Children with ‘ADHD’ Commonly Prescribed Antipsychotics

Despite little evidence for benefit, and substantial risk of harm, antipsychotics are commonly prescribed to children diagnosed with ADHD

Peter Simons
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A new study, published online this month in the Canadian Journal of Psychiatry, finds that antipsychotic medications are commonly prescribed to children diagnosed with attention deficit/hyperactivity disorder (ADHD), despite limited evidence of effectiveness and significant risk of harm. Even more troubling is that, in this study, more than 25% of those prescribed antipsychotics did not have a diagnosis for which that medication would be indicated.

Photo Credit: Flickr

The researchers, led by Tonya S. Hauck, MD, PhD, at the University of Toronto, examined 10,000 medical records of children between the ages of 1 and 24, randomly selected from across the Canadian province of Ontario. The total prevalence of ADHD diagnosis was 5.4%, and it was far more prevalent in males (7.9%) than females (2.7%). 70% of the children with ADHD were prescribed stimulant or non-stimulant ADHD medications. The most commonly prescribed medications for ADHD are amphetamines such as Adderall and Vyvanse, and methylphenidates such as Ritalin.

Additionally, 11.9% of the children with ADHD received a prescription for an antipsychotic medication. Strangely, 28.1% of those children did not have any mental health diagnosis besides ADHD.

 “We don’t know why these children and youth with ADHD are on antipsychotics, but there is a risk associated with early antipsychotic exposure,” according to the researchers, writing in a press release about the study.

Risperidone (Risperdal) was the most commonly prescribed antipsychotic medication for children with ADHD. The drug has FDA approval for the treatment of schizophrenia and bipolar disorder, but not for ADHD. The makers of Risperdal are Janssen Pharmaceuticals, a division of Johnson & Johnson. They are currently facing extensive lawsuits alleging that they hid data about the risks of adverse effects of the drug, particularly gynecomastia, or an increase in the size of male breast tissue. Gynecomastia has been associated with psychological distress in the form of shame, isolation, and low self-esteem. Another common side effect of antipsychotic medications is extreme weight gain, which puts children at risk for diabetes and other metabolic disorders.

Dr. Hauck and her colleagues go on to discuss the lack of evidence for the efficacy of antipsychotics for ADHD. They write, “Despite the widespread use of antipsychotics for ADHD, the evidence for their use is sparse […] they are not indicated for the core symptoms of inattention and hyperactivity.”

The researchers conclude that for antipsychotics, “there is little evidence of benefit and substantial evidence of potential harm.”

Numerous researchers have questioned whether ADHD itself is overdiagnosed, and concerns have been raised about the risks of prescribing stimulant medications to children.

It is unclear why antipsychotics are so commonly prescribed for ADHD. The only predictor that correlated with the prescription of antipsychotics was that the child was likely to have had a visit with a psychiatrist.

An article about the study, published in Medscape Medical News, quotes Steven V. Faraone, PhD, of SUNY Upstate Medical University, in response to these questions. He states, “I wouldn’t be surprised if sometimes a psychiatrist doesn’t want to make another diagnosis, like pediatric bipolar disorder, because, one they’re not comfortable; two, they don’t want to stigmatize; or three, they’re not sure, but they know that this kid is really disturbed and very aggressive and possibly having some psychosis.”

To clarify, then, according to Dr. Faraone—who was not involved in the research study—psychiatrists may be prescribing antipsychotic medications when they are “not sure” what is happening or when they are “not comfortable” making an official diagnosis beyond ‘ADHD.’ This explanation, if true, raises important questions. For example, should medications with minimal evidence for benefit and many side effects be prescribed off-label to young children?

To answer these questions, many practitioners are likely to turn to clinical practice guidelines for recommendations. Of note is the difference between American guidelines and guidelines in other countries. For instance, the researchers write that “American guidelines (American Academy of Child & Adolescent Psychiatry) suggest “medications not FDA approved” as a treatment option if first-line treatment fails in preschool children, whereas the United Kingdom (National Institute for Health and Care Excellence) guidelines say, “drug treatment is not recommended” in preschool children who do not respond to first-line treatment.”

