Journal of the American Academy of Child & Adolescent Psychiatry
Volume 49, Issue 1 , Pages 13-23 , January 2010

Trends in Antipsychotic Drug Use by Very Young, Privately Insured Children

  • Mark Olfson, M.D., M.P.H.

      Affiliations

    • Columbia University and the New York State Psychiatric Institute, New York
    • Corresponding Author InformationCorrespondence to Dr. Olfson, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
    • ,
  • Stephen Crystal, Ph.D.

      Affiliations

    • Institute for Health, Health Care Policy & Aging Research of Rutgers University, New Jersey
    • ,
  • Cecilia Huang, Ph.D.

      Affiliations

    • Institute for Health, Health Care Policy & Aging Research of Rutgers University, New Jersey
    • ,
  • Tobias Gerhard, Ph.D.

      Affiliations

    • Rutgers University

,Accepted 10 September 2009.

References 

  1. Patel NC, Crismon ML, Hoagwood K, et al. Trends in the use of typical and atypical antipsychotics in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2005;44:548–556
  2. Cooper WO, Hickson GB, Fuchs C, Arbogast PG, Ray WA. New users of antipsychotic medications among children enrolled in TennCare. Arch Pediatr Adoelsc Med. 2004;158:753–759
  3. Zito JM, Safer DJ, Valluri S, Gardner JF, Korelitz JJ, Mattison DR. Psychotherapeutic medication prevalence in Medicaid-insured preschoolers. J Child Adolesc Psychopharmacol. 2007;17:195–203
  4. Constantine R, Tandon R. Changing trends in pediatric antipsychotic use in Florida's Medicaid program. Psych Services. 2008;59:1162–1168
  5. Masi G, Cosenza A, Mucci M, Brovedani P. Open trial of risperidone in 24 young children with pervasive developmental disorders. J Clin Psychiatry. 2003;64:1039–1047
  6. Biederman J, Mick E, Hammerness P, et al. Open-label, 8-week trial of olanzapine and risperidone for the treatment of bipolar disorder in preschool-age children. Biol Psychiatry. 2005;58:589–594
  7. Nicolson R, Awad G, Sloman L. An open trial of risperidone in young autistic children. J Am Acad Child Adolesc Psychiatry. 1998;37:372–376
  8. Oner P. Psychopharmacology of pediatric obsessive-compulsive disorder: three case reports. J Psychopharmacol. 2008;22:809–811
  9. Posey DJ, Walsh KH, Wilson GA, McDougle CJ. Risperidone in the treatment of two very young children with autism. J Child Adolesc Psychopharmacol. 1999;9:273–276
  10. Staller JA. Psychopharmacologic treatment of aggressive preschoolers: a chart review. Prog Neuro-Psychopharmacol Biol Psychiatry. 2007;31:131–135
  11. Correll CU. Antipsychotic use in children and adolescents: minimizing adverse effects to maximize outcomes. J Am Acad Child Adolesc Psychiatry. 2008;47:9–20
  12. Luby J, Mrakotsky C, Stalets MM, et al. Risperidone in preschool children with autistic spectrum disorders: an investigation of safety and efficacy. J Child Adolesc Psychopharmacol. 2006;16:575–587
  13. Bartelink IH, Rademaker CMA, Schobben AF, van den Anker JN. Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic consideration. Clin Pharmacokinetics. 2006;45:1077–1097
  14. Gleason MM, Egger HL, Emslie GJ, et al. Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry. 2007;46:1532–1572
  15. Costa LG, Steardo L, Cuomo V. Structural effects and neurofunctional sequelae of developmental exposure to psychotherapeutic drugs: experimental and clinical aspects. Pharmacol Rev. 2004;56:103–147
  16. Cuomo V, Cagiano R, Coen E, et al. Enduring behavioral and biochemical effects in the adult rat after prolonged postnatal administration of haloperidol. Psychopharmacology. 1981;74:166–169
  17. Cuomo V, Cagiano P, Mocchetti I, et al. Biochemical and behavioral effects after early postnatal administration of neuroleptics in rats. In:  Zbinden G,  Cuomo V,  Racagni G,  Weiss B editor. Application of Behavioral Pharmacology in Toxicology. New York: Raven Press; 1983;
  18. Danielyan A, Pathak S, Kowatch RA, Arszman SP, Johns ES. Clinical characteristics of bipolar disorder in very young children. J Affect Dis. 2007;97:51–59
  19. DeBar LL, Lynch F, Powell J, Gale J. Use of psychotropic agents in preschool children associated symptoms, diagnosis, health care services in a health maintenance organization. Arch Pediatr Adolesc Med. 2003;157:150–157
  20. Version 9.2 of the SAS System. Cary, NC: SAS Institute; 2008;
  21. Jensen PS, Youngstrom EA, Steiner H, et al. Consensus report on impulsive aggression as a symptom across diagnostic categories in child psychiatry: implications for medication studies. J Am Acad Child Adolesc Psychiatry. 2007;46:309–322
