In the Journals

Half of young people with ADHD receive antipsychotics without proper indication

Image of Ryan Sultan
Ryan Sultan

Approximately half of youth who received antipsychotics during the year after an ADHD diagnosis had a diagnosis for which antipsychotics are indicated, and less than half of these youth received a stimulant — the evidence-supported first-line ADHD treatment, study data revealed.

“In this current study, we were interested in a new and deeper look at the use of antipsychotic medications in youth with ADHD,” Ryan S. Sultan, MD, assistant professor of psychiatry at Columbia University, told Healio Psychiatry. “Previous work has shown the increasing use of antipsychotics in the treatment of children with mental disorders and that ADHD was the most commonly associated diagnosis.”

Using data on commercially insured youth, taken from the 2010 to 2015 MarketScan Commercial Database, the researchers reported the percentage of 187,563 young people aged 3 to 24 years prescribed an antipsychotic without an FDA-indicated condition that would warrant antipsychotic treatment in the first year after receiving a new ADHD diagnosis.

They also reported the percentage of youth prescribed antipsychotics who were diagnosed with conduct disorder, oppositional defiant disorder or a disorder with a relevant indication for use, such as schizophrenia, bipolar disorder and Tourette disorder, as well as the percentage of youth who filled an antipsychotic prescription before filling a stimulant prescription.

Within the year after receiving a new ADHD diagnosis, 4,869 youths with ADHD (2.6%; 95% CI, 2.5-2.7) were treated with an antipsychotic medication, according to the results.

Sultan and colleagues found that young people with ADHD who received an antipsychotic were more likely than youth who were not receiving an antipsychotic to have:

  • recent self-harm and/or suicidal ideation (adjusted OR = 7.5; 95% CI, 5.9-9.6);
  • oppositional defiant disorder (aOR = 4.4; 95% CI, 3.9-4.9);
  • substance use disorder (aOR = 4; 95% CI, 3.6-4.5); and
  • received inpatient treatment (aOR = 7.9; 95% CI, 6.7-9.3).

The results showed that 47.9% of participants who initiated antipsychotic medication were not prescribed a stimulant between their ADHD diagnosis and antipsychotic initiation and 52.7% of participants treated with antipsychotics in the year following the new ADHD diagnosis also received a diagnosis indicated for the use of antipsychotic medication.

“We found that, at the time their diagnosis of ADHD, those youth who are treated with an antipsychotic were more likely to have a history of other mental health conditions, such as recent mental health hospitalizations, suicidality and substance abuse. These are potential markers for severity of ADHD,” Sultan said.

In addition, the researchers found that antipsychotic prescriptions were tied to neurodevelopmental disorders (aOR = 3.9; 95% CI, 1.3-11.2) and recent inpatient mental health-related treatment (aOR = 8.9; 95% CI, 1.7-45.8).

“A take home message for clinicians is that nationally, a small, but meaningful percentage of youth with ADHD are being treated with antipsychotics without a clear clinical justification,” Sultan told Healio Psychiatry. “Clinicians treating ADHD should always exhaust safer treatments for ADHD, such a stimulant medication, and consider behavioral-based interventions before antipsychotic medications.” – by Savannah Demko

Disclosures: One author reports personal fees from Lundbeck Pharmaceuticals.

Image of Ryan Sultan
Ryan Sultan

Approximately half of youth who received antipsychotics during the year after an ADHD diagnosis had a diagnosis for which antipsychotics are indicated, and less than half of these youth received a stimulant — the evidence-supported first-line ADHD treatment, study data revealed.

“In this current study, we were interested in a new and deeper look at the use of antipsychotic medications in youth with ADHD,” Ryan S. Sultan, MD, assistant professor of psychiatry at Columbia University, told Healio Psychiatry. “Previous work has shown the increasing use of antipsychotics in the treatment of children with mental disorders and that ADHD was the most commonly associated diagnosis.”

Using data on commercially insured youth, taken from the 2010 to 2015 MarketScan Commercial Database, the researchers reported the percentage of 187,563 young people aged 3 to 24 years prescribed an antipsychotic without an FDA-indicated condition that would warrant antipsychotic treatment in the first year after receiving a new ADHD diagnosis.

They also reported the percentage of youth prescribed antipsychotics who were diagnosed with conduct disorder, oppositional defiant disorder or a disorder with a relevant indication for use, such as schizophrenia, bipolar disorder and Tourette disorder, as well as the percentage of youth who filled an antipsychotic prescription before filling a stimulant prescription.

Within the year after receiving a new ADHD diagnosis, 4,869 youths with ADHD (2.6%; 95% CI, 2.5-2.7) were treated with an antipsychotic medication, according to the results.

Sultan and colleagues found that young people with ADHD who received an antipsychotic were more likely than youth who were not receiving an antipsychotic to have:

  • recent self-harm and/or suicidal ideation (adjusted OR = 7.5; 95% CI, 5.9-9.6);
  • oppositional defiant disorder (aOR = 4.4; 95% CI, 3.9-4.9);
  • substance use disorder (aOR = 4; 95% CI, 3.6-4.5); and
  • received inpatient treatment (aOR = 7.9; 95% CI, 6.7-9.3).

The results showed that 47.9% of participants who initiated antipsychotic medication were not prescribed a stimulant between their ADHD diagnosis and antipsychotic initiation and 52.7% of participants treated with antipsychotics in the year following the new ADHD diagnosis also received a diagnosis indicated for the use of antipsychotic medication.

“We found that, at the time their diagnosis of ADHD, those youth who are treated with an antipsychotic were more likely to have a history of other mental health conditions, such as recent mental health hospitalizations, suicidality and substance abuse. These are potential markers for severity of ADHD,” Sultan said.

In addition, the researchers found that antipsychotic prescriptions were tied to neurodevelopmental disorders (aOR = 3.9; 95% CI, 1.3-11.2) and recent inpatient mental health-related treatment (aOR = 8.9; 95% CI, 1.7-45.8).

“A take home message for clinicians is that nationally, a small, but meaningful percentage of youth with ADHD are being treated with antipsychotics without a clear clinical justification,” Sultan told Healio Psychiatry. “Clinicians treating ADHD should always exhaust safer treatments for ADHD, such a stimulant medication, and consider behavioral-based interventions before antipsychotic medications.” – by Savannah Demko

Disclosures: One author reports personal fees from Lundbeck Pharmaceuticals.