Photo by Dana Johnson.

In 1998, William Cooper, M.D., associate professor of Pediatrics, and Catherine Fuchs, M.D., associate professor of Psychiatry, began noticing an increasing number of children who were on antipsychotic drugs. In 2001, Cooper and Fuchs began research to find out if the increase was true, and if so, what was causing it.

They found nearly one in 100 adolescent TennCare recipients are being prescribed powerful antipsychotic medications for behavioral problems associated with attention-deficit/hyperactivity disorder (ADHD). The study, published in August’s Archives of Pediatric and Adolescent Medicine, tracked medical records of thousands of children listed in TennCare between 1996 and 2001.

 “There were three areas of concern: First, these drugs appeared to be being prescribed for disorders they are not proven to treat in children; second the side effects of these drugs in children are not well understood; and third, usage of these drugs appears to be increasing dramatically.” Cooper said.

The study revealed that between 1996 and 2001, the proportion of TennCare children who were new users of antipsychotic medications nearly doubled. Use for and mood disorders increased even more. Perhaps most concerning, the adolescent population had tripled its use of the drugs for ADHD/conduct disorder – nearly one in every 100 adolescents covered under TennCare.

The drugs include clozapine, risperidone, olanzapine, quetiapine fumarate and ziprasidone hydrochloride. This new class of antipsychotics was introduced during the 90s for use in psychosis and Tourettes syndrome. Older classes of antipsychotic drugs are known to have potential side effects like movement disorders and neurologic problems not seen in the newer class of drugs.

“The newer drugs do have their own set of potential side effects, including serious weight gain, heart rhythm problems, and diabetes,” Cooper said. “These are potential side effects that are not well understood when applied to children. In fact, some preliminary studies suggest that the side effects from these medications are more common and may be more severe in children than in adults.”

Cooper said there is modest evidence to support the use of antipsychotic medications to treat severe disruptive behaviors associated with autism and mental retardation, but not for behavioral symptoms associated with ADHD and conduct disorders. He said the apparent overuse could be due to the perception that newer antipsychotic drugs are safer and can help children with aggressive behaviors.

“But those studies still need to be done. We don’t know if the drugs are really safe and beneficial when used this way,” Cooper said.

Cooper said there are anecdotal reports leading him to believe the same questions need to be asked for all children. Cooper and his colleagues are already working with records from the Centers for Disease Control in a new study to find out if this concern extends to the entire population.

“We would like for physicians to think very carefully before prescribing these drugs to children,” Cooper said. “We hope this study encourages more research to find out how these drugs might be best used to help children.”