Nav: Home

Antipsychotic use in youths with ADHD is low, but still cause for concern

July 26, 2019

NEW YORK, NY (JULY 26, 2019) -- Although fewer young people with ADHD are treated with antipsychotic drugs than suspected, many prescriptions for the drugs do not appear to be clinically warranted, according to a new study from psychiatry researchers at Columbia University Vagelos College of Physicians and Surgeons. They also found that antipsychotic use among youths with ADHD was highest among preschool-age children.

Background

In recent years, pediatricians and parents have expressed concern that some physicians are prescribing antipsychotic drugs to youths with ADHD who have significant aggressive or impulsive behavior. Youths with ADHD who are treated with antipsychotics are often also diagnosed with depression, oppositional defiant disorder (ODD), or conduct disorders (CD), even though there is limited evidence that the drugs are effective for ODD or CD and no evidence they are effective in treating depression.

"We didn't know how widespread this practice was among young people starting ADHD treatment," says senior author Mark Olfson, MD, MPH, Elizabeth K Dollard Professor of Psychiatry, Medicine, and Law at Columbia University Vagelos College of Physicians and Surgeons. "There are substantial risks associated with the use of antipsychotic drugs in young people, including weight gain, hyperlipidemia, diabetes, and even unexpected death."

To determine the prevalence of antipsychotic use in youths with ADHD, the researchers analyzed medical and prescription drug data on 187,563 commercially insured youths (ages 3 to 24) who were diagnosed with ADHD between 2010 and 2015. None of the youths had a recent coexisting psychiatric diagnosis (such as schizophrenia or bipolar disorder) that would warrant treatment with antipsychotic drugs.

What the Study Found

The researchers found that 2.6% of youths diagnosed with ADHD were prescribed an antipsychotic drug within a year of diagnosis--four times the rate among young people in general. Antipsychotic drug use was highest (4.3%) in the youngest children diagnosed with ADHD, those aged 3-5 years.

In about half of those taking antipsychotic drugs, the researchers identified a potential diagnostic rationale--such as bipolar disorder, psychosis, ODD, or CD--for prescribing them.

"While antipsychotics are not FDA-approved for these diagnoses, there is scientific evidence to support their use in treating severe symptoms of ADHD," says Ryan S. Sultan, MD, lead author of the paper and assistant professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons.

The study also found that fewer than half of the children and adolescents taking antipsychotic drugs had been treated first with stimulants such as Adderall and Ritalin, the recommended medication treatment for ADHD.

"Many physicians bypassed stimulants and went right to antipsychotics--contrary to expert opinion about treatment for ADHD, and unnecessarily exposing patients to the risk of severe side effects such as substantial weight gain," adds Sultan.

What the Study Means

"It's reassuring that only a relatively small percentage of these children were prescribed antipsychotics," Olfson says. "But we should be working to reduce that number even further. For at least half of the young people in our sample who were prescribed antipsychotics, we couldn't find a rationale in their claims records to explain why they were taking these medications."

"While hospitalization and use of other medications may be markers for more severe symptoms, we don't have enough information from these records to determine symptom severity," adds Sultan. "Antipsychotic medications play a small role in the treatment of severe ADHD symptoms, but in the absence of severe symptoms, there are safer, more effective medications for youths with ADHD."

Both Sultan and Olfson suggested that many of the behavioral symptoms that prompted physicians to prescribe antipsychotic medications as an initial treatment might have been resolved by prescribing recommended ADHD medications first.
-end-
More Details

Mark Olfson, MD, MPH, is also a professor of epidemiology at Columbia University Mailman School of Public Health.

Ryan S. Sultan, MD, is a child psychiatrist at Columbia University Irving Medical Center.

The study is titled "Antipsychotic Treatment Among Youths With Attention-Deficit Hyperactivity Disorder" and was published July 26 in JAMA Network Open.

Additional authors are Shuai Wang (Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY) and Stephen Crystal (Rutgers University, New Brunswick, NJ).

The study was supported by the Agency for Healthcare Research and Quality (grants 1R01HSO26001-01A1 and U19HSO21112-01) and the American Academy of Child and Adolescent Psychiatry Pilot Research Award for Attention Disorders.

Dr. Olfson received personal fees from Lundbeck Pharmaceuticals during the conduct of the study. No other disclosures were reported.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.

The Columbia University Department of Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center

Related Science Articles:

75 science societies urge the education department to base Title IX sexual harassment regulations on evidence and science
The American Educational Research Association (AERA) and the American Association for the Advancement of Science (AAAS) today led 75 scientific societies in submitting comments on the US Department of Education's proposed changes to Title IX regulations.
Science/Science Careers' survey ranks top biotech, biopharma, and pharma employers
The Science and Science Careers' 2018 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.
Science in the palm of your hand: How citizen science transforms passive learners
Citizen science projects can engage even children who previously were not interested in science.
Applied science may yield more translational research publications than basic science
While translational research can happen at any stage of the research process, a recent investigation of behavioral and social science research awards granted by the NIH between 2008 and 2014 revealed that applied science yielded a higher volume of translational research publications than basic science, according to a study published May 9, 2018 in the open-access journal PLOS ONE by Xueying Han from the Science and Technology Policy Institute, USA, and colleagues.
Prominent academics, including Salk's Thomas Albright, call for more science in forensic science
Six scientists who recently served on the National Commission on Forensic Science are calling on the scientific community at large to advocate for increased research and financial support of forensic science as well as the introduction of empirical testing requirements to ensure the validity of outcomes.
World Science Forum 2017 Jordan issues Science for Peace Declaration
On behalf of the coordinating organizations responsible for delivering the World Science Forum Jordan, the concluding Science for Peace Declaration issued at the Dead Sea represents a global call for action to science and society to build a future that promises greater equality, security and opportunity for all, and in which science plays an increasingly prominent role as an enabler of fair and sustainable development.
PETA science group promotes animal-free science at society of toxicology conference
The PETA International Science Consortium Ltd. is presenting two posters on animal-free methods for testing inhalation toxicity at the 56th annual Society of Toxicology (SOT) meeting March 12 to 16, 2017, in Baltimore, Maryland.
Citizen Science in the Digital Age: Rhetoric, Science and Public Engagement
James Wynn's timely investigation highlights scientific studies grounded in publicly gathered data and probes the rhetoric these studies employ.
Science/Science Careers' survey ranks top biotech, pharma, and biopharma employers
The Science and Science Careers' 2016 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.
Three natural science professors win TJ Park Science Fellowship
Professor Jung-Min Kee (Department of Chemistry, UNIST), Professor Kyudong Choi (Department of Mathematical Sciences, UNIST), and Professor Kwanpyo Kim (Department of Physics, UNIST) are the recipients of the Cheong-Am (TJ Park) Science Fellowship of the year 2016.
More Science News and Science Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.