Research Lead: David M. Rubin, MD, MSCE
Supported by: Agency for Healthcare Research and Quality
Background
Increasing numbers of children are being prescribed antidepressants, stimulant medications and newer classes of antipsychotic medications. Recent evidence suggests that the use of atypical antipsychotics may be significant among high-risk youth, particularly those in foster care. Of all the psychotropic medications, the greatest interest has been in the off-label use of atypical antipsychotic medications by children, given insufficient evidence-base for their safety and effectiveness in this population. In addition, metabolic adverse effects may be worse among children. This is especially concerning given that antipsychotic use among children has increased 2 to 5-fold in the period from 1987 to 1996. Despite these concerns, no national studies have examined potential adverse effects of these medications in children, and likewise, the growth in their use among state populations over time.
Aims
- Generate an evidence-base for atypical antipsychotic use in pediatric populations and in turn inform program policies that promote effective and safe practices for children.
- Examine magnitude of risk for the development of hypertension and diabetes among children who are exposed to antipsychotic medication, and if this risk varies by sub-populations within the Medicaid program
- Examine the degree of variation in the use of antipsychotic medications across different populations of children within the Medicaid program, and across children living in different states
- Identify if there are state-specific system-level factors influencing atypical antipsychotic medication use among children within the Medicaid program
- Determine various consent rules for minors, their parents and substitute caretakers regarding the prescription of antipsychotic medications
Methods
Study Design: The sequential analysis plan includes longitudinal and repeated cross-sectional approaches to data analysis that will account for potential case-mix bias in working with administrative data. Additionally, the study includes a statutory analysis of medical consent laws in ten state sample.
Population: Medicaid administrative data in 10 largest states in the United States
Progress
Data analysis is ongoing.
