Antipsychotic Use in Children on Medicaid Needs Close Monitoring, Researchers Suggest

Very young children and those in foster care who are enrolled in Maryland’s Medicaid program are more likely to be taking atypical antipsychotic medications for attention-deficit/hyperactivity disorder (ADHD) that is not comorbid with other illnesses than other young people receiving Medicaid benefits. Noting the "profound" increase in off-label use of antipsychotics, including for ADHD, researchers from the University of Maryland, Johns Hopkins University, and Morgan State University, all in Maryland, examined administrative data on 266,590 youth. About 2.5% of the 2- to 12-year-olds and 5.2% of the 13- to 17-year-olds were prescribed atypical antipsychotics for ADHD in 2006, reported Julie Zito, Ph.D., a professor of pharmacy and psychiatry at the University of Maryland School of Pharmacy, online Tuesday in the Journal of Child and Adolescent Psychopharmacology.

Zito and colleagues found differences in atypical antipsychotic medication use that varied by age, Medicaid eligibility, and diagnostic status. For example, youth in foster care diagnosed with ADHD and no other comorbid illness were three times more likely to be taking atypical antipsychotics and for an additional 100 days per year than their peers enrolled in Medicaid because of low family income. Since side effects such as weight gain, high cholesterol, elevated blood glucose, or insulin resistance can occur with use of antipsychotic drugs, the researchers urged careful review of each case before prescribing and continued monitoring and research to assure that the benefits of these medications outweigh the risks in children and adolescents. They concluded, "Exposure to atypical antipsychotics in Medicaid-insured youth, in particular for children in foster care and those diagnosed with ADHD, was substantial, warranting outcomes research for long-term effectiveness, safety, and oversight for appropriate cardiometabolic monitoring."

To read more in Psychiatric News about the use of antipsychotic medications in young people, see the article, “Increase in Off-Label Antipsychotic Use Seen in Canadian Youth.” Also see Clinical Manual of Child and Adolescent Psychopharmacology, Second Edition, from American Psychiatric Publishing.

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