The findings, published in the journal JAMA Network Open, show that fewer than half of the youth in the study who were prescribed antipsychotic drugs had first been treated with stimulants such as Adderall and Ritalin, the recommended medication treatments for ADHD.
“We didn’t know how widespread this practice was among young people starting ADHD treatment,” said senior author Mark Olfson, M.D., M.P.H., Elizabeth K Dollard Professor of Psychiatry, Medicine, and Law at Columbia University Vagelos College of Physicians and Surgeons. “There are substantial risks associated with the use of antipsychotic drugs in young people, including weight gain, hyperlipidemia, diabetes, and even unexpected death.”
In recent years, pediatricians and parents have expressed concern that some physicians are prescribing antipsychotic drugs to children with ADHD who have significant aggressive or impulsive behavior.
Children and teens with ADHD who are treated with antipsychotics are often also diagnosed with depression, oppositional defiant disorder (ODD), or conduct disorders (CD), even though there is limited evidence that the drugs are effective for ODD or CD and no evidence they are effective in treating depression.
To determine the prevalence of antipsychotic use in youths with ADHD, the researchers analyzed medical and prescription drug data on 187,563 commercially insured children and young people (ages 3 to 24) who were diagnosed with ADHD between 2010 and 2015.
The team discovered that 2.6% of youths diagnosed with ADHD were prescribed an antipsychotic drug within a year of diagnosis — four times the rate among young people in general. Antipsychotic drug use was highest (4.3%) in the youngest children diagnosed with ADHD, those ages 3-5 years.
“It’s reassuring that only a relatively small percentage of these children were prescribed antipsychotics,” Olfson says. “But we should be working to reduce that number even further.
“For at least half of the young people in our sample who were prescribed antipsychotics, we couldn’t find a rationale in their claims records to explain why they were taking these medications.”
“While antipsychotics are not FDA-approved for these diagnoses, there is scientific evidence to support their use in treating severe symptoms of ADHD,” said Ryan S. Sultan, M.D., lead author of the paper and assistant professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons.
The findings show that fewer than half of the young people taking antipsychotic drugs had been treated first with stimulants such as Adderall and Ritalin, the recommended medication treatment for ADHD.
The researchers suggest that many of the behavioral symptoms that prompted physicians to prescribe antipsychotic medications as an initial treatment might have been resolved by prescribing recommended ADHD medications first.
“Many physicians bypassed stimulants and went right to antipsychotics — contrary to expert opinion about treatment for ADHD, and unnecessarily exposing patients to the risk of severe side effects such as substantial weight gain,” said Sultan.
“Antipsychotic medications play a small role in the treatment of severe ADHD symptoms, but in the absence of severe symptoms, there are safer, more effective medications for youths with ADHD.”