Boys more likely to have antipsychotics prescribed, regardless of age.

Boys are more likely than girls to receive a prescription for antipsychotic medication regardless of age, researchers have found. Approximately 1.5 percent of boys ages 10-18 received an antipsychotic prescription in 2010, although the percentage falls by nearly half after age 19. Among antipsychotic users with mental disorder diagnoses, attention deficit hyperactivity disorder (ADHD) was the most common among youth ages 1-18, while depression was the most common diagnosis among young adults ages 19-24 receiving antipsychotics.

Despite concerns over the rising use of antipsychotic drugs to treat young people, little has been known about trends and usage patterns in the United States before this latest research, which was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.Mark Olfson, M.D., M.P.H., of the Department of Psychiatry, College of Physicians and Surgeons and Columbia University and New York State Psychiatric Institute, New York City, and colleagues Marissa King, Ph.D., Yale, New Haven, Connecticut, and Michael Schoenbaum, Ph.D., NIMH, report their findings on July 1 in JAMA Psychiatry.

“No prior study has had the data to look at age patterns in antipsychotic use among children the way we do here,” said co-author Michael Schoenbaum, Ph.D., senior advisor for mental health services, epidemiology and economics at NIMH. “What’s especially important is the finding that around 1.5 percent of boys aged 10-18 are on antipsychotics, and then this rate abruptly falls by half, as adolescents become young adults.”

“Antipsychotics should be prescribed with care,” says Schoenbaum. “They can adversely affect both physical and neurological function and some of their adverse effects can persist even after the medication is stopped.”

The U.S. Food and Drug Administration (FDA) has approved antipsychotics for children with certain disorders, particularly bipolar disorder, psychosis/schizophrenia, and autism. However, the research team found that the medication use patterns do not match the illness patterns. The mismatch means that many antipsychotic prescriptions for young people may be for off-label purposes, that is, for uses not approved by FDA.

For example, maladaptive aggression is common in ADHD, and clinical trial data suggest that at least one antipsychotic, risperidone, when used with stimulants, can help reduce aggression in ADHD. To date, FDA has not approved the use of any antipsychotic for ADHD, making its use for this diagnosis off-label. In the current study, the combination of peak use of antipsychotics in adolescent boys and the diagnoses associated with prescriptions (often ADHD) suggest that these medications are being used to treat developmentally limited impulsivity and aggression rather than psychosis.

Olfson and colleagues worked with the IMS LifeLink LRx database, which includes 63 percent of outpatient prescriptions filled in the U.S. The team looked at prescription data for 2006-2010 and found antipsychotic use increased with age in both boys and girls, beginning at 0.11 percent in 2010 for ages 1-6 years, increasing to 0.80 percent for ages 7-12 years and increasing again to 1.19 percent for youth ages 13-18 years before dropping substantially to 0.84 percent for ages 19-24.

In children ages 1-6, boys were more than twice as likely as girls to receive an antipsychotic prescription (0.16 vs. 0.06 percent in 2010). This pattern held true for boys and girls ages 7-12 (1.20 vs. 0.44 percent in 2010) before narrowing for the 13-18 age group (1.42 vs. 0.95 percent) and finally becoming more comparable for young men and women ages 19 to 24 (0.88 to 0.81 percent in 2010). Among young people treated with antipsychotics in 2010, the youngest children, ages 1-6, were the least likely to receive the prescription from a psychiatrist (57.9 vs. 71.9, 77.9, and 70.4 percent for the other three age groups). This is a source of concern, as practice guidelines caution practitioners on the use of antipsychotic medications for young children in particular.

Among young people receiving antipsychotic prescriptions, fewer than half had any medical visit that included a mental disorder diagnosis. That may be in part due to stigma about mental illness, or because primary care providers are concerned about reimbursement for treatment related to such diagnoses.

“In addition to having a new look at antipsychotic use among youth, one positive finding coming from this study is that around 75 percent of these kids have at least some contact with a psychiatrist,” said NIMH Director Thomas Insel, M.D.

What You need to Know About ADHD - Attention Deficit Hyperactivity Disorder

Most children get restless, rowdy, or distracted at times. That’s all part of being a kid. But some kids have such trouble paying attention, staying focused, and finishing tasks that it interferes with their schoolwork, home life, and friendships. These difficulties might be signs of a developmental disorder called attention deficit hyperactivity disorder, or ADHD.

ADHD is a common brain condition in children. Nationwide, more than 1 in 10 kids ages 4 to 17 have been diagnosed with ADHD. Many will have all or some of their symptoms as adults too. While there’s no cure for ADHD, it can be treated and managed with medication and therapy.

“Kids with ADHD are impaired in their functioning in school, with friends, in activities, at home, or in the community,” says Dr. Benedetto Vitiello, a psychiatrist and child mental health expert at NIH. “The diagnosis is made because the level of hyperactivity or lack of concentration is extreme and prevents the child from engaging in what would be expected activities appropriate to their development.”

Children with ADHD usually get diagnosed around age 7, but more severe cases may be identified earlier. Often a teacher or parent notices the child seems out of control and has more serious and persistent behavior problems than other kids the same age.

Some children with ADHD are hyperactive (overactive) and impulsive (acting quickly without thinking). These kids are constantly in motion, fidget a lot, and find it hard to sit still. They’re impatient and have trouble controlling their behavior or waiting their turn.

Other children with ADHD, especially girls, are mainly inattentive (have trouble paying attention). Kids with the inattentive kind of ADHD have a hard time concentrating and following instructions. They often forget and lose things; they can’t seem to get organized or complete assignments or chores. Most kids with ADHD have a combination of the hyperactive-impulsive and inattentive types.

Researchers have been studying what might cause ADHD. The condition tends to run in families, but experts believe many complex factors may play a role.

Studies suggest that some aspects of brain development can be delayed by 2 or 3 years in kids with ADHD, especially in the parts of the brain involved in thinking, planning, and paying attention. For many kids, Vitiello says, the brain later develops normally and these kids catch up, even though some symptoms may continue throughout their lives.

There’s no single test to diagnose ADHD. If you’re concerned about it, talk with your child’s doctor or a mental health specialist. Medication and counseling can help kids focus and learn skills so they eventually won’t need constant reminders to do and finish routine tasks.

“Make sure there’s a good schedule of activities and a system of reinforcing the child to follow through on assignments,” says Vitiello. “Reward the child for good behavior and discourage distraction, impulsiveness, and other problematic behaviors.”

The most effective ADHD medications are stimulants, Vitiello says. In kids with ADHD, stimulants reduce hyperactivity and improve attention. Children taking these drugs should be monitored by a doctor. If symptoms don’t improve, or if side effects occur (such as loss of appetite, difficulty sleeping, or anxiety), the doctor might lower the dose or change the medicine.

“Considering there are different types and forms of the condition,” says Vitiello, “each child and each family needs to identify and tailor the approach to that child, without relying just on medication alone.”