The use of antipsychotic drugs for very young children with behavior problems approximately doubled between 1999-2001 and 2007. Yet fewer than half of these children received a mental health assessment, a psychotherapy visit, or a visit with a psychiatrist while taking these medications, reveals a new study.
The rate of antipsychotic drug treatment among privately insured children, aged 2-5 years, rose from 0.78 to 1.59 per 1,000 children during the study period, and increased more for girls (148 percent) than for boys (94 percent). Treatment with antipsychotic drugs rose significantly for children diagnosed with pervasive developmental delay/mental retardation (57 percent), disruptive behavior disorders (54 percent), and attention deficit/hyperactivity disorder (70 percent). Antipsychotic drug treatment for children without a diagnosed mental disorder increased by 65 percent, although the rate per 1,000 children remained low. Over the same time period, the rate of nondrug interventions decreased or remained unchanged. The rate of mental health assessments for children treated with antipsychotic drugs remained essentially unchanged from 1999-2001 (40 percent) to 2007 (almost 41 percent). While 50 percent of children treated with antipsychotic drugs in 1999-2001 had at least one psychotherapy session during a treatment year, this rate fell to slightly more than 41 percent by 2007.
These findings raise safety concerns, note the researchers. They point out the paucity of evidence supporting the efficacy of these medications to treat young children, their known adverse metabolic effects, and unknown long-term effects on the developing brain. Their findings were based on analysis of service and pharmacy claims from the MarketScan Research Databases on privately insured individuals and their families from 150 United States employers.
The study was funded in part (HS16097) by the Agency for Healthcare Research and Quality (AHRQ) to the Center for Education and Research on Mental Health Therapeutics at Rutgers University, one of 14 Centers for Education and Research in Therapeutics (CERTs) funded by AHRQ. For more information on the CERTs program, visit the
Centers for Education & Research on Therapeutics (CERTs)
More details are in "Trends in antipsychotic drug use by very young, privately insured children," by Mark Olfson, M.D., M.P.H., Stephen Crystal, Ph.D., Cecilia Huang, Ph.D., and others in the January 2010 Journal of the American Academy of Child & Adolescent Psychiatry 49(1); pp. 13-23.