologist wrote on his own Substack newsletter, 2026-03-10. hear it in context → the speaker cited: state Medicaid prescribing data obtained by an advocacy group through public-records requests.

the episode: we call it medicine: the mass psychiatric drugging of poor children (at 00:00). we link the show's own page; we do not re-host audio.

first, the part that holds

The underlying worry is real and the public record backs it: in the 2025 reporting year the median state documented first-line psychosocial care for only 59.2 percent of children aged 1 to 11 starting an antipsychotic, got both required metabolic blood tests for 29.1 percent of young children on two or more antipsychotic prescriptions, and saw 47.6 percent of children newly prescribed an ADHD medicine again within 30 days. Those are the states' own numbers.

what we found when we went and looked

We pulled the same questions from records anyone can download. The large "anti-anxiety" count for children under five is driven by hydroxyzine, an antihistamine that is not a benzodiazepine and not a controlled substance; the 2024 State Drug Utilization Data file shows 8,675,297 hydroxyzine prescriptions across all ages against 11,753,095 for the whole benzodiazepine class, and the file has no age field, so no under-five share can be computed from it. The 37.7 percent Oregon figure has no published method and cannot be checked. The statement that no psychiatric drug is FDA-approved under five is contradicted by the amphetamine label, which carries dosing for attention deficit disorder from age three. The concerns about monitoring, follow-up and oversight are confirmed by the Child Core Set measures every state reports.

assertion by assertion

both directions

for the speaker: Every monitoring and follow-up measure the states report sits well below 100 percent, and in some states below one child in three. Antipsychotic use in children under six on Medicaid is documented in the literature, with long durations and heavy polypharmacy in the cohorts studied (see the topic page). An off-label prescription to a four-year-old is a legitimate thing to ask about.

against: The headline class is wrong: hydroxyzine is an antihistamine, and rolling it into "anti-anxiety drugs" makes a benzodiazepine story out of an antihistamine one. The FDA-approval claim is false for stimulants. The Oregon percentage cannot be checked. And the trend runs the other way: antipsychotic use among Medicaid children fell substantially between 2008 and 2016, and foster children, the group with the most prescriptions, are now more likely than other Medicaid children to get psychosocial care and metabolic monitoring, because oversight was built for them first.

what this cannot say

The Child Core Set is state-reported with differing methods, and between the 2024 and 2025 reporting years every state moved the metabolic and ADHD measures to electronic clinical data systems, so no state's rate is comparable to its own prior year. CMS withholds most denominators. The SDUD file has no age, diagnosis or prescriber field, so our hydroxyzine and benzodiazepine sums are all-ages totals, not children's numbers. We did not see the FOIA files behind the original post; if they are shared, we will read them.

the full evidence page: /topics/psychiatric-drugs-for-children-on-medicaid

sources, each one fetched and read

1. CMS Medicaid/CHIP Child Core Set, 2025 reporting year: APP-CH (first-line psychosocial care for children and adolescents on antipsychotics), APM-CH (metabolic monitoring for children and adolescents on antipsychotics), ADD-CH (follow-up care for children prescribed ADHD medication). Downloaded and read 2026-09-28; only rows flagged as used in the state mean and median. What we read there: Medians across the reporting states: APP-CH ages 1 to 11, 59.2 percent; APM-CH both tests ages 1 to 11, 29.1 percent; ADD-CH initiation phase ages 6 to 12, 47.6 percent. Fetched 2026-10-06 (HTTP 200). https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
2. CMS State Drug Utilization Data 2024 (sdud2024_updatedJuly2026.csv, 5,308,407 rows, downloaded 2026-09-28). Our own sums by product name across all reporting states and territories, all ages. What we read there: Hydroxyzine (incl. Vistaril, Atarax rows): 8,675,297 prescriptions, $105,553,404 reimbursed. Benzodiazepine class: 11,753,095 prescriptions, $321,772,863. The file carries no age, diagnosis or prescriber field. Fetched 2026-10-06 (HTTP 200). https://data.medicaid.gov/dataset/61729e5a-7aa8-448c-8903-ba3e0cd0ea3c
3. FDA label, hydroxyzine hydrochloride tablets, via openFDA. Read 2026-09-28. What we read there: Indicated "for symptomatic relief of anxiety and tension associated with psychoneurosis"; dosing for "children under 6 years, 50 mg daily in divided doses". Hydroxyzine is an antihistamine; it is not a benzodiazepine and is not a controlled substance. Fetched 2026-10-06 (HTTP 200). https://api.fda.gov/drug/label.json?search=openfda.generic_name:%22hydroxyzine+hydrochloride%22
4. FDA label, amphetamine sulfate tablets, via openFDA. Read 2026-09-28. What we read there: "Amphetamines are not recommended for use as anorectic agents in children under 12 years of age, or in children under 3 years of age with Attention Deficit Disorder with Hyperactivity", i.e. labelled dosing exists from age 3. Fetched 2026-10-06 (HTTP 200). https://api.fda.gov/drug/label.json?search=openfda.generic_name:%22amphetamine%22

speakers are described by role, not named. one sentence is quoted under fair use, with attribution and a link to the original at the timestamp; we do not re-host audio or video. nothing on this page is a reason to start, stop or change a medication. if you have the file behind anything marked unverifiable, the research board is where people can answer. adam