Antipsychotic Medications for Low-Income Preschoolers: Long Duration and Psychotropic Medication Polypharmacy
W David Lohr1, Kahir Jawad1, Yana Feygin1
1Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Lohr, Jawad, Feygin, Le, Pasquenza, Williams, Jones, Myers, Davis); Department of Health Management and System Sciences, University of Louisville School of Public Health and Information Science, Louisville, Kentucky (Creel).
Insights
Many young children are prescribed antipsychotic medications for extended durations, with factors like male gender and autism spectrum disorder influencing use. Further research is needed to establish evidence-based practices for reducing medication use and improving outcomes in this population.
Area of Science:
- Pediatric pharmacology
- Child psychiatry
- Public health
Background:
- Antipsychotic medication use in young children is a growing concern.
- Understanding prescribing patterns and duration of use is crucial for optimizing treatment and minimizing risks.
- Low-income populations may have unique factors influencing medication access and adherence.
Purpose of the Study:
- To evaluate antipsychotic prescribing patterns in low-income, preschool-age children.
- To identify factors predicting the duration of antipsychotic medication use in this demographic.
- To inform clinical practice and future research regarding pediatric antipsychotic prescribing.
Main Methods:
- Analysis of State Medicaid claims data from 2012 to 2017 for children under 6 years old.
- Utilized ICD-9 and ICD-10 codes to identify diagnoses associated with antipsychotic use.
- Employed descriptive and multivariable analyses to determine usage patterns and predictors of duration.
Main Results:
- In 2012, 316 children under 6 started antipsychotics; common diagnoses included ADHD, neurodevelopmental disorders, anxiety, and autism spectrum disorders (ASDs).
- The average exposure duration was 2.6 years, with 27% exposed for over 4 years; 31% received polypharmacy, and 42% had metabolic screening.
- Male gender, foster care, and diagnoses of ASD or disruptive mood dysregulation disorder were associated with longer antipsychotic use.
Conclusions:
- A significant proportion of preschoolers receive antipsychotic medications for prolonged periods.
- Evidence-based strategies are needed to reduce antipsychotic exposure and enhance outcomes in young children.
- Further research should focus on developing guidelines for appropriate antipsychotic use in pediatric populations.
Objective:
This study aimed to evaluate prescribing patterns of antipsychotic medication and factors that predict duration of use among low-income, preschool-age children.
Methods:
State Medicaid claims from 2012 to 2017 were used to identify antipsychotic medication use for children <6 years old. ICD-9 and ICD-10 codes were used to describe child diagnoses. Descriptive and multivariable analyses were used to determine patterns of antipsychotic medication use and factors that predicted duration of use.
Results:
In 2012, 316 children <6 years of age started an antipsychotic medication in a southeastern state. Most were non-Hispanic White (N=202, 64%) and boys (N=231, 73%). Diagnoses included attention-deficit hyperactivity disorder (N=288, 91%), neurodevelopmental disorders (N=208, 66%), anxiety and trauma-related diagnoses (N=202, 64%), and autism spectrum disorders (ASDs) (N=137, 43%). The mean±SD duration of exposure to antipsychotic medication for children in the cohort was 2.6±1.7 years, but 86 children (27%) had >4 years of exposure. Almost one-third (N=97, 31%) received polypharmacy of four or more medication classes, and 42% (N=131) received metabolic screening. Being male, being in foster care, and having a diagnosis of ASD or disruptive mood dysregulation disorder were significantly associated with duration of use of antipsychotic medications; race-ethnicity was not significantly associated with duration of use. Emergency department visits (N=277, 88%) and inpatient hospitalizations (N=107, 34%) were observed during the study period.
Conclusions:
Many preschoolers received antipsychotic medications for substantial periods. Further research is needed to identify evidence-based practices to reduce medication use and improve outcomes.
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