Psychotropic Practice Patterns for Youth

Zito, Julie Magno; Safer, Daniel J.; dosReis, Susan; Gardner, James M.; Magder, Laurence S.; Soeken, Karen L.; Boles, Myde; Lynch, Frances L.; Riddle, Mark A.

doi:10.1001/archpedi.157.1.17

Cited by 468 publications

(306 citation statements)

References 38 publications

Supporting

Mentioning

269

Contrasting

Unclassified

Order By: Relevance

“…24 Schoolbased studies in Maryland, Northern Virginia, and North Carolina, as well as studies of children with Medicaid coverage in a mid-Atlantic and a Midwestern state, have reported less medication use for ADHD among African American and Hispanic children than white children. [25][26][27][28] While the results of this analysis are consistent with the findings from a number of previous studies, several limitations should be considered. Measures of ADHD and LD were based on parental reports of identified cases rather than on psychiatric, psychological, or educational assessments of children.…”

Section: Discussionsupporting

confidence: 83%

Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey

2005

View full text Add to dashboard Cite

Objectives. Racial and ethnic disparities have been documented for many physical health outcomes in children. Less is known, however, about disparities in behavioral and learning disorders in children. This study uses data from a national health survey to examine racial and ethnic differences in identified attention deficit hyperactivity disorder (ADHD) and learning disability (LD). Methods. The 1997–2001 National Health Interview Surveys obtained information from parents about the health and sociodemographic characteristics of children. Using these data, prevalence rates of identified ADHD and/or LD were estimated for Hispanic, African American, and white children 6–11 years of age. Racial and ethnic differences in health conditions, income, and insurance coverage were examined as possible explanations for disparities in parental reports of ADHD and LD, as well as the use of any prescription medication among children with ADHD. Results. Hispanic and African American children, compared to white children, had parental reports of identified ADHD without LD less often, and adjustments for the confounding variables—birthweight, income, and insurance coverage—did not eliminate these differences. Hispanic and African American children, compared to white children, also had parental reports of ADHD with LD less often after adjustments for the effects of confounding variables. By contrast, after adjustments for confounding variables, Hispanic and African American children were as likely as white children to have LD without ADHD. Among children with ADHD, use of any prescription medication was reported less often for Hispanic and African American children than white children. These disparities in medication use persisted after adjustments for confounding variables. Conclusions. The prevalence of ADHD and the use of any prescription medication among children with ADHD differed among Hispanic, African American, and white children. These disparities could not be explained by racial and ethnic differences in other health conditions and sociodemographic variables.

show abstract

Section: Discussionsupporting

confidence: 83%

Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey

2005

View full text Add to dashboard Cite

show abstract

“…Nevertheless, a subgroup of participants was on one or more psychotropics. This is consistent with national trends marked by a significant increase in number of adolescents with adjustment problems who are prescribed psychotropic medications (Zito et al, 2003). These include stimulants, antidepressants and, to a lesser extent, antipsychotics.…”

