National Trends in Off-Label Use of Atypical Antipsychotics in Children and Adolescents in the United States
Open accessAbstract
The objectives of the study were as follows: to examine the national trend of pediatric atypical antipsychotic (AAP) use in the United States; to identify primary mental disorders associated with AAPs; to estimate the strength of independent associations between patient/provider characteristics and AAP use. Data are from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. First, average AAP prescription rates among 4 and 18-year-old patients between 1993 and 2010 were estimated. Second, data from 2007 to 2010 were combined and analyzed to identify primary mental disorders related to AAP prescription. Third, a multivariate logistic regression model was developed having the presence of AAP prescription as the dependent variable and patient/provider characteristics as explanatory variables. Adjusted odds ratios (AORs) with associated 95% confidence intervals (CIs) were estimated. Outpatient visits including an AAP prescription among 4 to 18-year-old patients significantly increased between 1993 and 2010 in the United States, and over 65% of those visits did not have diagnoses for US Food and Drug Administration-approved AAP indications. During 2007 to 2010, the most common mental disorder was attention-deficit hyperactivity disorder, accounting for 24% of total pediatric AAP visits. Among visits with attention-deficit hyperactivity disorder diagnosis, those with Medicaid as payer (AOR 1.66, 95% CI 1.01-2.75), comorbid mental disorders (e.g., psychoses AOR 3.34, 95% CI 1.35-8.26), and multiple prescriptions (4 or more prescriptions AOR 4.48, 95% CI 2.08-9.64) were more likely to have an AAP prescription. The off-label use of AAPs in children and adolescents is prevalent in the United States. Our study raises questions about the potential misuse of AAPs in the population.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Off-label use of low-dose second-generation antipsychotics for indications like sleep and anxiety is increasingly being prescribed.
“off-label use of low dose second generation antipsychotic for indications like sleep and anxiety, as this might create equally serious weight problems and is increasingly being prescribed (98).”
From Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [98]
The Discussion (page not provided) reports increasing off-label prescribing of atypical antipsychotics in pediatric outpatient visits. The paper does not establish that the increase involved low-dose prescriptions specifically for sleep or anxiety; its Results instead identify ADHD as the most common primary diagnosis among visits without an FDA-approved indication. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
No references could be resolved yet.
Research works printed but not linked: 21
- [1]Pieters T Majerus B The introduction of chlorpromazine in Belgium and the Netherlands (1951-1968); tango between old and new treatment features. Stud History Philos Biol Biomed Sci 2011; 42: 443– 452. 22035718
- [2]Seida JC Schouten JR Boylan K Antipsychotics for children and young adults: a comparative effectiveness review. Pediatrics 2012; 129: e771– 784. 22351885
- [3]Scheltema Beduin A de Haan L Off-label second generation antipsychotics for impulse regulation disorders: a review. Psychopharmacol Bull 2010; 43: 45– 81. 21150846
- [4]Pathak P West D Martin BC Evidence-based use of second-generation antipsychotics in a state Medicaid pediatric population, 2001-2005. Psychiatric Serv 2010; 61: 123– 129. 20123816
- [5]Crystal S Olfson M Huang C Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Affairs 2009; 28: w770– 781. 19622537 PMC2896705
- [6]Lieberman JA Stroup TS McEvoy JP Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209– 1223. 16172203
- [7]Bobes J Arango C Aranda P Cardiovascular and metabolic risk in outpatients with schizophrenia treated with antipsychotics: results of the CLAMORS Study. Schizophr Res 2007; 90: 162– 173. 17123783
- [8]Friedman JH Atypical antipsychotics in the elderly with Parkinson disease and the “black box” warning. Neurology 2006; 67: 564– 566. 16924004
- [9]Lindsley CW The top prescription drugs of 2011 in the United States: antipsychotics and antidepressants once again lead CNS therapeutics. ACS Chem Neurosci 2012; 3: 630– 631. 22896807 PMC3419448
- [10]Zito JM Safer DJ DosReis S Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med 2003; 157: 17– 25. 12517190
- [11]Patel NC Crismon ML Hoagwood K Trends in the use of typical and atypical antipsychotics in children and adolescents. J Am Acad Child Adolesc Psychiatry 2005; 44: 548– 556. 15908837
- [12]Olfson M Blanco C Liu L National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 2006; 63: 679– 685. 16754841
- [13]McCaig LF Burt CW Understanding and interpreting the National Hospital Ambulatory Medical Care Survey: key questions and answers. Ann Emerg Med 2012; 60: 716– 721. e711. 23083968
- [15]Cooper WO Arbogast PG Ding H Trends in prescribing of antipsychotic medications for US children. Ambul Pediatr 2006; 6: 79– 83. 16530143
- [16]Rosenbaum S Medicaid. N Engl J Med 2002; 346: 635– 640. 11856811
- [17]Shatin D Levin R Ireys HT Health care utilization by children with chronic illnesses: a comparison of Medicaid and employer-insured managed care. Pediatrics 1998; 102: E44. 9755281
- [18]Alaimo K Olson CM Frongillo EA Jr Low family income and food insufficiency in relation to overweight in US children: is there a paradox? Arch Pediatr Adolesc Med 2001; 155: 1161– 1167. 11576013
- [20]Santosh PJ Taylor E Swanson J Refining the diagnoses of inattention and overactivity syndromes: a reanalysis of the Multimodal Treatment study of attention deficit hyperactivity disorder (ADHD) based on ICD-10 criteria for hyperkinetic disorder. Clin Neurosci Res 2005; 5: 307– 314.
- [21]Prendergast M Taylor E Rapoport JL The diagnosis of childhood hyperactivity. A U.S.-U.K cross-national study of DSM-III and ICD-9. J Child Psychol Psychiatry 1988; 29: 289– 300. 3417805
- [22]Faraone SV Sergeant J Gillberg C The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2003; 2: 104– 113. 16946911 PMC1525089
- [23]Döpfner M Breuer D Wille N How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample: results of the BELLA study. Eur Child Adolesc Psychiatry 2008; 17 Suppl 1: 59– 70. 19132305
Cited by
Sorted by citations
Verhaegen, A. A., & Van Gaal, L. F. (2021) · Current Obesity Reports · doi:10.1007/s13679-020-00419-5 · Cited by 53 · see citing works
Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis
Speyer, H., Westergaard, C., Albert, N., Karlsen, M., Stürup, A. E., Nordentoft, M., & Krogh, J. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.577919 · Cited by 44 · see citing works
- Authors
- Sohn, M., Moga, D. C., Blumenschein, K., & Talbert, J.
- Affiliations
- United States Food and Drug Administration (US)
- Corresponding author
- Sohn, Minji
- Venue
- Medicine
- Published
- 2016-06
- Volume
- 95
- Issue
- 23
- Pages
- e3784
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC4907659
- OpenAlex
- W2466519839
- Cited by
- 102
- References
- 0
- Citations by year
- 2026: 10 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 9 · 2021: 14 · 2020: 16 · 2019: 11 · 2018: 11 · 2017: 10 · 2016: 1
- FWCI
- 11.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Medicine (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UKnowledge (University of Kentucky) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- atypical antipsychotics, off-label drug use, pediatric prescribing, children and adolescents, attention deficit hyperactivity disorder, Medicaid, comorbid mental disorders, psychosis, prescribing trends, outpatient visits
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Cross-Sectional Studies, Drug Utilization, Follow-Up Studies, Humans, Population Surveillance, Psychotic Disorders, Retrospective Studies, Antipsychotic Agents, United States, Incidence, Off-Label Use
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
