Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)

The percentage of persons 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment. 

Why It Matters

Although antipsychotic medications may serve as effective treatment for a narrowly defined set of psychiatric disorders in children, they are often prescribed for nonpsychotic conditions such as attention-deficit hyperactivity disorder and disruptive behaviors (1,2,3), conditions for which psychosocial interventions are considered first-line treatment (4,5). Thus, clinicians may be underutilizing safer first-line psychosocial interventions and using antipsychotics for nonprimary indications in children and adolescents. 

Antipsychotic medications are associated with a number of potential adverse impacts, including weight gain and diabetes (6,7,8), which can have serious implications for future health outcomes. Children without primary indication for an antipsychotic and who are not given the benefit of a trial of psychosocial treatment first, may unnecessarily incur the risks associated with antipsychotic medications. Mental health conditions in youth are associated with a number of potential adverse effects, including increased risk for substance use (9). To the extent that psychosocial interventions are associated with better outcomes (10,11,12), underuse of these therapies may lead to poorer mental and physical health outcomes. 

In the absence of a Food and Drug Administration indication for an antipsychotic medication, guidelines recommend that psychosocial treatments be provided prior to initiating an antipsychotic (13,14,15). Guidelines for individual conditions that recommend use of antipsychotics in the absence of a primary indication address the use of psychosocial interventions prior to use of an antipsychotic. Treatment guidelines for management of aggression (16) and disruptive behavior disorders all endorse psychosocial interventions as first-line treatment.  

* Developed with financial support from the Agency for Healthcare Research and Quality (AHRQ) and CMS under the CHIPRA Pediatric Quality Measures Program Centers of Excellence grant number U18HS020503, from a measure developed by MedNet Medical Solutions. 

Historical Results – National Averages

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References

  1. McKinney, C., and K. Renk. 2011. “Atypical Antipsychotic Medications in the Management of Disruptive Behaviors in Children: Safety Guidelines and Recommendations.” Clinical Psychology Review 31(3):465–71. 
  2. Cooper, W.O., G.B. Hickson, C. Fuchs, P.G. Arbogast, W.A. Ray. 2004. “New Users of Antipsychotic Medications Among Children Enrolled in TennCare.” Archives of Pediatric Adolescent Medicine 158(8):753–9. DOI:10.1001/archpedi.158.8.753. 
  3. Olfson, M., C. Blanco, L. Liu, C. Moreno, G. Laje. 2006. “National Trends in the Outpatient Treatment of Children and Adolescents with Antipsychotic Drugs.” Archives of General Psychiatry 63(6):679–85. DOI:10.1001/archpsyc.63.6.679. 
  4. Kutcher, S., M. Aman, S.J. Brooks, J. Buitelaar, E. van Daalen, J. Fegert and S. Tyano. 2004. “International Consensus Statement on Attention-Deficit/Hyperactivity Disorder (ADHD) and Disruptive Behaviour Disorders (DBDs): Clinical Implications and Treatment Practice Suggestions.” European Neuropsychopharmacolog 14(1):11–28. 
  5. Pappadopulos, E., N.S. Rosato, C.U. Correll, et al. December 2011. “Experts’ Recommendations for Treating Maladaptive Aggression in Youth.” Journal of Child and Adolescent Psychopharmacology 21(6):505-515. 
  6. Andrade, S.E., J.C. Lo, D. Roblin, et al. December 2011. “Antipsychotic Medication Use Among Children and Risk of Diabetes Mellitus.” Pediatrics 128(6):1135–41. 
  7. Bobo, W.V., W.O. Cooper, C.M. Stein, et al. October 1, 2013. “Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth.” JAMA Psychiatry 70(10):1067–75. 
  8. Correll, C.U. 2008. “Antipsychotic Use in Children and Adolescents: Minimizing Adverse Effects to Maximize Outcomes.” FOCUS: The Journal of Lifelong Learning in Psychiatry 6(3):368–78. 
  9. Substance Abuse and Mental Health Services Administration. May 3, 2007. The NSDUH Report: Depression and the Initiation of Alcohol and Other Drug Use Among Youths Aged 12 to 17. Rockville, MD. 
  10. Jensen, P.S., S.P. Hinshaw, J.M. Swanson, et al. February 2001. “Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers.” Journal of Developmental and Behavioral Pediatrics 22(1):60–73. 
  11. Eyberg, S.M., M.M. Nelson, S.R. Boggs. January 2008. “Evidence-Based Psychosocial Treatments for Children and Adolescents with Disruptive Behavior.” Journal of Clinical Child and Adolescent Psychology 37(1):215–37. 
  12. Schimmelmann, B.G., S.J. Schmidt, M. Carbon, C.U. Correll. March 2013. “Treatment of Adolescents with Early-Onset Schizophrenia Spectrum Disorders: In Search of a Rational, Evidence-Informed Approach.” Current Opinion in Psychiatry 26(2):219–30. 
  13. American Academy of Child and Adolescent Psychiatry. 2011. Practice Parameter for the Use of Atypical Antipsychotic Medications in Children and Adolescents. http://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_web.pdf (Accessed July 12, 2012) 
  14. Gleason, M.M., H.L. Egger, G.J. Emslie, et al. December 2007. “Psychopharmacological Treatment for Very Young Children: Contexts and Guidelines.” J Am Acad Child Adolesc Psychiatry 46(12):1532–72. 
  15. Scotto, Rosato N., C.U. Correll, E. Pappadopulos, A. Chait, S. Crystal, P.S. Jensen. June 2012. “Treatment of Maladaptive Aggression in Youth: CERT guidelines II. Treatments and Ongoing Management.” Pediatrics 129(6):e1577–86. 

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