Aug. 2, 2004 -- A growing number of children with behavioral problems, such as ADHD, are being treated with new antipsychotic medications that haven't been well-studied or proven to work safely in children, according to a new study.
Researchers found the proportion of children on TennCare, Tennessee's program for Medicaid enrollees and the uninsured, prescribed antipsychotics for the first time nearly doubled from 1996 to 2001. At the same time, use of these drugs for the treatment of attention deficit hyperactivity disorder (ADHD) or conduct disorders among adolescents more than tripled.
"There were three areas of concern. First, these drugs appeared to be prescribed for disorders they are not proven to treat in children; second, the side effects of these drugs in children are not well understood; and third, usage of these drugs appears to be increasing dramatically," says researcher William Cooper, MD, of Vanderbilt University, in a news release.
Researchers say that in the past, use of antipsychotics to treat behavioral problems in children and adolescents was limited due to the high risk of side effects, such as movement disorders, associated with the drugs available at that the time.
A new generation of antipsychotics was introduced in the 1990s that don't carry the risks of these traditional side effects at least in adults. But researchers say the safety and effectiveness of these drugs in children is not yet thoroughly understood.
This new generation of antipsychotics includes Clozaril, Risperdal, Zyprexa, Seroquel, and Geodon. They are approved for use in treating psychosis and Tourette syndrome in adults- a neurological disorder characterized by involuntary movements and uncontrolled vocal noises.
"The newer drugs do have their own set of potential side effects, including serious weight gain, heart rhythm problems, and diabetes," says Cooper. "These are potential side effects that are not well understood when applied to children. In fact, some preliminary studies suggest that the side effects from these medications are more common and may be more severe in children than in adults."
Antipsychotic Use Rising Among Children
In the study, researchers looked at the use of antipsychotic medications among children aged 2 to 18 years enrolled in TennCare. The results appear in the August issue of Archives of Pediatric & Adolescent Medicine.
The study showed that the number of children who were prescribed antipsychotics for the first time nearly doubled from 23 per 10,000 in 1996 to 45 per 10,000 in 2001. More than 43% of the children who received the drugs were diagnosed as having ADHD or conduct disorder.
Researchers say there were also significant changes in how antipsychotics were used among children. For example, use of the drugs for the treatment ADHD and mood disorders increased by more than twofold during the study period, while use of the drugs for psychosis or Tourette syndrome remained relatively constant.
The greatest increase in antipsychotic use was among adolescents aged 13 to 18 with ADHD and conduct disorders. Prescriptions for antipsychotics among these users rose by more than threefold.
Researchers say the increased use of antipsychotics for the treatment of children and adolescents with affective or mood disorders (such as depression or anxiety) may be due in part to recent findings that show the drugs may be effective in treating adults in the manic phase of bipolar disorder.
Cooper says it may also be perceived that these drugs are safer for children and may help with in the treatment of aggressive disorders, but those studies still need to be done.
"We would like for physicians to think very carefully before prescribing these drugs to children," says Cooper. "And we hope this study encourages more research to find out how these drugs might be best used to help children."