Soaring numbers of American children are being prescribed anti-psychotic
drugs — in many cases, for attention deficit disorder or other behavioral
problems for which these medications have not been proven to work, a study found.
The annual number of children prescribed anti-psychotic drugs jumped fivefold
between 1995 and 2002, to an estimated 2.5 million, the study said. That is
an increase from 8.6 out of every 1,000 children in the mid-1990s to nearly
40 out of 1,000.
But more than half of the prescriptions were for attention deficit and other
non-psychotic conditions, the researchers said.
The findings are worrisome "because it looks like these medications are
being used for large numbers of children in a setting where we don't know if
they work," said lead author Dr. William Cooper, a pediatrician at Vanderbilt
The increasing use of anti-psychotics since the mid-1990s corresponds with
the introduction of costly and heavily marketed medications such as Zyprexa
and Risperdal. The packaging information for both says their safety and effectiveness
in children have not been established.
Anti-psychotics are intended for use against schizophrenia and other psychotic
However, attention deficit disorder is sometimes accompanied by temper outbursts
and other disruptive behavior. As a result, some doctors prescribe anti-psychotics
to these children to calm them down — a strategy some doctors and parents
The drugs, which typically cost several dollars per pill, are considered safer
than older anti-psychotics — at least in adults — but they still
can have serious side effects, including weight gain, elevated cholesterol and
Anecdotal evidence suggests similar side effects occur in children, but large-scale
studies of youngsters are needed, Cooper said.
The researchers analyzed data on youngsters age 13 on average who were involved
in annual national health surveys. The surveys involved prescriptions given
during 119,752 doctor visits. The researchers used that data to come up with
Cooper said some of the increases might reflect repeat prescriptions given
to the same child, but he said that is unlikely and noted that his findings
echo results from smaller studies.
The study appears in the March-April edition of the journal Ambulatory Pediatrics.
Heavy marketing by drug companies probably contributed to the increase
in the use of anti-psychotic drugs among children, said Dr. Daniel Safer, a
psychiatrist affiliated with Johns Hopkins University, who called the potential
side effects a concern.
Safer said a few of his child patients with behavior problems are on the drugs
after they were prescribed by other doctors. Safer said he has let these children
continue on the drugs, but at low doses, and he also does periodic tests for
high cholesterol or warning signs of diabetes.
Dr. David Fassler, a University of Vermont psychiatry professor, said more
research is needed before anti-psychotics should be considered standard treatment
for attention deficit disorders in children.
"Given the frequency with which these medications are being used, there's
no question that we need additional studies on both safety and efficacy in pediatric
populations," Fassler said.