That is, the US guidelines recommend that if preschool children do not improve quickly, then medications that have not been vetted by the FDA are suggested. It is unclear how treatment guidelines can ethically suggest that pharmaceuticals that have not been rigorously tested and approved for this purpose are an appropriate treatment for preschoolers.

Although this study was conducted in Canada, the authors note that their prevalence rates and rates of medication use match previous research in both Canada and the US. A strength of this study was that the researchers collected data from a large, demographically diverse sample of the population. However, because the study used medical records only from family physicians and general practitioners, children receiving prescriptions from other sources (hospitals or pediatricians, for instance) may not have been part of the dataset. The researchers also note that their study could only determine the prevalence of doctor’s prescription, not whether the prescriptions were actually filled or whether the children adhered to their medication regimen.

Dr. Hauck and her colleagues suggest that more research is needed to determine why antipsychotic medications are being prescribed at such a high rate to children diagnosed with ADHD. They recommend that doctors carefully consider alternative options before turning to medications with limited evidence of benefit and substantial risk of harm.

 

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Hauck, T. S., Lau, C., Wing, L. F. F., Kurdyak, P., & Tu, K. (2017). ADHD treatment in primary care:Demographic factors, medication trends, and treatment predictors. Canadian Journal of Psychiatry, 1-10. doi: 10.1177/0706743716689055 (Abstract)

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35 COMMENTS

  1. This is horrific in so many ways. What professionals have been doing to children in the name of care is immoral. I could go on but I am too saddened. At least, this form of child abuse is coming out.
    Alice Miller books should be required reading for all college students. And not just once but again and again.

  2. I have an idea why this happened. When speed was the rage in ADHD drugs, it was possible for kids and parents to sell it on the open market instead of consuming it. Neuroleptics don’t have the alcohol-related buzz of ordinary downers, merely turning you and your kids into zombies, instead- no market outside of places using zombies for cheap labor, as in Ghana or Nigeria.

  3. “Professionals” providing “care”?? Nothing professional or caring about poisoning little children with neurotoxins that disrupt the normal development of their brains.
    These are simply confused, uneducated, dangerous people “not sure” about anything because they know nothing about human beings and distress or behavioral differences.
    Parents who allow pseudo doctors practicing pseudo science to drug their children with stimulants and antipsychotics for simply being children, bored or hyperactive or whatever, should be charged with child abuse.

  4. My best bet is that the kids given the neuroleptics are from lower socioeconomic status groups and/or minorities. My other guess is that more of the parents of the neuroleptic kids are more abusive than the kids given the uppers. I’m sure there’s family problems and straight up abuse in both groups, but I’m going to guess and say that more hardcore abusive parents would be interested in tranquilizing their offspring.

    • it would be useful to see a study of the parents who do or do not allow their children to be pharma-drugged. We’ve seen that foster children are certainly pharma-drugged disproportionately (not surprising), but uninformed guesses that heap scorn go nowhere. I know personally of families of all socioeconomic groups allowing their children to be pharma-drugged, and none of them are ‘abusive’. This is a problem of a pharma-drugged society and world, not of ‘abusive’ parenting. Or else call ALL pharma, conventional medicine, public schooling, and government education departments (these are all the groups who push drugs on families) ‘abusive’ and call it a day. ALL parents want to tranquilize their unruly children, or else this would not be a billion-dollar business.
      Liz Sydney

      • Trauma of all kinds does account for child “misbehavior”/acting out. We can and should be clear that parents directly impact their children, both for good and for bad. We all had imperfect caregivers, and in some cases some very detrimental parenting which is highly abusive. To ignore this contributing factor is to turn a blind eye to abuse and neglect,t which is one of the primary causes of childhood suffering. No doubt big pharma is the blame but parents are the ones who are ultimately responsible for their children’s well being.

