The study, published in the August 3 issue of Archives of Pediatric Adolescent Medicine, revealed that between 1996 and 2001 the proportion of children on TennCare, Tennessee's program for Medicaid enrolles and the uninsured, who were new users of powerful atypical antipsychotic medications almost doubled, from 23 per 10,000 children to 45 per 10,000. Use for behavioral problems associated with attention-deficit/hyperactivity disorder (ADHD) and mood disorders increased more than twofold. Perhaps most concerning, the adolescent population had more than a threefold increase in use of the drugs for ASDHD/conduct disorder, that amounted to nearly one in every 100 adolescents covered under TennCare.
The study's authors, led by William Cooper, M.D., associate professor of Pediatrics at Children's Hospital, tracked medical records of thousands of children listed in Tennessee's managed care program between 1996 and 2001. They eliminated any child listed with a severe disability, including a severe mental illness like psychosis or autism. The team suspects the concerns extend to the entire population and have started working with CDC records in a new study to determine the problem's extent.
Cooper and Catherine Fuchs, M.D., associate professor of Psychiatry at Vanderbilt, began noticing an increasing number of children in Vanderbilt's clinics who were on antipsychotic drugs. In 2001, Cooper and Fuchs began the retrospective research.
"There were three areas of concern. First, these drugs appeared to be prescribed for disorders they are not proven to treat in children; second, the side effects of these drugs in children are not well understood; and third, usage of these drugs appears to be increasing dramatically." Cooper said.
The drugs were introduced during the 1990s as a new generation of antipsychotics, and include clozapine, risperidone, olanzapine, quetiapine fumarate and ziprasidone hydrochloride. They were approved for use in psychosis and Tourettes syndrome. Cooper theorized the introduction of this new class of antipsychotic drugs was part of the reason for the increase in off-label use. The older antipsychotic drugs are well known to have potential side effects like movement disorders and other serious neurologic problems not seen in the newer class of drugs.
"The newer drugs do have their own set of potential side effects, including serious weight gain, heart rhythm problems, and diabetes," said Cooper. "These are potential side effects that are not well understood when applied to children. In fact, some preliminary studies suggest that the side effects from these medications are more common and may be more severe in children than in adults."
Cooper said there is modest evidence to support the use of this newer class of antipsychotic medications to treat severe disruptive behaviors associated with autism and mental retardation, but not for behavioral symptoms associated with ADHD and conduct disorders. He said it may be perceived that newer antipsychotic drugs are safer for children, and that the drugs can help children with aggressive behaviors.
"But those studies still need to be done. We don't know if the drugs are really safe and beneficial when used this way," Cooper said.
"We would like for physicians to think very carefully before prescribing these drugs to children," Cooper said. "And we hope this study encourages more research to find out how these drugs might be best used to help children."
Fuchs agrees. "The goal of this article is to encourage physicians to carefully consider the risk/benefit ratio in their decision making about prescribing practices for the new generation of antipsychotics. The medications are very effective. However, it is important for us as physicians to develop increased understanding of behavioral changes as they relate to illness; with the understanding that we will be able to make more effective treatment decisions," she said.
Cooper's area of special interest is application of research to public health programs. He and Fuchs, along with co-investigators Gerald Hickson, M.D., professor of Pediatrics and Psychiatry; Patrick Arbogast, Ph.D., assistant professor of Preventive Medicine and Wayne Ray, Ph.D., director of the division of Pharmacologic Epidemiology, were assisted by the state's TennCare program in gathering data for the study.
TV package script:
| VIDEO | AUDIO |
| Kids playing in park | SHOULD CHILDREN WITH PROBLEMS LIKE A-D-H-D BE PLACED ON NEW ANTIPSYCHOTIC MEDICATIONS? WE'LL TELL YOU WHY RESEARCHERS AT VANDERBILT CHILDREN'S HOSPITAL SAY IT MAY BE A CONCERNING CHOICE, NEXT. |
| Antipsychotic medications Pills pouring from bottle |
|
| Doctor talking Vanderbilt Children's Hospital exterior shot |
TOTAL RUNNING TIME - :30
SUGGESTED STUDIO INTRO: A NEW STUDY BY RESEARCHERS AT VANDERBILT MEDICAL CENTER, RELEASED TODAY (Embargoed until 3 pm CDT, August 2, 2004) IN THE ARCHIVES OF PEDIATRICS AND ADOLESCENT MEDICINE, FOUND THAT FROM 1996 TO 2001, A GROWING NUMBER OF ADOLESCENT CHILDREN EITHER INSURED OR COVERED BY A MANAGED CARE PROGRAM IN TENNESSEE WERE BEING PRESCRIBED NEW ANTIPSYCHOTIC MEDICATIONS FOR BEHAVIORAL PROBLEMS SUCH AS A-D-H-D. REPORTER HEATHER HALL EXPLAINS.
