Elsevier

Journal of Pediatric Health Care

Volume 26, Issue 2, March–April 2012, Pages 139-145
Journal of Pediatric Health Care

Department
Pharmacology Continuing Education
Antipsychotic Medication Prescribing Trends in Children and Adolescents

https://doi.org/10.1016/j.pedhc.2011.10.009Get rights and content

Abstract

The Food and Drug Administration has approved the use of antipsychotic medications in some children and adolescents with severe emotional and behavioral disorders. However, recent national data show a dramatic rise in off-label and Food and Drug Administration–approved uses of these medications. Of particular note is a twofold to fivefold increase in the use of antipsychotic medications in preschool children, despite little information on their long-term effects. This article describes the trend in pediatric antipsychotic medication use, possible explanations for the increase, implications for children’s health, and recommendations for pediatric providers who work with parents of children and adolescents who seek or receive antipsychotic medication treatments.

Section snippets

Antipsychotic Medications and Their Adverse Effects

The FDA has approved the use of select antipsychotic medications for children and adolescents for treatment of severe conduct problems that are resistant to other forms of treatment. Specific child psychiatric disorders include Tourette’s syndrome and behavioral symptoms associated with autistic disorder, childhood schizophrenia, and bipolar disorder (Crystal et al., 2009, Pathak et al., 2010). Medications approved for pediatric treatment of these disorders include haloperidol (Haldol),

Possible Reasons for the Rising Trend in Antipsychotic Use

Many hypotheses have been generated to explain the increased use of antipsychotic medications in children and adolescents. Some of these explanations are described below.

Implications for Pediatric Health Care Providers

Increasing consensus exists that antipsychotic medication should be the treatment of last resort, after parenting skills training and other behavioral treatments have been tried and have failed (Gleason et al., 2007). Many of the causes of children’s aggressive or disruptive behaviors are linked to family relationships and stressful, unpredictable home environments, which also may be violent and aggressive (National Research Council and the Institute of Medicine, 2009). Under these situations,

Conclusions

Although an increase in the off-label use of antipsychotic medications in children and adolescents has occurred, no standardized oversight exists to guide such use. Close monitoring in collaboration with a qualified mental health provider is needed to ensure safe prescribing practices. Given the significant adverse effects of antipsychotic medications and our limited knowledge of their long-term effects on children’s health, open communication with parents or legal guardians about the potential

Joyce Nolan Harrison, Medical Director, Community Child Psychiatry Programs, and Assistant Professor, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.

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  • Cited by (0)

    Joyce Nolan Harrison, Medical Director, Community Child Psychiatry Programs, and Assistant Professor, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD.

    Fallon Cluxton-Keller, NIMH Postdoctoral Fellow, Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD.

    Deborah Gross, Leonard and Helen Stulman Professor in Mental Health and Psychiatric Nursing, Johns Hopkins University School of Nursing, Baltimore, MD.

    Conflicts of interest: None to report.

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