        • A problem with MIA is that there is no space and no writing (anymore; there has been some in the past) on children. (And agenda-driven writing by people inside and outside MIA who have no actual, longterm experience with very difficult children is useless.) By all means make sweeping generalizations and bash parents you don’t know, but it means MIA will never be a place for great, thinking parents to go who have parented well and have children with issues. MANY kids who were NEVER abused or traumatized develop symptoms/behaviours; and great, thinking parents have to deal with it in a pharma-crazy environment. The vast majority of drugging parents should not be drugging their kids, but I don’t blame them because to NOT drug a difficult kid means adults losing their livelihoods, and untenable pressure by schools. Nobody is treating behaviour problems (or the perception of ‘bad’ behaviour) as a systemic problem, so desperate parents are left to their own devices. At any rate this is a big and complex issue that MIA doesn’t address. Big weakness on MIA’s part. NAMI does address it, and makes parents feel good about drugging, so I guess that’s how it sweeps parents into its fold.

          • Hi ourviolentchild,

            There’s some good news on this front, actually. There will be a new “parent resources” section going up on the Mad in America site in the near future, curated by Eric Maisel. He’s already built up a wide-ranging list of resources and we’re just needing some design work to get the content up on the site. Look out for it soon.

          • Your point is very well taken. I have written on this topic in the past for MIA, maybe it’s time for me to take another swing at it. There have been some articles about foster kids, but regular old kids like yours and mine who just happen to be very inconvenient and difficult for adults to manage just don’t have sufficient cache to pull in big numbers of readers.

            Do you have any thoughts as to a better venue to get the attention of parents who are loving and well-intended but need some help figuring out their options?

          • Ourviolentchild,

            So do you deny that some parents/caregivers physically, emotionally, or sexually abuse their children? I do believe that people are generally doing the best they can with what they know, but often what they know is insufficient. In the case of child abuse and neglect, I fail to find any reasonable justification for it.

            I agree with you that it’s a complicated issue, and parents certainly aren’t totally to blame. Society as a whole needs to take a more holistic approach to examine the root causes of human suffering and to create lasting solutions which do no harm. We still have a long way to go for sure.

  5. It is disheartening how often kiddos are given psych drugs instead of getting help dealing with the root causes of their behavior. Too often they are experiencing trauma of some kind, or at the very least changes or stress in their home life (e.g., parents divorcing). And too often parents are conditioned by the system to think that if their kiddo gets the right meds the problematic behaviors will be erased. The sad reality is that many parents are the cause of their children’s suffering but don’t feel compelled to do the hard work to look at themselves and their behaviors. Easier to blame biology rather than look at other possibilities.

  6. I was given neuroleptics as a kid. It is straight up child abuse. I wish they’d just hit me instead, because then the abuse would’ve been obvious.

    It’s a shame we can’t criminally charge the people within the pharma companies who were responsible for pushing these drugs on children, and sue every doctor who participated into the bankruptcy. There are countless people in prison who have done less harm than these ‘professionals’.

    • Agree absolutely the fault lies with pharma. The lying narrative starts there. Then mediocre professionals in public education, medicine, psychology, and teaching carry that narrative without ever sparking a single neuron of their own until it’s stuffed by parents into children’s mouths.
      Liz Sydney

    • Thinking more on this, I suspect the belief that most of the kids who are being drugged have behavior problems may be an exaggeration. No doubt some do, but I didn’t — I was just lonely and anxious. My abusive psychologist (not a psychiatrist!) slapped a bogus label of ‘aspergers’ on me, then decided, “Hey, antipsychotics are used for autism. Let’s give him somma doze.”

      And so on her recommendation, the psychiatrist rubber-stamped a script for a neuroleptic, and I spent the next three years of high school as a zombie.

      Frankly, I think we’re underestimating how much drugging happens with only the barest of justifications to kids with no behavior problems at all. We know how J&J falsely marketed Risperdal to children, (resulting in over a billion dollar fine) and now we’ve got a fair number of shrinks who think it’s reasonable to prescribe these drugs willy-nilly as if they’re harmless as vitamins.

