In a study published this month in the Canadian Journal of Psychiatry, researchers pointed out that children and youth diagnosed with ADHD may be prescribed antipsychotic medication at a much higher rate than the average population. The study, entitled ADHD Treatment in Primary Care Demographic Factors, Medication Trends, and Treatment Predictors, was funded by the Institute for Clinical Evaluative Sciences and the Ontario Ministry of Health and Long-Term Care.
ADHD, or Attention Deficit/Hyperactivity Disorder, is “characterized by inattention, hyperactivity and impulsivity, and is one of the most common mental health conditions in children,” says Statistics Canada. While information from the study seems to emphasize the effects of antipsychotics on children, it did look at patients between the ages of one and 24. Statistics Canada states on their website that about 75 per cent of childhood cases of ADHD will continue into adulthood.
The study had two goals. The first was to find out how common an ADHD diagnoses was in Ontario and the characteristics of the disorder. The second was to figure out what common factors were present when a patient was prescribed antipsychotic drugs to treat the disorder.
The study found that 5.4 per cent of the 10,000 medical records, randomly selected from over 250,000 patients in Ontario, were diagnosed with ADHD. This is consistent with previous studies on the prevalence of ADHD conducted in Canada and the United States. Further, the study noted that 11.9 per cent of the ADHD patients were prescribed antipsychotic drugs.
“The patterns of medication use are also very similar to studies conducted in Canada and the United States and confirm that the number of prescriptions is high even in a diverse study of youth across Ontario,” the authors say in their paper.
While the study also noted that 19.8 per cent of ADHD patients were prescribed antidepressants, those patients also had other factors in common, such as getting older, seeing a psychiatrist, and an anxiety or depression diagnosis. The patients prescribed antipsychotics had only a psychiatric consultation as a common predictor.
The study’s authors stated in their paper that “it is important to understand the prevalence of both this diagnosis and associated comorbidities and the factors that determine treatment outcomes,” in order to “promote the health of children with ADHD.”
Researchers noted that treatment of ADHD might be difficult for doctors because of the risk factors associated with stimulant medications used as first-line treatment for the disorder. “Beyond drug misuse and serious adverse effects, there is considerable variability in how ADHD is treated, including the use of off-label, non stimulant medication, such as antipsychotics.”
The paper compared recommendations for treatment of ADHD in preschoolers in the United States and the United Kingdom and found that the former recommended additional medications not approved for treating ADHD by the FDA if they didn’t see results from their initial treatment, whereas in the UK, additional medication was not recommended for children in that age group.
“ADHD is common,” stated researchers in the study. “The treatment for ADHD appears to be highly varied and includes medications such as atypical antipsychotics, for which there is little evidence of benefit and substantial evidence of potential harm.” Potential complications from the use of risperidone, an antipsychotic commonly prescribed for ADHD that also goes by the brand name Risperdal, include drowsiness and dizziness, weight-gain, or, rarely, mood changes such as anxiety and restlessness, according to WebMd.
Dr. Paul Kurdyak, lead of the mental health and addictions research program at the Institute for Clinical Evaluative Sciences and one of the authors of the study, told the Globe and Mail that “[For] a child who’s being prescribed antipsychotics, you would also hope that every other treatment alternative would have been tried so that the risks that are inherent with antipsychotic use in kids is balanced by the benefits, given the severity of the situation.”
Psychosis, a loss of contact with reality that is the typical diagnosis associated with the use of antipsychotics, typically appears in the form of a “psychotic episode,” in the late teens or early twenties, says the Centre for Addiction and Mental Health. The study notes that psychosis in children with ADHD is “very low” and “does not appear to explain the use of antipsychotics.”
“Given the known adverse consequences of antipsychotic exposure in youth, such as metabolic consequences, and the limited evidence for their use in ADHD treatment, the circumstances and outcomes related to antipsychotic use in ADHD need further exploration,”