Experts Decry Dangerous Use of Antipsychotics in Children

In a featured article for Psychiatric Services, psychiatrists from Dartmouth raise the alarm on the increasing numbers of children prescribed dangerous antipsychotic drugs. Despite the fact that data on the safety of long-term use of these drugs in this vulnerable population “do not exist,” the rate of children and adolescents being prescribed antipsychotic drugs have continued to increase over the past fifteen years.

“The crux of the issue is this: Children in the United States have increasingly been prescribed antipsychotic medications despite potentially serious short- and long-term side effects,” the authors write. “Yet other efficacious and safer interventions are available.”

Though there is a lack of quality research on the use of antipsychotics in children, existing studies reveal that side-effects like rapid weight gain and adverse hormonal effects are more extreme in children. Other serious side effects include fainting, sedation, gastrointestinal issues, metabolic syndrome, hypertension, abnormal breast development and even potentially irreversible movement disorders like Parkinson’s disorder, akathisia (restlessness), and tardive dyskinesia.  Due to the dearth in research, the long-term effects in children are unknown, but it has been linked to obesity, diabetes, heart disease, reduced social functioning and “progressive neurotoxicity” in young adults.

“We should be concerned about overuse of antipsychotics for many reasons. Children are inherently vulnerable because their brains and bodies are still developing and may be permanently altered by powerful medications.”

While the FDA has approved antipsychotic drugs for children who have been diagnosed with schizophrenia, bipolar disorder, and “severe behavior problems associated with autism,” the study authors point out that most randomized control trials for these uses have been “brief, and many have been sponsored by industry.” However, the majority of antipsychotic prescriptions in children are “off-label,” meaning they are prescribed in the absence of a diagnosis for which they are approved. Recent analysis shows that the most common diagnoses for a child prescribed an antipsychotic drug is ADHD and “the most vulnerable children— those in foster care, the juvenile justice system, and institutions— have been the most likely to receive antipsychotics.”

“Their disruptive behaviors are often related to disruptive parenting and stressful environments, which deserve primary attention. Adults may be motivated by the desire to achieve short-term control of behavior rather than to enhance children’s long-term growth and development.”

The authors also point out that psychosocial interventions and different forms of psychotherapy have been shown to be effective alternatives. “On the basis of the available evidence,” they add, “a workgroup of the American Academy of Child and Adolescent Psychiatry has recommended psychosocial rather than pharmacological interventions as the first-line treatment for children with aggressive behaviors.”

The paper presents five recommendations for decreasing the use of antipsychotics. First, preventative care can address socioenvironmental problems. They note that other wealthy countries provide for extended maternal leave and family supports and that children receiving antipsychotics “often come from situations of family disruption, neglect, trauma, abuse, changes in parenting and guardianship, poverty, environmental exposure to toxins, and other stressors.” Second, they stress the need to make mental health professional more aware of safer, evidence-based therapies and interventions and of the dangerous effects of antipsychotics in children. Third, changes in clinical guidelines should be made, and additional steps should be taken to increase compliance to these guidelines. Fourth, they suggest shared decision making. Clinicians, patients, and parents all need better information on antipsychotics and should all be involved in deciding on appropriate treatment methods. Lastly, education programs should be undertaken to reach the agencies and counselors who take care of and support vulnerable children.

“Health professionals, researchers, families, and legal guardians must protect children. Clinicians have an ethical obligation to provide evidence-based treatment—but also to do no harm.”

 

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Daviss, W. B., Barnett, E., Neubacher, K., & Drake, R. E. (2016). Use of Antipsychotic Medications for Nonpsychotic Children: Risks and Implications for Mental Health Services. Psychiatric Services.  (Abstract)