Antipsychotics for kids are down, but risks remain

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The use of antipsychotics in young children is declining, according to new research.

The study also finds, however, that doctors continue to prescribe these medications off-label for non-FDA approved conditions and without the recommended psychiatric consultation.

Researchers looked at 301,311 antipsychotic prescriptions filled for privately insured children ages 2 to 7 in the United States from 2007 to 2017.

While results are encouraging that antipsychotic prescribing declined in recent years, the researchers note that doctors continue to prescribe them for conditions lacking safety and effectiveness data such as conduct disorder, ADHD, anxiety, and depression.

“We lack information on the effectiveness and safety of antipsychotics for treating those conditions in young children,” says Greta Bushnell, an assistant professor at Rutgers University School of Public Health and lead author of the study in the Journal of the American Academy of Child and Adolescent Psychiatry.

“Guidelines recommend that psychosocial services are used before antipsychotic treatment and that children are carefully assessed before initiating antipsychotics. However, fewer than half of the children receiving antipsychotic treatment in our study had a visit with a psychiatrist or a psychotherapy claim.”

Pervasive developmental disorders (PDD)—characterized by delays in the development of socialization and communication skills—accounted for the most antipsychotic prescribing in recent years.

“While there is some evidence supporting the use of antipsychotics in young children with PDD or intellectual disabilities, antipsychotics are not FDA approved for conduct disorders or ADHD,” says Bushnell, who is also a member of the Rutgers Institute for Health, Health Care Policy and Aging Research.

“Despite continued prescribing, there is limited evidence for the efficacy of antipsychotics for conduct or disruptive behavior disorders in very young children and the long-term outcomes remain poorly understood.”

In addition, the study found that antipsychotics were more often prescribed to boys, especially between ages 6 and 7, and that most of the children receiving antipsychotics also filled a prescription for another class of psychotropic medications, such as stimulants, clonidine or guanfacine for managing ADHD symptoms, and antidepressants.

Children who take antipsychotic medication are at risk of weight gain, sedation, diabetes, high cholesterol, cardiovascular disease, and unexpected death. In very young children, antipsychotics might cause developmental and other long-term adverse effects.

“The low rate of use of safer first-line psychosocial treatments, such as parent-child interaction therapy or cognitive-behavioral therapy, potentially puts children at unnecessary risks associated with antipsychotic treatment,” Bushnell says.

Source: Rutgers University