| VIDEO | AUDIO |
| NATSOUND: Kids playing in park | NATSOUND: Kids playing in park (:03) |
| Kids playing in park continues | JENNIE CONRAD HAS TWO SONS WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER OR A-D-H-D, AND A DAUGHTER WITH ATTENTION DEFICIT DISORDER OR A-D-D. SHE STRUGGLED WITH DECIDING WHETHER MEDICATION WAS NECESSARY. (:12) |
| CU: daughter playing in park | |
| CU: Jennie watching kids at play | |
| SOT: Jennie Conrad | SOT: Jennie Conrad: "I really hesitated to use medicine because I feel like behavior management is a real strong component, but I think that sometimes you have to back off and use both of those." (:10) |
| WS: Doctor Cooper walking around hallway to meet nurse at station MS: Nurse listening to Doctor Cooper OTS: Doctor Cooper talking to nurse MS: Pharmacy technician getting pill bottle from shelf Pills pouring onto pill counter, bottle in background |
DOCTOR WILLIAM COOPER FROM VANDERBILT CHILDREN'S HOSPITAL AGREES. HIS STUDY IDENTIFIED THAT INCREASINGLY HEALTH CARE PROVIDERS APPEAR TO BE RELYING PRIMARILY ON MEDICATIONS INCLUDING NEW ANTIPSYCHOTIC MEDICATIONS, MANY NOT ADEQUATELY TESTED FOR USE IN CHILDREN AND ADOLESCENTS. (:15) |
| SOT: William Cooper, M.D. | SOT: William Cooper, M.D.: "We found a near doubling of the children that were placed on that, in particular for example, teenagers, where by 2001 one out of every one-hundred teenagers in our study population were being placed on these medications." (:13) |
| Kids at park playing | DOCTOR COOPER SAYS THERE ARE NO STUDIES TESTING THE USE OF THESE NEW ANTIPSYCHOTIC MEDICATIONS IN CHILDREN WITH PROBLEMS LIKE A-D-H-D. (:08) |
| VO/SOT: William Cooper, M.D. Kids playing in park |
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| SOT: Dr. Cooper up full here | VO/SOT: William Cooper, M.D.: "If there's an increasing number of kids being placed on these medicines and we don't know these things that would be potentially a lot of children being placed at risk for having dangerous and severe side effects." (:11) |
| Pharmacist pulls pills from shelf MS: various pill bottles CU: pills pouring onto counter |
SO WHY THE DRAMATIC INCREASE IN CHILDREN TAKING THESE MEDICATIONS? DOCTOR COOPER THINKS NEWER MEDICINES HITTING THE MARKET ARE PART OF IT. (:07) |
| SOT: William Cooper, M.D. | SOT: William Cooper, M.D.: "The older antipsychotics had severe neurological side effects and people didn't use them for that reason. The newer side effects are there, they just appear to be a different type of side effects." (:10) |
| MS: Mother with daughter in lap in exam room CU: looking inside young patient's throat MS: Doctor Cooper checking young patient's throat CU: Doctor Cooper listening to her lungs and talking to her |
DOCTOR COOPER SAYS FURTHER STUDIES ARE NECESSARY TO DETERMINE IF THESE NEWER ANTIPSYCHOTIC MEDICATIONS WILL BE APPROPRIATE FOR USE IN CHILDREN. THIS IS HEATHER HALL REPORTING. (:09) |
SUGGESTED STUDIO TAG: DOCTOR COOPER SUGGESTS A LACK OF MENTAL HEALTH RESOURCES FOR COMMUNITIES ADDS TO THE PROBLEM, MAKING IT DIFFICULT FOR PARENTS OF CHILDREN WITH BEHAVIORAL PROBLEMS TO FIND ADDITIONAL TREATMENT OPTIONS, INCLUDING BEHAVIOR MANAGEMENT. HE ADVISES PARENTS TO BE SURE THEIR CHILD IS EVALUATED AND PROPERLY DIAGNOSED WITH A-D-H-D OR OTHER PROBLEMS FIRST, AND TO DISCUSS SIDE EFFECTS OF MEDICATIONS WITH A HEALTH CARE PROVIDER IN ORDER TO MAKE INFORMED DECISIONS ABOUT THE BEST CHOICE FOR THEIR CHILD.
TRT: 1:40
SUPERS:
Jennie Conrad :14-:25
Concerned Parent
William Cooper, M.D. :40-:53
Vanderbilt Children's Hospital
Journal
Archives of Pediatrics and Adolescent Medicine