Antipsychotic prescribing for young children in the United States decreased between 2007 and 2017, according to a study published online in the Journal of the American Academy of Child & Adolescent Psychiatry.
“Nevertheless, a majority of use remains off-label and for conditions lacking effectiveness and safety data,” researchers reported. “Improving antipsychotic prescribing in young children remains a challenge.”
The study focused on children aged 2 through 7 years in a nationwide commercial claims database. Researchers evaluated data for 301,311 filled prescriptions, diagnoses, and mental health services for the young patients.
Between 2007 and 2017, the annual rate of antipsychotic use in young children dropped from 0.27% to 0.17%, according to the study. In 2017, 38% of antipsychotic prescriptions were for children diagnosed with pervasive developmental disorder, 21% for conduct or disruptive disorder, and 18% for attention-deficit/hyperactivity disorder (ADHD).
“While there is some evidence supporting the use of antipsychotics in young children with pervasive developmental disorder or intellectual disabilities, antipsychotics are not FDA approved for conduct disorders or ADHD,” said study lead author Greta Bushnell, PhD, an assistant professor at Rutgers University, New Brunswick, New Jersey. “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.”
The study also found that boys received the most antipsychotic prescriptions, especially at ages 6 and 7. In addition, most children prescribed antipsychotics had prescriptions for other psychiatric medications, such as antidepressants or stimulants, clonidine, or guanfacine for ADHD symptoms.
Just 43% of children prescribed an antipsychotic in 2017 had seen a psychiatrist, and only 32% had more than 4 psychotherapy claims, researchers reported.
“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,” Dr. Bushnell said.
Such risks include weight gain, sedation, diabetes, high cholesterol, cardiovascular disease, and unexpected death.
Bushnell GA, Crystal S, Olfson M. Trends in antipsychotic medication use in young privately insured children. Journal of the American Academy of Child & Adolescent Psychiatry. 2020 October 19;[Epub ahead of print].