Trends in Antipsychotic Drug Use by Very Young, Privately Insured Children

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Objective:This study describes recent trends and patterns in antipsychotic treatment of privately insured children aged 2 through 5 years.Method:A trend analysis is presented of antipsychotic medication use (1999–2001 versus 2007) stratified by patient characteristics. Data are analyzed from a large administrative database of privately insured individuals. Participants were privately insured children, aged 2 through 5 years, with 12 months of continuous service enrollment in 1999–2001 (N = 400,196) or 2007 (N = 755,793). The main outcomes are annualized rates of antipsychotic use and adjusted rate ratios (ARR) of year effect on rate of antipsychotic use adjusted for age, sex, and treated mental disorder.Results:The annualized rate of any antipsychotic use per 1,000 children increased from 0.78 (95% confidence interval [CI] 0.69–0.88) (1999–2001) to 1.59 (95% CI 1.50–1.68) (2007) (ARR 1.76, 95% CI 1.56–2.00). Significant increases in antipsychotic drug use were evident for boys (ARR 1.66, 95% CI 1.44–1.90) and girls (ARR 2.26, 95% CI 1.70–3.01) and for children diagnosed with several different psychiatric disorders. Among antipsychotic-treated children in the 2007 sample, pervasive developmental disorder or mental retardation (28.2%), attention deficit/hyperactivity disorder (ADHD) (23.7%), and disruptive behavior disorder (12.9%) were the most common clinical diagnoses. Fewer than one-half of antipsychotic-treated young children received a mental health assessment (40.8%), a psychotherapy visit (41.4%), or a visit with a psychiatrist (42.6%) during the year of antipsychotic use.Conclusions:Despite increasing rates of antipsychotic use by very young children, provision of formal mental health services remains sparse. These service patterns highlight a critical need to improve the availability of specialized and well integrated mental health care for very young children with serious mental health problems.

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