Study finds nationwide increase in antipsychotic medications used for children with ADHD

A disturbing nationwide trend has been documented by a researcher at the Monroe Carell Jr. Children's Hospital at Vanderbilt: Doctors are prescribing antipsychotic medicines for children with behavioral problems that are not defined as "psychosis," such as attention deficit hyperactivity disorder (ADHD).

Lead author of the study, William Cooper, M.D., M.P.H., associate professor of Pediatrics in the Child and Adolescent Health Research Unit, says that the majority of the use of the medicines is for children, especially boys, with behavioral problems and ADHD.

The study, "Trends in Prescribing of Antipsychotic Medications for U.S. Children" was released today in the March-April issue of the journal Ambulatory Pediatrics. It documented that the overall frequency of antipsychotic prescribing in the U.S. increased fivefold -- from 8.6 out of 1,000 U.S. children in 1995-1996 to 39.4 out of 1,000 children in 2001-2002.

Data were drawn from the National Ambulatory Medical Care Survey and the National Hospital-Based Ambulatory Medical Care Survey, which provided national samples of the health care services rendered to the nation. Researchers looked at children 2 to 18 years old who were given antipsychotic prescriptions during the seven-year study period.

From 1995-2002, there were 5.7 million visits by U.S. children during which an antipsychotic was prescribed, and more than half (53 percent) of the prescriptions were given for behavioral indications or affective disorders, conditions for which antipsychotics have not been carefully studied in children. Almost one-third of those prescriptions were written by pediatricians or family medicine doctors.

The increase in prescribing coincided with the introduction of atypical antipsychotic medications, which some providers may consider to be safer than older antipsychotic medications because of their lack of neurologic side effects.

But Cooper says atypical antipsychotics have other side effects including the risk of substantial weight gain, diabetes and cardiac dysrythmias, which may be more severe in children than in adults.

He adds that there is limited information on the effectiveness of antipsychotic medications for behavioral and affective disorders, the conditions for which over half of the prescriptions were written.

"These are really powerful medications and it's important that providers have a handle on both the potential benefits and potential risks," Cooper said. "They haven't been studied in children yet and we don't know if they work, and we don't know what the potential risks are."

"These findings really reinforce that we need to conduct well-controlled studies to know which medications will be helpful and also to understand risks," Cooper said. "Individual health care providers need to evaluate what evidence is available before beginning therapies with these medicines in children."

Co-investigators for the study are Patrick Arbogast, Ph.D., assistant professor of Preventive Medicine; Hua Ding, biostatistician in the Department of Biostatistics; Gerald Hickson, M.D., associate dean for Clinical Affairs; Catherine Fuchs, M.D., associate professor of Psychiatry in the Division of Child and Adolescent Psychiatry and Wayne Ray, Ph.D., professor of Preventive Medicine.

In 2004, Cooper was the lead author on a similar study done on a statewide level, tracking children from the TennCare population. That study revealed that between 1996 and 2001 the proportion of TennCare children who were new users of antipsychotic medications increased from 23 per 10,000 children to 45 per 10,000.

This work was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) to the Vanderbilt University Center for Education and Research on Therapeutics (CERTs). The mission of the CERTs is to conduct research and provide education that advances the optimal use of drugs, medical devices and biological products.

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