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Prescriptions of antipsychotic medications for young children are declining, a new study finds.

However, doctors are continuing to prescribe the drugs “off-label” for kids with conditions like attention deficit hyperactivity disorder (ADHD), anxiety, depression and conduct disorders, the research found.

The medications don’t have the safety and effectiveness data needed, nor do they have U.S. Food and Drug Administration approval for this off-label usage, according to the study.

“We lack information on the effectiveness and safety of antipsychotics for treating those conditions in young children,” said lead author Greta Bushnell, a member of the Rutgers Institute for Health, Health Care Policy and Aging Research and an assistant professor at Rutgers School of Public Health in New Brunswick, N.J.

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

The study looked at more than 301,000 antipsychotic prescriptions filled between 2007 and 2017 for children ages 2 to 7 who were covered by private insurance.

In recent years, pervasive developmental disorders (PDD) accounted for the most antipsychotic prescribing. PDD includes delays in development of socialization and communication skills. The medications also were most often prescribed to boys, especially between the ages of 6 and 7. Most of the children who were prescribed antipsychotics were also taking other psychotropic medications, including stimulants, antidepressants or drugs to treat ADHD, according to the study.

“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,” said Bushnell. “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.”

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Antipsychotic medication comes with risks to children, including weight gain, sedation, diabetes, high cholesterol, cardiovascular disease and unexpected death. The drugs can also affect development in very young children.

“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 said.

The study was published recently in the Journal of the American Academy of Child and Adolescent Psychiatry


Rutgers University, news release, Nov. 9, 2020

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