Should Children Take Antipsychotic Drugs?

Posted on March 5, 2014

Prescriptions are on the rise, but evidence for the drugs' safety and effectiveness is mixed

Modern antipsychotic drugs are increasingly prescribed to children and adolescents diagnosed with a broad variety of ailments. The drugs help to alleviate symptoms in some disorders, such as schizophrenia and bipolar disorder, but in others their effectiveness is questionable. Yet off-label prescribing is on the rise, especially in children receiving public assistance and Medicaid. Psychotic disorders typically arise in adulthood and affect only a small proportion of children and adolescents.

Off-label prescriptions, however, most often target aggressive and disruptive behaviors associated with attention-deficit hyperactivity disorder (ADHD). "What's really concerning now is that a lot of this prescription is occurring in the face of emerging evidence that there are significant adverse effects that may be worse in youth than in adults," says David Rubin, a general pediatrician and co-director of PolicyLab at Children's Hospital of Philadelphia.

ADHD and Disruptive Behavior Disorders
Doctors frequently prescribe antipsychotics to young people with conduct disorder, oppositional defiant disorder or ADHD, even though the drugs are not approved for these conditions. In a 2012 review of eight randomized controlled trials that took place between 2000 and 2008, researchers concluded that modern antipsychotics diminished aggressive tendencies in children with disruptive behavior disorders, but the effects were only marginally significant. A 2011 survey of off-label uses of these antipsychotics found that evidence supporting their effectiveness in children diagnosed with ADHD alone was "low or very low."

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Source material from Scientific American


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