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Characteristics of Children Prescribed Antipsychotics: Analysis of Routinely Collected Data
Sinead Brophy1, Jonathan Kennedy1, Fabiola Fernandez-Gutierrez2
11 FARR Institute (CIPHER), Swansea University Medical School , Swansea, United Kingdom .
Insights
Antipsychotics are commonly prescribed to children with intellectual disabilities or autism, often for behavioral control rather than psychosis. This use is linked to increased risks of respiratory illness, injury, and depression in this group.
Area of Science:
- Pediatric pharmacology
- Child and adolescent psychiatry
- Public health
Background:
- Antipsychotics are approved for psychosis but frequently prescribed off-label for behavioral management in children.
- Understanding the characteristics and health outcomes of children prescribed antipsychotics is crucial for clinical practice and public health.
- There is a need to evaluate the real-world utilization and potential adverse events associated with antipsychotic use in pediatric populations.
Purpose of the Study:
- To examine the characteristics of children prescribed antipsychotics.
- To investigate the health outcomes, including adverse events, associated with antipsychotic use in children.
- To compare outcomes between children with and without intellectual disabilities/autism.
Main Methods:
- A large-scale cohort study utilizing linked general practice, hospital, and education records in Wales (1999-2015).
- Involved analysis of 1,488,936 children.
- Descriptive statistics and multilevel logistic regression with prior event rate ratio (PERR) were used to analyze characteristics and outcomes.
Main Results:
- Children with intellectual difficulty/autism were significantly more likely to receive antipsychotics (2.8%) at younger ages and for longer durations compared to children without these conditions (0.15%).
- Antipsychotic use was associated with increased rates of respiratory illness in all children. Those with intellectual difficulty/autism also experienced higher rates of injury and hospitalized depression.
- Conversely, children without intellectual difficulty/autism showed lower rates of depression post-antipsychotic use.
Conclusions:
- Antipsychotics are predominantly used for behavioral management in children with intellectual difficulty/autism, not solely for diagnosed psychosis.
- Evidence suggests increased risks of respiratory disease, epilepsy, and diabetes following antipsychotic use across all children.
- Adverse events such as depression and injury are higher in children with intellectual difficulty/autism using antipsychotics, potentially increasing healthcare costs.
Objective:
Antipsychotics are licensed for psychosis and are also prescribed for behavior control. This study aims to examine characteristics and outcomes of children prescribed antipsychotics.
Methods:
A cohort study using general practice and hospital records linked with education records for 1,488,936 children living in Wales between 1999 and 2015. The characteristics of the children who were prescribed antipsychotics are presented using descriptive statistics and outcomes such as respiratory illness, diabetes, and injury were analyzed using multilevel logistic regression and the prior event rate ratio (PERR).
Results:
Children with intellectual difficulty/autism were more likely to be prescribed antipsychotics (2.8% have been prescribed an antipsychotic [75% with autism] compared with 0.15% of children without intellectual difficulty). Those with intellectual disabilities/autism were prescribed antipsychotics at a younger age and for a longer period. Antipsychotic use was associated with a higher rate of respiratory illness for all (PERR of hospital admission: 1.55 [95% CI: 1.51-1.598] or increase in rate of 2 per 100 per year in those treated), and for those with intellectual difficulty/autism, there was a higher rate of injury and hospitalized depression. However, among those without intellectual difficulty/autism, there were lower rates of depression (PERR: 0.55 [95% CI: 0.51-0.59]).
Conclusions:
This work shows real-world use of antipsychotics and provides information on the rate of possible adverse events in children treated. Antipsychotics are predominantly used for those with intellectual difficulty/autism rather than those with a psychotic diagnosis. There is evidence that rates of respiratory disease, epilepsy, and diabetes are also higher postantipsychotic use for all. In those with intellectual difficulty/autism, hospital-admitted depression and injury are higher postantipsychotic use. The use of antipsychotics for behavioral management is likely to have increased cost implications to the healthcare system.
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