The safe and judicious use of antipsychotic medications is a critical issue for children and youth. Antipsychotics are powerful medications indicated for treating a limited range of children’s mental health problems, including schizophrenia and bipolar disorder.1 While antipsychotic medications may serve as an effective treatment for a defined set of psychiatric disorders in children and adolescents, they are often prescribed for non-psychotic conditions, such as attention-deficit/hyperactivity disorder (ADHD), maladaptive aggression behaviors, disruptive behavior disorders, and other non-indicated conditions.2,3,4 The use of antipsychotics in children and adolescents can increase the risk for developing serious health concerns, such as metabolic and physical health complications, which can adversely affect development.5 Antipsychotic medications are associated with a number of negative health impacts, including weight gain and diabetes, which can have serious implications for future health outcomes.6,7,8 Additionally, there are serious risks associated with antipsychotic medications in children, including liver toxicity, cardiac arrhythmias, extrapyramidal side effects, sedation, and somnolence.9
Despite known health risks, antipsychotic prescribing in children and adolescents rapidly increased in recent decades.5,10,11,12 This increase appears to be related to off-label use of antipsychotics to treat aggression, maladaptive behaviors, and other non-indicated mental health problems. Psychosocial interventions are considered first-line treatment for children, adolescents, and their families for a variety of mental health disorders, including but not limited to bipolar disorder, maladaptive aggression, and oppositional defiant disorder, and have been proven as effective treatments. Children and adolescents without a primary indication for an antipsychotic (e.g., schizophrenia, bipolar disorder) who are not first provided a trial of psychosocial treatment may unnecessarily incur the metabolic and physical health risks associated with antipsychotic medications.2,3,4 Psychosocial interventions are associated with better outcomes, while underuse of these therapies may lead to poorer mental and physical health outcomes.13,14,15 In addition, given the health risks associated with the use of antipsychotics in children and adolescents, multiple and concurrent antipsychotics should be avoided unless there is a compelling rationale to the contrary.16
In response to reviews of guidelines and identified gaps in care, NCINQ developed three measures to assess safe and judicious antipsychotic use among children and adolescents.16 These measures were adopted into HEDIS beginning in 2015.17
