Antipsychotic drug prescriptions nearly double for kids with ADHD

August 02, 2004

NASHVILLE While parents, schools and physicians still struggle with the perceived 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 (Vanderbilt Children's Hospital) have found a new class of antipsychotic medications is being prescribed for an increasing number of TennCare children with attention deficit/hyperactivity disorder (ADHD).

The study, published in the August 3 issue of Archives of Pediatric Adolescent Medicine, revealed that between 1996 and 2001 the proportion of children on TennCare, Tennessee's program for Medicaid enrolles and the uninsured, who were new users of powerful atypical antipsychotic medications almost doubled, from 23 per 10,000 children to 45 per 10,000. Use for behavioral problems associated with attention-deficit/hyperactivity disorder (ADHD) and mood disorders increased more than twofold. Perhaps most concerning, the adolescent population had more than a threefold increase in use of the drugs for ASDHD/conduct disorder, that amounted to nearly one in every 100 adolescents covered under TennCare.

The study's authors, led by William Cooper, M.D., associate professor of Pediatrics at Children's Hospital, tracked medical records of thousands of children listed in Tennessee's managed care program between 1996 and 2001. They eliminated any child listed with a severe disability, including a severe mental illness like psychosis or autism. The team suspects the concerns extend to the entire population and have started working with CDC records in a new study to determine the problem's extent.

Cooper and Catherine Fuchs, M.D., associate professor of Psychiatry at Vanderbilt, 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 they are not proven to treat in 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.

The drugs were introduced during the 1990s as a new generation of antipsychotics, and include clozapine, risperidone, olanzapine, quetiapine fumarate and ziprasidone hydrochloride. They were approved for use in psychosis and Tourettes syndrome. Cooper theorized the introduction of this new class of antipsychotic drugs was part of the reason for the increase in off-label use. The older antipsychotic drugs are well known to have potential side effects like movement disorders and other serious neurologic problems not seen in the newer class of drugs.

"The newer drugs do have their own set of potential side effects, including serious weight gain, heart rhythm problems, and diabetes," said Cooper. "These are potential side effects that are not well understood when applied to children. In fact, some preliminary studies suggest that the side effects from these medications are more common and may be more severe in children than in adults."

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 mental retardation, but not for behavioral symptoms associated with ADHD and conduct disorders. He said it may 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 and beneficial when used this way," Cooper said.

"We would like for physicians to think very carefully before prescribing these drugs to children," Cooper said. "And we hope this study encourages more research to find out how these drugs might be best used to help children."

Fuchs agrees. "The goal of this article is to encourage physicians to carefully consider the risk/benefit ratio in their decision making about prescribing practices for the new generation of antipsychotics. The medications are very effective. However, it is important for us as physicians to develop increased understanding of behavioral changes as they relate to illness; with the understanding that we will be able to make more effective treatment decisions," she said.

Cooper's area of special interest is application of research to public health programs. He and Fuchs, along with co-investigators Gerald Hickson, M.D., professor of Pediatrics and Psychiatry; Patrick Arbogast, Ph.D., assistant professor of Preventive Medicine and Wayne Ray, Ph.D., director of the division of Pharmacologic Epidemiology, were assisted by the state's TennCare program in gathering data for the study.
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TV package script:
TOTAL RUNNING TIME - :30

SUGGESTED STUDIO INTRO: A NEW STUDY BY RESEARCHERS AT VANDERBILT MEDICAL CENTER, RELEASED TODAY (Embargoed until 3 pm CDT, August 2, 2004) IN THE ARCHIVES OF PEDIATRICS AND ADOLESCENT MEDICINE, FOUND THAT FROM 1996 TO 2001, A GROWING NUMBER OF ADOLESCENT CHILDREN EITHER INSURED OR COVERED BY A MANAGED CARE PROGRAM IN TENNESSEE WERE BEING PRESCRIBED NEW ANTIPSYCHOTIC MEDICATIONS FOR BEHAVIORAL PROBLEMS SUCH AS A-D-H-D. REPORTER HEATHER HALL EXPLAINS.SUGGESTED STUDIO TAG: DOCTOR COOPER SUGGESTS A LACK OF MENTAL HEALTH RESOURCES FOR COMMUNITIES ADDS TO THE PROBLEM, MAKING IT DIFFICULT FOR PARENTS OF CHILDREN WITH BEHAVIORAL PROBLEMS TO FIND ADDITIONAL TREATMENT OPTIONS, INCLUDING BEHAVIOR MANAGEMENT. HE ADVISES PARENTS TO BE SURE THEIR CHILD IS EVALUATED AND PROPERLY DIAGNOSED WITH A-D-H-D OR OTHER PROBLEMS FIRST, AND TO DISCUSS SIDE EFFECTS OF MEDICATIONS WITH A HEALTH CARE PROVIDER IN ORDER TO MAKE INFORMED DECISIONS ABOUT THE BEST CHOICE FOR THEIR CHILD.

TRT: 1:40

SUPERS:

Jennie Conrad :14-:25
Concerned Parent

William Cooper, M.D. :40-:53
Vanderbilt Children's Hospital

Vanderbilt University Medical Center

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