A new study finds that teens and young adults with Down syndrome between the ages of 12 and 21 were significantly more likely to be on psychotropic medications than children five to 11 years old.
Among children less than 12, the odds of being on a psychotropic medication increased with age for all classes of medications studied.
For 12- to 18-year-olds, the odds of being on a stimulant significantly decreased with age, while the odds of being on a medication from other classes of drugs remained stable over time.
“Variations in medication use over time in children and teens with Down syndrome suggest that the type and severity of neurobehavioral problems likely change over time, too,” says Julia Anixt, M.D., a developmental pediatrician at Cincinnati Children’s Hospital and a co-author of the study.
The study is published online in the Journal of Developmental & Behavioral Pediatrics.
In the younger age group, the odds of being on a stimulant increased 1.37 times for each additional year of age from five to 11. This means that a nine year old would be 3.5 times as likely to be on a stimulant medication as a five year old.
This increase in use “may reflect increasing impairment in functioning due to ADHD symptoms as children approach 11 years. After that age, the use of stimulants declined with each increasing year.”
Declining behavioral problems (outwardly disruptive behaviors) and increasing emotional problems, such as depression and anxiety, with age are also common in typically developing children and those with intellectual disability.
Use of atypical antipsychotics (AAP) peaked in the age range of 11 to 14, which is an age range that previous studies have identified as consistent with a peak in challenging behaviors in children with Down syndrome.
AAPs are approved for the treatment of irritability and aggression in children with autism spectrum disorders but are often prescribed “off-label” to target problem behaviors in children with disruptive behavior disorder and developmental disabilities.
The study found that the rates of AAP use in boys was higher than in girls for all ages.
Researchers reviewed data on 832 children taken between 2010 and 2013. All were patients at Cincinnati Children’s. The division of Developmental and Behavioral Pediatrics at Cincinnati Children’s is home to The Thomas Center, a specialized clinical program for the care of children with Down syndrome.
Researchers believe the review was insightful in showing that medical and pharmaceutical management for this special cohort can be improved.
“Providers must be more systematic in the screening, diagnosis, and management of mental health conditions in children and teens with Down syndrome,” said Anixt.
“Eventually, the American Academy of Pediatrics health guidelines for children with Down syndrome could be expanded beyond physical health conditions to include treating behavioral and mental health conditions, thus improving the long-term outcomes and quality of life of individuals with Down syndrome.”