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Member Research and Reports

Columbia: Antipsychotic Drug Use in Youths with ADHD Is Low, But Still Cause for Concern

Fewer young people with attention deficit hyperactivity disorder (ADHD) are treated with antipsychotic drugs than suspected, yet many prescriptions for the drugs do not appear to be clinically warranted, according to a study in JAMA Network Open led by Columbia University Mailman School of Public Health epidemiology professor Dr. Mark Olfson. The researchers also found that antipsychotic use among youths with ADHD was highest among preschool-age children.

“We didn’t know how widespread this practice was among young people starting ADHD treatment,” said Dr. Olfson, who is also professor of psychiatry at Columbia Vagelos College of Physicians and Surgeons. “There are substantial risks associated with using the drugs in young people — weight gain, diabetes, and even unexpected death.”

To determine 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 had a recent coexisting psychiatric diagnosis that would warrant treatment with these drugs.

They found that 2.6 percent of youths diagnosed with ADHD were prescribed an antipsychotic drug within a year of diagnosis — four times the rate among young people in general. Use was highest (4.3 percent) in the youngest children.

In about half of those taking the drugs, researchers identified a potential diagnostic rationale — such as bipolar disorder, psychosis, or oppositional defiant disorder (ODD) — for prescribing them. They also found that fewer than half had been treated first with stimulants such as Adderall and Ritalin, the recommended medication treatment for ADHD.

“It’s reassuring that a relatively small percentage of children were prescribed antipsychotics,” Dr. Olfson says. “But we should be working to reduce that number further.”

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