ANTIPSYCHOTIC DRUG USE DOUBLES IN TENNESSEE ADHD CHILDREN

            At this time when parents, schools and physicians still struggle with the overuse of the medication Ritalin to treat children with attention difficulties, a new study suggests the potential for another controversy.  Researchers at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville have found a new class of antipsychotic medications is being prescribed for an increasing number children with attention deficit/hyperactivity disorder (ADHA).  These drugs have never been tested to find out if they work for ADHD or if they are safe for children.

            The study, published in the Archives of Pediatric Adolescents Medicine, found that nearly one in 100 adolescent TennCare recipients are being prescribed powerful antipsychotic medications for behavioral problems associated with ADHD.  The study, authored by William Cooper, M.D., associate professor of Pediatrics at Children’s Hospital, tracked medical records of thousands of children listed in TennCare, Tennessee’s managed care program Medicaid enrollees and the uninsured, between 1996 and 2001.

            The study revealed that between 1996 and 2001the proportions of the TennCare children who were new users of antipsychotic medications for ADHD and mood disorders nearly doubled from 23 to 45 per 10,000 children.  Perhaps most concerning, the amounted to nearly on in every 100 adolescents covered under TennCare.

            Cooper says it appears antipsychotic medications are targeted to help aggressive behavior associated with ADHD.  Cooper and Catherine Fuchs, M.D., associate professor of Psychiatry in the division of Child and Adolescent Psychiatry, said this was precisely the concern when, starting in 1998, they began noticing an increasing number of children in Vanderbilt’s clinics who were on antipsychotic drugs.  In 2001, Cooper and Fuchs began the retrospective research.

            “There were three areas of concern.  First, these drugs appeared to be prescribed for disorders that are not proven to treat children; second’ the side effects of these drugs in children are not well understood; and third, usage of these drugs appears to be increasing dramatically.” Cooper said.

            Cooper said there is modest evidence to support the use of this newer class of antipsychotic medications to treat severe disruptive behaviors associated with autism and metal retardation, but not for behavior symptoms associated with ADHD and conduct disorders.  He said it might be perceived that newer antipsychotic drugs are safer for children, and that the drugs can help children with aggressive behaviors.

            “But those studies still need to be done.  We don’t know if the drugs are really safe an beneficial when used this way,” Cooper said, adding that there are anecdotal reports leading him to believe the same questions need to be asked for all children. “We would like for physicians to think very carefully before prescribing these drugs to children.” Conrad said she hopes this study makes parents think seriously before seeking these powerful drugs as a quick fix.