October 1st, 2015

Use of antipsychotic drugs for ADHD is ‘worrisome’

In recent years, there has been an increase in the prescription of antipsychotic medications to children aged 13-24 in the U.S. – especially adolescent boys, and often for the treatment of Attention Deficit Hyperactivity Disorder – according to a recent study in JAMA Psychiatry.

The study, published in July, looked at prescription information for antipsychotic medications in patients aged 1-24 in 2006, 2008 and 2010 from the IMS LifeLink LRx Longitudinal Prescription database. The database includes information from about 60 percent of retail pharmacies in the nation.

“What we found is that throughout childhood and adolescence, boys are more likely than girls to be treated with antipsychotics and this difference is especially impressive for children 8-12 years old, shortly before they start puberty,” said Mark Olfson, MPH, one of the lead authors, a professor of psychiatry at Columbia University Medical Center and a research psychiatrist at New York State Psychiatric Institute.

“The highest rates of antipsychotic use occur in the adolescent years, 11-17, and following that, there is a decline in use, both in boys and girls.”

Although the use of antipsychotics dropped slightly for children under 12, use increased in adolescents and young adults. “Consistent with clinical diagnoses suggesting that antipsychotics are primarily used to manage impulsive or aggressive behaviors in children associated with ADHD, the highest rate of antipsychotic treatment was in adolescent boys, approximately half of whom also filled prescriptions for stimulants,” reads the study.

Researchers also looked at accompanying diagnosis information, finding that there often wasn’t a mental health diagnoses for the prescription of antipsychotics, or if there was, ADHD was common.

“This pattern of the ADHD diagnosis, this predominance for boys and the use of stimulants all suggest that antipsychotics are being used to treat impulsive aggression and other behavioral symptoms,” Olfson said.

“The reason that is important is that although the U.S. Food and Drug Administration has approved antipsychotics in young people for things like bipolar disorder, schizophrenia and autism, they are not approved for ADHD. We think this study reveals areas of quality and concern for the management of children.”

Researchers also found that very few children getting antipsychotic prescriptions are receiving any psychotherapy. “The combination of receiving antipsychotics with the diagnosis of ADHD and not receiving psychotherapy is worrisome,” Olfson said. “This is happening at a time when a fair amount of progress has been made on developing psychosocial treatments for disruptive behaviors in children.”

Similar concerns have been apparent in other studies that looked at specific populations, he said. This study is the first to provide a broader look at the national use of antipsychotics in youth.

Although data in this study might be a few years old, Olfson said his guess is the situation has not changed. While there has been a push in recent years within the psychiatric community to limit the prescription of antipsychotics to their FDA-approved use, many children are getting prescriptions from pediatricians and primary care doctors, he said.

“Getting the word out to primary care physicians is more challenging. There are many more of them and they spend less time thinking about mental health problems,” he said. “If they are confronted with an upset parent who’s got a child who is out of control and they need to have something done quickly, these antipsychotic medications do often bring disruptive behaviors under control quickly. But the issue is how safe are they? Are there safer and more effective alternatives in the long run?”

Access is less of an issue in the New England area, Olfson said. “So hopefully there is greater opportunity to strengthen referral lines between primary care doctors, pediatricians, family practitioners and people who are mental health specialists and hopefully begin to turn this around.”

By Rivkela Brodsky

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