    • If parents had the analysis, time, money, and energy to ‘organize’ and ‘protest’, then they wouldn’t feel utterly pressured into drugging their kids in the first place. That ship has sailed. Good parents are absolutely overwhelmed. Having a difficult or ‘disruptive’ kid is just the cherry on top. Enter: Solutions by your caring pharma manufacturer, delivered by your caring family physician, advocated by your caring school…

  7. “Steven V. Faraone, PhD…states, ‘I wouldn’t be surprised if sometimes a psychiatrist doesn’t want to make another diagnosis, like pediatric bipolar disorder, because, one they’re not comfortable; two, they don’t want to stigmatize; or three, they’re not sure, but they know that this kid is really disturbed and very aggressive and possibly having some psychosis.”

    There are SO many things SO wrong on SO many levels with everything coming out of that PhD’s mouth in that one sentence. It almost sums up the problem. We’ll see in the future that there was no ‘pediatric bipolar disorder’, and that it was another wholesale invention to fatten the DSM. Unless it’s a group of symptoms created by a first one or two prescribed pharma drugs (antidepressants, probably).

    Next, I hope the ‘stop the stigma’ crowd sees that its ridiculous efforts have resulted in kids being prescribed even worse pharma drugs. Next, I know that the professionals are clueless about what constitutes a ‘really disturbed’ and ‘aggressive’ child, about why that child may be so, and about how to think about it. And I love the ‘possibly having psychosis’, so let’s throw a long-term antipsychotic drug at a developing brain of an unhappy child, likely leading to worse thinking in ten different ways.

    But it’s not just that particular clueless PhD (they mostly all are), it’s an entire ecosystem of sorts that has made parents believe that drugging is somehow a treatment and a solution… to a problem very few are interested in actually understanding.

    Liz Sydney

    • Exactly right. It’s an ecosystem combining money, advertising, a rhetoric of medicalization, the manipulation of well-intended parents, contemporary schooling, and the professional psych guilds that ends in mass drugging of children. An analysis of a few bad actors here and there misses the scale of the problem.

  8. This article really bugged me for a number of reasons. The most disturbing is the apparent bafflement of the psychiatric community as to why antipsychotics are being prescribed to kids with “ADHD” diagnoses. The answer is obvious to anyone who knows the biochemistry of stimulants and antipsychotics. The reason is because the kids are taking stimulants.

    Stimulants’ main effect is to INCREASE the amount of available dopamine in the brain. It is well known that increasing dopamine is associated with increases in aggression and moodiness (anyone who has ever worked with meth addicts can attest to this). Sufficient dosages of stimulants can lead to frank psychosis in otherwise healthy adults or kids. Some kids who take stimulants predictably become aggressive at “therapeutic” doses.

    Antipsychotics’ main effect is to DECREASE the amount of available dopamine in the brain. Note that this is the OPPOSITE effect of the stimulants. So the obvious reason for so many prescriptions for Risperdal et al is because they are making these kids aggressive with stimulants, and then “treating” the resulting aggression with antipsychotics. In chemical terms, they are upping dopamine with stimulants and then decreasing dopamine with antipsychotics. There is nothing surprising about it.

    What SHOULD be disturbing is that psychiatrists are so corrupt and/or ignorant not to recognize or acknowledge that their own “treatment” is causing the secondary problem they are “treating” with the antipsychotics. If they really wanted less dopamine in the brain, why don’t they just stop increasing it by reducing or eliminating the stimulants???? But that would require logic, something noticeably lacking in most psychiatric settings.

    To add insult to injury, the authors separate amphetamines from “methylphenidates,” when the mechanism of action is so similar as to be essentially identical. Ritalin is an amphetamine in both structure and action.

    None of this even begins to address the infinite stupidity of using behavioral variables to diagnose a “disease” that is then “treated” in this ham-handed fashion. This article is a complete repudiation of psychiatry’s approach to kids who are active and don’t like to sit still or follow directions. They can’t even evaluate the effects of their own interventions, and are baffled by something so obvious that a college biochem student could figure it out in their spare time.

