Antipsychotic prescription medication for children has declined significantly, according to a Rutgers study that found a 43 percent drop for Medicaid-enrolled children from 45 states.

Published in the July issue of Health Affairs, the study examined Medicaid claims data between 2008 to 2016, looking at the off-label usage of these medications and found that antipsychotic prescription use sharply declined among children across age, sex, racial and ethnic groups and foster care status.

“The decline we observed likely reflects the convergence of multiple state safer-use policies along with educational initiatives and the implementation of quality metrics for safe antipsychotic prescribing,” said Stephen Crystal, director of the Center for Health Services Research at Rutgers Institute for Health, Health Care Policy and Aging Research (IFH) and senior author of the study. “They reflect the results of many cross-state and within-state efforts to address national concerns about safe prescribing.”

Certain antipsychotic medications are approved by the Food and Drug Administration (FDA) to treat children diagnosed with mental health conditions, including schizophrenia, irritability associated with autism, bipolar disorder and Tourette syndrome. These medications have also been prescribed for unapproved conditions such as attention deficit hyperactivity disorder, even though there are potentially serious side effects, such as type 2 diabetes or sudden cardiac death.

According to the study, while most antipsychotic use still continues to be among children without FDA-approved mental health conditions, prescribing antipsychotics has started to become more focused on children with approved diagnoses.

“Despite declines in pediatric antipsychotic use, safety concerns remain,” said Greta Bushnell, an author of the study, faculty member at the Center for Pharmacoepidemiology and Treatment Science at IFH and an assistant professor at the Rutgers School of Public Health. “Our findings highlight the need for continued focus on the judicious prescribing of antipsychotics in this young population.”

Researchers said further study is needed to shed light on disparities in antipsychotic use, including potentially inappropriate prescribing as well as under-prescribing for children with a need for treatment. 

Coauthors of the study include Stephen Crystal, James Lloyd and Sharon Cook of the Center for Health Services Research at IFH; Mark Olfson of Columbia University Irving Medical Center and New York State Psychiatric Institute; and Himshikha Das, a former student of the Rutgers School of Public Health. Research was supported by the Agency for Healthcare Research and Quality (5R01HS026001), National Institutes of Health (5K01DA050769) and the National Center for Advancing Translational Sciences (UL1TR003017).