Antipsychotic medications are often used for in 'second-generation' form - that is, for unlabeled indications, such as treatment of children and adolescents with attention-deficit hyperactivity disorder (ADHD). Currently, atypical antipsychotic medications are FDA approved for use only in youth for schizophrenia, bipolar disorder, and irritability associated with autism. To date, no atypical antipsychotic agent has an FDA-labeled indication for use in behavioral disorders in children and adolescents.

The results of a study of atypical antipsychotic drug use among youths with ADHD, comparing age groups, Medicaid eligibility, and presence in foster care are presented in Journal of Child and Adolescent Psychopharmacology. The data was provided by the Maryland Department of Health and Mental Hygiene.

Mehmet Burcu and Julie Zito, University of Maryland, Aloysius Ibe, Morgan State University, and Daniel Safer, Johns Hopkins Medical Institutions, Baltimore, MD, report that nearly one-third of the ADHD-diagnosed foster care youth ages 2-17 years of age included in the assessment received atypical antipsychotics during the study period.  The study cohort was youths who had continuous enrollment for 12 months in the state Medicaid program in 2006 and were in the 2–17 age range as of January 1, 2006. Continuously enrolled youth represented 72.0% of the state Medicaid program enrollees.

The most common medications given were risperidone, aripiprazole, and quetiapine, according to the article and the median annual duration of atypical antipsychotic use was 180 days. Pre-teens (ages 2-12) had longer durations of use than did teenagers (ages 13–17) and in the absence of any comorbid psychiatric diagnosis, ADHD-diagnosed foster care youth had more than threefold greater adjusted odds of atypical antipsychotic use than did youth enrolled in income-eligible Medicaid categories.

Frequency of concomitant atypical antipsychotic regimens among continuously enrolled Medicaid-insured youth with concomitant antipsychotic use, n=643. 

There are limitations to this kind of study. Data sets were extracted from administrative claims for reimbursement in the Medicaid insurance system, and may be subject to unmeasured confounding bias, such as disease severity, and because of the cross-sectional nature of its design, the study had limitations with respect to assessing the temporal relationship of antipsychotic exposure and prior treatment patterns.

Citation: Burcu Mehmet, Zito Julie Magno, Ibe Aloysius, Safer Daniel J., 'Atypical Antipsychotic Use Among Medicaid-Insured Children and Adolescents: Duration, Safety, and Monitoring Implications', Journal of Child and Adolescent Psychopharmacology, doi:10.1089/cap.2013.0094.