Abstract
T
Burcu et al. add critical hard data to our understanding of this persistent trend, which has historically been the focus of anecdotal and often contradictory explanation. The authors' article analyzes data from more than 250,000 Medicaid-covered youth in a mid-Atlantic state and focuses on an interesting subgroup: Children with attention-deficit/hyperactivity disorder (ADHD) diagnoses, and no comorbid disorders, in foster care.
One finding: These children were three times more likely to be prescribed antipsychotics and to be treated for substantially longer periods than ADHD patients in other studied populations. The authors note that “the annual prevalence of atypical antipsychotic use in 2006 was 2.5% in children (2–12-year olds) and 5.2% in adolescents (13–17-year olds).” In their group of non-comorbid ADHD subjects in foster care, the rate was almost 32%.
“We chose to examine non-comorbid ADHD because it constitutes a common condition for which antipsychotic use is deemed off label,” Burcu et al. write in their discussion. “Antipsychotic use in youth for ADHD and other behavioral problems underscores the need for oversight and post-marketing research, to assure that benefits outweigh the risks.” This suggestion is a commonsense one, but coupled with persuasive data on the extent of the issue it takes on great significance.
The study suggests three conclusions: We must better understand the long-term effects of these compounds and how to monitor them; we must find alternatives to treat aggressive behavior; and we must look long and hard at the system that has created this phenomenon. JCAP this month addresses two of the above issues, in the works of Calarge et al. and Dean et al.
Calarge et al. investigate weight and cardiometabolic outcomes in children being treated with risperidone, primarily for externalizing disorders and aggressive behavior. The results are certainly promising: Even after years of treatment, excessive weight gain and adverse cardiac and metabolic effects can be reversed or improved by discontinuing medication. Of course, the authors note, this does not mitigate risk to patients who must continue.
Finally, Dean et al. undertake a necessary study of the efficacy of fish oil treatment in curbing aggression in the pediatric population. The promise of this relatively benign therapeutic has been suggested repeatedly by epidemiological investigations and studies in other populations. Though the authors' negative results indicate this may not be a promising complementary treatment, this knowledge is of great value to clinicians who often discuss these and other possibilities with patients and families.