    — Steve

    • Hi Steve, Always enjoy seeing your comments. Yes, all articles on drugging kids are upsetting because somewhere at the bottom is the default notion that delivering these insane pharma cocktails to kids is acceptable. Want to tear my hair out right there. And I have to show your chemistry ABC to my own kids, just to underline the insanity of the systems they face.

      [Only one personal correction to your reply to me above: I wish my child HAD merely been garden-variety, so-called ‘ADHD-type’ obnoxious. Unfortunately, he was WAAAY beyond that, which is what forced me down this whole road in the first place.]

      Liz Sydney

      • Believe me, I feel your pain. My oldest put us through the ringer! We had to create our own plan as we went along, as no one really had a great approach that respected our values. I was fortunate to get training in intensive behavior management for my work, but most of that still didn’t work unless we adapted it to his unique needs and strengths.

        Thanks for your positive words!

  9. I feel the need to clarify my first post. I used Alice Miller because not only did she discuss childhood trauma she also discusses the systematic non-caring of children in our society. The rule of silence is golden is still too sadly true.Children now are products for advertising. How much money can they bring to the coffers?
    And when one is in the grips of the Big Pharma lie and one sees their child getting abused, or hurt, or in academic trouble it is easy to go for the chemical brass ring. It is the only ring one has at times or is given to you. To search out and follow through with other treatments requires time, money, and energy that many parents or caregivers just don’t have.
    Glad MIA is getting on the parent bandwagon. There also has to be the acknowledgement that sometimes parents are on the rat wheel just as much as their children.And how to we help those families?

  10. Catnight, we can help the families you mention via support, encouragement, and supporting political candidates who will support policies and laws which provide resources and financial support to the marginalized.

    I’ve noticed on MIA that many posters seem to fixate on psychiatry and psych drugs while ignoring other problematic, powerful forces at work in society. We cannot ignore clear truths, such as many families aren’t supported and feel stressed because of socioeconomic inequalities. We need to fight for all forms of justice.

  11. There is not even one instance of any Amish children getting diagnosed with ADHD when raised within their community where the common practice is to NOT ALLOW VACCINATIONS . As we know guild protected employees don’t allow and aren’t allowed to let truth or real science get in the way of cash flow no matter what the human cost. I’m certain if real studies and real science were done psychiatry and big pharma would be openly exposed to be as deadly to human life as bubonic plague was in medieval times .

  12. Hi Christopher Page,

    Interesting to hear. We’ll see. Material relating to children has been very spotty on MIA, and the people who write on them as well. Virtually all the psych professionals here equivocate on drugs, which is disappointing. MIA psych pros need to explain precisely when and where they drug children, and why. And how they get through the issue of informed consent (!) when they do. For my part as a parent and reader, I had a post accepted and then passively rejected because my child is not a so-called ‘survivor’ or ‘consumer’, which was ridiculous. I went to hell and back in order to NOT psych drug my child or make him a psych-system ‘consumer’, so it was ironic was that our experience was only acceptable/interesting to MIA if I was dumb enough to have drugged him. Bizarre judgment on the part of MIA.

    Liz Sydney

  13. Two words, “off-label prescribing”. This is bingo for the drug companies. You’ve got articles rationalizing the off-label prescribing of drugs for cancer patients. You’ve got mental health propagandists comparing “mental ill health” labels to cancer. If the kid is deemed “treatment resistant” or “suffering” from a “co-occurring disorder” label, what’s a doctor to do? Turn to the drug company literature, of course. Meanwhile, where is the person to explain to doctors and parents that amphetamine and neuroleptic drugs aren’t sugared aspirin, and that they shouldn’t be doled out like candy? Medical school should be teaching doctors not to drug children. Medical school should also be teaching doctors not to leap into the labeling game that so often precedes drugging. The evidence doesn’t support it, and, in the long-run, the “treatment” tends to produce results much worse than the label itself. “Treatment” will kill you; name calling, not so much.