Which Kids Should Take Antipsychotics?

Antipsychotics prescribed for ADHD off label are increasing among children

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Some medications can be used to treat multiple conditions, especially in mental health. But drugs are also sometimes prescribed for conditions they aren't approved to treat.

A recent study has found that an increasing number of children diagnosed with ADHD have been taking antipsychotics.

However, these drugs are not typically approved to treat ADHD.

"Ask your doctor if your meds are off label."

The study, led by Meredith Matone, MHS, of the PolicyLab at The Children's Hospital of Philadelphia, looked at how antipsychotics have been prescribed to children enrolled in Medicaid.

The researchers used a data set from the Medicaid Analytic Extract files for all 50 states, plus Washington, DC, for the years 2002 through 2007.

They basically compared what antipsychotic prescriptions the children had filled with what their mental health diagnosis was.

Overall, the researchers found that the use of antipsychotics had increased 62 percent during the study period.

Mental health diagnoses also increased over this time, but only by 28 percent, which does not explain the jump in prescriptions.

By 2007, 354,000 children, which is 2.4 percent of all children on Medicaid, were being prescribed antipsychotics.

The children most likely to receive these prescriptions were those diagnosed with bipolar disorder, schizophrenia or autism.

However, over the study period, it was children who had been diagnosed with attention deficit hyperactivity disorder (ADHD) and those who had been diagnosed with three or more mental health conditions who filled the most number of prescriptions for antipsychotics.

By 2007, about 50 percent of the children using antipsychotics were children with a diagnosis of ADHD. For about 1 of every 7 children prescribed antipsychotics, ADHD was their only diagnosis.

The authors expressed concern that this high use of antipsychotics among children with ADHD means more research is necessary into the effectiveness of these medications for the condition.

"In the context of safety concerns, disproportionate antipsychotic use among youth with non-approved indications illustrates the need for more generalized efficacy data in pediatric populations," the authors wrote.

Antipsychotics are not typically designed to be given to children with ADHD and most have not been approved by the FDA for the treatment of ADHD.

Prescribing an antipsychotic to a child with ADHD is using the drug in a way called "off label."

"Off label" means that an FDA-approved medication is being prescribed for a condition that it was not tested and approved to treat.

If the FDA did not approve a drug to be used for ADHD, but a drug is prescribed to treat it, that is using the drug off label.

In this study, by 2007, approximately 65 percent of the children taking antipsychotics were using the medications off label.

Using medications off label is not necessarily a bad thing. It is legal, and there are many valuable uses of off label medications.

However, it is important that safety and effectiveness data exist to support the use of medications for conditions they were not intended for.

When a medication can cause other side effects, it's especially important that these safety and efficacy studies be conducted for off label uses.

The study was published online September 4 in the journal Health Services Research. The research was funded by a grant from the Agency for Healthcare Research and Quality and a fellowship from the Stoneleigh Foundation.

Reviewed by: 
Review Date: 
September 24, 2012
Last Updated:
October 4, 2012