Atypical antipsychotics increasingly used in kids

Atypical antipsychotic drugs are increasingly being prescribed for children with attention deficit/hyperactivity disorder (ADHD) and mood disorders, investigators report. However, there is little evidence that the benefits of treatment outweigh the risk.

Dr. William O. Cooper and associates at Vanderbilt University in Nashville, Tennessee, reviewed medical records of children enrolled between 1996 and 2001 in Tennessee's expanded Medicaid program to identify new users of atypical antipsychotics, such as Risperdal (risperidone) and Zyprexa (olanzapine).

During this period, 6,803 children became new users, approximately doubling from 23 per 10,000 in 1996 to 45 per 10,000 in 2001.

Use of these drugs for ADHD or conduct disorder, and mood disorders increased up to 2.5-fold, the authors report in the Archives of Pediatrics and Adolescent Medicine. The proportions of children starting these drugs for its indicated uses - psychosis, mental retardation, autism or Tourette syndrome - remained relatively constant.

Whether this increase is warranted or not remains to be seen, Cooper told Reuters Health. Clinical trials have been conducted for ADHD and mood disorders "among institutionalized children with severe behavioral problems and aggressive behaviors, and there has been some benefit observed in those children," he explained. However, there have been "no studies done among community-based children."

Of concern are the preliminary studies suggesting that the potential adverse effects, such as obesity, type 2 diabetes, and cardiac arrhythmias, "may be more common and potentially more severe in children compared with adults," he said.

"It is possible that the benefits may outweigh the risks," he added, "but we just don't know."

The increased reliance on these drugs may be the result of increasingly limited resources for mental health services for children, Cooper theorized. As a result, he is concerned that drugs may be substituted for other safer, but more expensive options, such as behavioral therapy.

So what should parents do if these medications are being considered for their child? According to Cooper, "parents should talk with their doctor to understand what the medicine is being used for and what the known risks are. Then they can make a decision about what will be best for that individual child."

SOURCE: Archives of Pediatrics and Adolescent Medicine, August 2004.