Antipsychotics Are Not Appropriate for a 2 Year Old
I remain astounded that psychiatrists and pediatricians think it’s occasionally appropriate to prescribe adult atypical antipsychotic medications — like Risperdal — to children younger than age 5.
Last week, The New York Times covered the story of Kyle Warren, a boy who began risperidone (Risperdal) treatment at age 2. Yes, you read the right — age 2.
He was rescued from this unbelievable prescription by Dr. Mary Margaret Gleason through a treatment effort called the Early Childhood Supporters and Services program in Louisiana. Dr. Gleason helped wean young Kyle off of the medications from ages 3 to 5, and helped understand that Kyle’s tantrums came from his stressful and upsetting family situation — not a brain disorder, bipolar disorder, or autism.
Imagine that — a child responding to a family situation that is stressful and involves his two primary role models — his parents.
After carefully reviewing the limited amount of research in this area, Psych Central recommends that parents should never accept an atypical antipsychotic medication prescription for a child age 5 or younger. If your doctor makes such a prescription, you should (a) look for another doctor and (b) consider filing a complaint with your state’s medical board against the doctor.
There is an astonishing lack of empirical or clinical data that suggest prescribing these kinds of medications to such young children — age 5 or younger — results in any significant change in mood or behavior. Lacking such data, it our opinion that it is simply irresponsible and inappropriate for medical professionals to prescribe such medications to young children.
There have been virtually no longitudinal studies conducted on children younger than 13 on these medications. We have no idea what the long-term effects of prescribing risperdal to a 2-year-old has on their long term cognitive and personality development. What few studies have been conducted and use the term “longitudinal” measure results and side effects at time periods like 6 months or 12 months (the maximum time of study we could find in a literature search). Yet few children are prescribed these kinds of medications for only 6 or 12 months. There’s continues to be a serious disconnect between how medications are prescribed in practice, and how they are researched.
The amount and number of tiny studies done on young children — those younger than 13 — for most of these medications is equally heart-stopping. They are few and far between, with typically small sample sizes (often in the 20 to 30 person range).
What brought this on was a recent article in The New York Times about a 3-year-old who was on an atypical antipsychotic. He was eventually diagnosed as simply having attention deficit disorder later on, but who knows what damage was done by the medication to his young, developing brain in the meantime.
It’s time to put a stop to this out-of-control prescription of atypical antipsychotics off-label. The American Academic of Child and Adolescent Psychiatry apparently agrees:
Dr. Lawrence L. Greenhill, president of the American Academy of Child and Adolescent Psychiatry, concerned about the lack of research, has recommended a national registry to track preschoolers on antipsychotic drugs for the next 10 years. “Psychotherapy is the key to the treatment of preschool children with severe mental disorders, and antipsychotics are adjunctive therapy — not the other way around,” he said.
So why do doctors continue to prescribe clearly inappropriate medications to younger and younger children? Costs and time. Medication is cheaper than psychotherapy in most cases. And psychotherapeutic interventions require a time and commitment on the family’s part to embrace change. Changing the family dynamics, changing the nature and quality of the parenting relationships, and changing how a parent copes with stress and the behavior of their child. Many parents fear a therapist will also be more judgmental — telling them that their parenting styles may have led to the child’s current problematic behavior. Some parents just aren’t able to hear that (even if therapists are usually far more tactful than looking to place blame — therapy is about helping produce beneficial changes, not blame).
But it is cheaper to medicate children than to pay for family counseling, a fact highlighted by a Rutgers University study last year that found children from low-income families, like Kyle, were four times as likely as the privately insured to receive antipsychotic medicines.
Texas Medicaid data obtained by The New York Times showed a record $96 million was spent last year on antipsychotic drugs for teenagers and children — including three unidentified infants who were given the drugs before their first birthdays.
In addition, foster care children seem to be medicated more often, prompting a Senate panel in June to ask the Government Accountability Office to investigate such practices.
In the last few years, doctors’ concerns have led some states, like Florida and California, to put in place restrictions on doctors who want to prescribe antipsychotics for young children, requiring a second opinion or prior approval, especially for those on Medicaid. Some states now report that prescriptions are declining as a result.
A study released in July by 16 state Medicaid medical directors, which once had the working title “Too Many, Too Much, Too Young,” recommended that more states require second opinions, outside consultation or other methods to assure proper prescriptions.
In a followup to the main article, Dr. Gleason responds to some readers’ questions, in an article entitled A Child Psychiatrist Responds. She confirms our reading of the research:
There is no scientific support for the use of psychiatric medications in infants and toddlers and limited support in preschoolers. However, parents know better than anyone else that there few available resources for families worried about their young child’s emotional or behavioral well being.
While the latter may be true, that’s little excuse for what’s happening with these kinds of crazy young prescriptions. Doctors, of course, should know better. But parents too have a responsibility to read up and become educated about the treatments a doctor is recommending for their toddler or preschooler.
The program Dr. Gleason is associated with sounds ideal — I wish we could replicate it across the country:
In our program, we also do consider the role of medication as part of the treatment plan in older preschoolers whose severe symptoms persist after therapy and who have a diagnosis that has been shown to respond to medications. We try to use all available research to guide these considerations. It is important in psychiatry — just like in other medical specialties — that we make treatment recommendations based on careful assessment and understanding of the child’s symptoms, relationships and life stressors. We also need to track how treatment is working and stop medications that are not improving a child’s functioning or are causing side effects that interfere with the child’s optimal functioning. Our goal is to help children and families enjoy each other, function at the highest level they can, and maintain physical health.
In my mind, a treatment approach that uses comprehensive assessment, and considers biological, psychological, and social factors in the patient’s life and uses treatments supported by the strongest evidence is far from anti-psychiatry. It is the best kind of psychiatry we can offer.
I understand the problems parents face when dealing with an out-of-control 2 year old. But the answer is not an atypical antipsychotic medication. The answer lies in gaining better parenting skills, and getting the child into a child psychologist or other early intervention child care program that understands the value of examining a family’s dynamics to get the whole story.
Because a 2 or 3-year-old should never be prescribed an atypical antipsychotic psychiatric medication.
Read the original article about Kyle and his family’s ordeal: Child’s Ordeal Shows Dangers of Antipsychotic Drugs
Grohol, J. (2010). Antipsychotics Are Not Appropriate for a 2 Year Old. Psych Central. Retrieved on July 3, 2015, from http://psychcentral.com/blog/archives/2010/09/07/antipsychotics-are-not-appropriate-for-a-2-year-old/