Rxs for antipsychotics to treat ADHD on the rise for young in foster care

Antipsychotic drugs are increasingly being prescribed to treat attention-deficit/hyperactivity disorder (ADHD) in children and teens in foster care, according to a study published in the Journal of Child and Adolescent Psychopharmacology.

Using information gathered in a mid-Atlantic state in 2006, Julie Magno Zito, PhD, professor of pharmacy and psychiatry in the Department of Pharmaceutical Health Services Research at the University of Maryland, Baltimore, and colleagues reviewed data covering more than 260,000 Medicaid-insured foster-care children of two to 17 years of age. Their purpose was to determine the average number of days of use by children of second-generation antipsychotics. They also looked specifically at a subgroup of children with ADHD who were not diagnosed with any other mental health conditions.

“Such treatment is off-label - that is, lacks adequate information of benefits and risks,” said Zito. “This usage was more than three-fold greater than in other Medicaid-insured children and adolescents. Second-generation antipsychotic use for behavioral conditions in youth populations is prominent, with substantially longer durations of exposure in foster-care youth and very young children. Exposure to second-generation antipsychotics, in particular for children in foster care and those diagnosed with ADHD, was substantial, warranting independently conducted outcomes research for long-term effectiveness, safety, and appropriate cardiometabolic monitoring.”

The numbers

Overall, the median annual duration of atypical antipsychotic use was 180 days (interquartile range: 69–298 days).

Children (ages 2–12 years) had longer durations of use than did adolescents (aged 13–17 years) (median 192 vs. 179 days), respectively.

Nearly one-third of the ADHD-diagnosed foster-care youth received atypical antipsychotics regardless of age group, with annual duration of use >250 median days in those 2 to 12 years of age.

When treatment involved concomitant atypical antipsychotic regimens, risperidone, aripiprazole, and quetiapine were the most common.

Although fee-for-service and managed-care enrollees were included in the study, they were not analyzed separately, Zito said. “Data were not analyzed in terms of generic vs. brand-name products which might affect formulary decisions,” she said.

“Safety concerns about the second-generation antipsychotics suggest serious treatment-emergent adverse events,” she added. “Youth are especially concerning, because adverse events in children are distinct from those of adults.”