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Antipsychotics often prescribed for learning difficulty in children

Children with intellectual difficulty or autism are more likely to be prescribed antipsychotic medications than those with a psychotic diagnosis and are prescribed antipsychotics at a younger age and for a longer period, according to research findings.

“There are ‘deep concerns’ about the overuse of antipsychotic medicines in people with intellectual difficulty and autism in terms of the extent to which these drugs are used outside licensed indications with the aim of managing behavior problems,” Sinead Brophy, PhD, FARR Institute, Swansea University Medical School, U.K., and colleagues wrote. “The evidence base for behavioral management using antipsychotics is still at an early stage and there are few studies examining the long-term effects of this medication when started in childhood.”

To assess characteristics and outcomes of children prescribed antipsychotic medications, researchers conducted a cohort study of more than 1.4 million children living in Wales between 1999 and 2015 using data from general practice, hospital and education records. The investigators analyzed respiratory illness, diabetes and injury outcomes using multilevel logistic regression and the prior event rate ratio.

The results showed that children with intellectual difficulty or autism were more likely to be prescribed antipsychotics. Overall, 2.8% of children with difficulties or autism had been prescribed an antipsychotic — 75% of whom had autism — compared with 0.15% of those without intellectual difficulty. Children with autism or intellectual difficulties were also less likely to have a psychotic disorder. Youth prescribed an antipsychotic were more likely to be boys, have epilepsy, ADHD and be in special needs school. Furthermore, youth with intellectual disabilities/autism received antipsychotics at a younger age and for a longer period than those without these disabilities.

Use of antipsychotic medications was linked to a higher rate of respiratory illness, epilepsy and diabetes for all children, as well as injury and hospitalized depression for children with intellectual challenges or autism. However, among youth without intellectual difficulty or autism, there were lower rates of depression (prior event rate ratio: 0.55; 95% CI, 0.51–0.59).

“The findings suggest that children with intellectual difficulty/autism are prescribed antipsychotics predominately for behavioral control/aggression rather than psychotic disorder and predominately in those with autism,” Brophy and colleagues wrote. “Future work could extend this analysis to a larger population such as that in England and Scotland to confirm and validate findings as an increase in diabetes not only leads to a long-term chronic condition in those affected but also has implications for the [National Health Service].” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.