  22. McCracken JT, McGough J, Shah B, et al. Research Units on Pediatric Psychopharmacology Autism Network Risperidone in children with autism and serious behavioral problems. NEJM. 2002;347:314–321
  23. Fombonne E. The prevalence of autism. JAMA. 2003;289:87–89
  24. Blaxill MF. What's going on? (The question of time trends in autism). Pub Health Rep. 2004;119:536–551
  25. Coo H, Ouellette-Kuntz H, Lloyd JEV, et al. Trends in autism prevalence: diagnostic substitution revisited. J Autism Dev Disord. 2008;38:1036–1046
  26. Wakschlag LS, Briggs-Gowan MJ, Carter AS, et al. A developmental framework for distinguishing disruptive behavior from normative misbehavior in preschool children. J Child Psychol Psychiatry. 2007;48:976–987
  27. Gracious BL, Findling RL. Antipsychotic medications for children and adolescents. Pediatr Ann. 2001;30:138–145
  28. Reyes M, Buitelaar J, Toren P, Augustyns I, Eerdekens M. A randomized, double-blind, placebo-controlled study of risperidone maintenance treatment in children and adolescents with disruptive behavior disorders. Am J Psychiatry. 2006;163:402–410
  29. Findling RL, McNamara NK, Braniky LA, Schluchter MD, Lemon E, Blumer J. A double-blind pilot study of risperidone in the treatment of conduct disorder. J Am Acad Child Psychiatry. 2000;39:509–516
  30. Jensen PS, Buitelaar J, Pandina GJ, Binder C, Haas M. Management of psychiatric disorders in children and adolescents with atypical antipsychotics: a systematic review of published clinical trials. Eur Child Adolesc Psychiatry. 2007;16:104–120
  31. Cesena M, Gonzalez-Heydrich J, Szigethy E, Kolenberg TM, DeMaso DR. A case series of eight aggressive young children treated with risperidone. J Child Adolesc Psychpharmacol. 2002;12:337–345
  32. Luby JL, Si X, Belden AC, Tandon M, Spitznagel E. Preschool depression: homotypic continuity and course over 24 months. Arch Gen Psychiatry. 2009;66:897–905
  33. Shelton RC, Papakostas GI. Augmentation of antidepressants with atypical antipsychotics for treatment-resistant major depressive disorder. Acta Psychiatr Scand. 2008;117:253–259
  34. Thase ME, Corya SA, Osuntokun O, et al. A randomized, double-blind comparison of olanzapine/fluoxetine combination, olanzapine, and fluoxetine in treatment-resistant major depressive disorder. J Clin Psychiatry. 2007;68:224–236
  35. Gilmer TP, Dolder CR, Folsom DP, Mastin W, Jeste DV. Antipsychotic polypharmacy trends among Medicaid beneficiaries with schizophrenia in San Diego County, 1999–2004. Psychiatr Serv. 2007;58:1007–1010
  36. Botts S, Hines H, Littrell R. Antipsychotic polypharmacy in the ambulatory care setting, 1993–2000. Psychiatr Serv. 2003;54:1086
  37. Libby AM, Orton HD, Valuck RJ. Persisting decline in depression treatment after FDA warnings. Arch Gen Psychiatry. 2009;66:633–639
  38. Barbaresi WJ. Use of psychotropic medications in young, preschool children: primum non nocere. Arch Pediatr Adolesc Med. 2003;157:121–123
  39. Coyle JT. Psychotropic drug use in very young children. JAMA. 2000;283:1059–1060
  40. Mojtabai R, Olfson M. National trends in psychotherapy by office-based psychiatrists. Arch Gen Psychiatry. 2008;65:962–970
  41. Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F. Trends in the prescribing of psychotropic medications to preschoolers. JAMA. 2000;283:1025–1030
  42. Aparasu RR, Bhatara V. Patterns and determinants of antipsychotic prescribing in children and adolescents, 2003–2004. Curr Med Res Opin. 2007;23:49–56
  43. Kaiser Foundation. Health Insurance Coverage of America's Children. January, 2007;
  44. Wells JCK, Fewtrell MS. Is body composition important for paediatricians?. Arch Dis Child. 2008;93:168–172

 This article is discussed in an editorial by Dr. Helen Egger on page 3.

 This study was supported by AHRQ award U18 HS016097, the Center for Education and Research on Mental Health Therapeutics.

 Disclosure: Dr. Olfson has received research support from Bristol Myers Squibb, AstraZeneca, and Eli Lilly & Company. He has served as a consultant for Pfizer and AstraZeneca. He has served on the speakers' bureau for Janssen. Drs. Crystal, Huang, and Gerhard report no biomedical financial interests or potential conflict of interest.

PII: S0890-8567(09)00005-7

doi: 10.1016/j.jaac.2009.09.003

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 49, Issue 1 , Pages 13-23 , January 2010

Article Tools

* Image Usage & Resolution