supporting

confidence: 85%

Neurocognition and conversion to psychosis in adolescents at high-risk

Walder

Mittal

Trotman

et al. 2008

Schizophrenia Research

View full text Add to dashboard Cite

This study examined neurocognitive predictors of conversion to Axis I psychosis among adolescents at high-risk for psychosis (AHRP). There were no significant differences in neurocognitive performance between adolescents at high-risk for psychosis who converted (AHRP+) and adolescents at high-risk for psychosis who did not convert (AHRP−). Within-sex comparisons revealed a relation between risk status and performance among females, with AHRP+ performing below AHRP−, but this effect did not hold for males. Between-sex comparisons revealed AHRP− males performed worse than AHRP− females on several measures. Across groups, males performed better than their female counterparts on select measures. Results are discussed in terms of implications for use of neurocognitive profiles as bio-risk markers of psychosis, while considering sex differences. Keywordspsychosis; high-risk; adolescents; cognition; sex differences; bio-risk markers Neurocognitive deficits are a well-established characteristic of schizophrenia (see Green et al., 2006). Despite strong evidence of poor premorbid intellectual functioning (for a meta-analytic review, see Aylward et al., 1984;Seidman et al., 2006;Reichenberg et al., 2006) and literature suggesting subtle functional impairments in years preceding clinical onset (e.g., , only a few studies have examined neurocognitive functioning among high-risk youth in relationship to vulnerability for conversion to Axis I psychosis.There are some recent reports of neurocognitive impairments among clinical high-risk individuals (Gschwandtner et al., 2003), including adolescents meeting criteria for schizophrenia prodromal syndrome (Hawkins et al., 2004) and youth with schizotypal personality disorder (SPD;Trotman et al., 2006), though others have not replicated this (Brewer et al., 2006). There are also some reports of a relation between cognitive dysfunction and conversion to psychosis in clinical high-risk groups (Lencz et al., 2006;Keefe et al., 2006;Brewer et al., 2005). Specifically, two investigations revealed that poorer verbal memory predicted psychosis outcome (Brewer et al., 2005;Lencz et al., 2006). Another showed that a Corresponding author: Deborah J. Walder, Department of Psychology, Brooklyn College of The City University of New York, Phone: (718) 951-5000, x. 6013, FAX: (718) 951-4814, E-mail: dwalder@brooklyn.cuny.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Bilder et al., 2000; Gittelman-Klein and Klen, 1969;Erlenmeyer-Kimling et al., 1984). The vast majority of studies indicate better premorbid functioning during childhood among fe...

show abstract

“…35 White children were more likely than children in any other ethnic or racial group to use medications, similar to what previous studies have reported regarding psychotropic medication use in general. 34,36,37 Although this issue has not been examined in ASDs, studies of children with attention-deficit/hyperactivity disorder suggest that differences may be attributable to disparities in access to health care, beliefs about adverse effects of medication, and general trust of the health care system. 38,39 The finding that children who were eligible for Medicaid because of disability were more likely to use medication than children who were eligible because of poverty is not surprising and is in line with previous research 40 ; more concerning is the high prevalence of psychotropic medication and multiple medication use among children in foster care.…”

Section: Discussionmentioning

confidence: 99%

Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders

et al. 2008

View full text Add to dashboard Cite

OBJECTIVE-The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use.METHODS-This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60 641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use.RESULTS-Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed ≥3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications.CONCLUSIONS-Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. Given the limited evidence base, there is an urgent need to assess the risks, There is ongoing debate regarding the role of psychotropic agents in ASD management. 2,3 Although no medications are known to address the core symptoms of ASDs, they often are prescribed as adjunctive therapy to address symptoms such as aggression, self-injurious behaviors, stereotypies, and hyperactivity. [4][5][6] Many medications have been tested with varying levels of scientific rigor, 7 but only risperidone, an atypical neuroleptic that reduces aggression and irritability, has received Food and Drug Administration approval for the treatment of these symptoms in individuals with ASDs. 8Medication use is common among children with ASDs and seems to be increasing. A 1995 survey found that 30% of children with ASDs were using some psychotropic medication 9 ; follow-up studies 6 years later found 46% using them. 10,11 Neuroleptic agents were most common in 2 of 3 studies, 9,11 with antidepressants the most common in the third. 10 In 2001, 21% were using >1 drug, compared with 8% in 1995. A 2005 international Internet survey found that 52% of parents reported that their children were using psychotropic drugs. 12 These studies provided important information regarding psychotropic medication use in children with ASDs, but all relied on parent report, the validity of which is unknown. With 1 exception, 12 they sampled relatively small geographic areas, and all exc...

show abstract

Psychotropic Practice Patterns for Youth

Abstract: Youth psychotropic treatment utilization during the 1990s nearly reached adult utilization rates. Youth findings can be used to accurately assess the duration of treatment and unforeseen practice pattern changes, and to identify safety concerns.

Cited by 468 publications

References 38 publications

Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey

Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey

Neurocognition and conversion to psychosis in adolescents at high-risk

Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders

Contact Info

Product

Resources

About