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ADHD Driving Use of Antipsychotic Drug Prescriptions in Children

Cross-posted in Inside School Research

The National Institutes of Mental Health found stark sex differences and gaps in mental health diagnoses in the prescription of antipsychotic drugs, even for very young children, in a study released Thursday in the journal JAMA Psychiatry.

Boys at any age are likelier than girls to be given antipsychotic medicines, such as Risperdal and clozapine, according to the study, published online Thursday in the journal JAMA Psychiatry.

Also, the study found that less than half of the children, adolescents and young adults prescribed the medicines had an outpatient or inpatient diagnosis of a mental disorder.

Among the children and youth who did have a mental health diagnosis, attention deficit hyperactivity disorder was the most common diagnosis for children and adolescents. For young adults ages 19-24, the most common diagnoses were bipolar disorder or anxiety. Fewer than a quarter of the children and youth studied had an outpatient claim for psychotherapy.

NIMH researchers studied more than 765,000 prescriptions in 2006, more than 858,000 in 2008, and more than 851,000 in 2010, all for patients ages 1 to 24.

They found in 2010, doctors nationwide prescribed about 270,000 antipsychotic medicines to children under 6, 2.14 million to children ages 7 to 12, 2.80 million to adolescents ages 13 to 18, and 1.83 million to young adults ages 18 to 24. The study noted that after several years of increasing rates of antipsychotic treatment of children and adolescents, the rate of antipsychotic use among children decreased between 2008 and 2010.

As the chart below shows, the percentage of the boys and girls on antipsychotics rises during school years, with sex-based gaps closing in the years after high school:


Drug Prescriptions for Youth Linked to Impulsive, Aggressive Behaviors, Not Psychosis

So are mental health disorders more likely to be identified in the school years? Yes, but that doesn't seem to be what's going on here.

"Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms," the researchers conclude.

In an editorial accompanying the study, editors noted that antipsychotics are often prescribed to younger people off-label, for uses not yet approved by the FDA. In the editorial, researchers also noted that separate studies have found extended use of these drugs can lead to lower brain volume and neuron density. Those studies have been on adults; not much is yet known about how such drugs affect children whose brains are still developing.

"Antipsychotics should be prescribed with care," said NIMH researcher and co-author Michael Schoenbaum in a statement on the study. "They can adversely affect both physical and neurological function and some of their adverse effects can persist even after the medication is stopped."  

Chart: As of 2010, about 1.5 percent of boys ages 10 to 18 received an antipsychotic prescription. Sex-related gaps in prescriptions open up as children get older, but close again as they reach young adulthood. Source: "Treatment of Young People With Antipsychotic Medications in the United States."

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