Psychotropic medications for highly vulnerable children

Abstract

At least 20% of children in the U.S. are highly vulnerable because they lack healthcare and protection. Several factors produce vulnerability: trauma, disruptions of parenting, poverty, involvement in the juvenile justice and/or child welfare systems, residence in restrictive settings, and problems related to developmental disabilities. These children receive psychotropic medications at high rates, raising numerous concerns. Areas covered: The authors begin this review with a description of the population of highly vulnerable children. They then follow this with a review of the effectiveness and side effects of psychotropic medications for their most common diagnoses, using the highest-quality systematic reviews identified by multiple database searches. Expert opinion: Highly vulnerable children receive numerous psychotropic medications with high rates of polypharmacy, off-label use, and long-term use, typically in the absence of adjunctive psychosocial interventions. The current evidence contravenes these trends. Future studies of psychotropic medications in vulnerable children should include long-term effectiveness trials and polypharmacy in conjunction with evidence-based, family-centered, psychosocial treatments.

High-risk psychotropic medications for US children with trauma sequelae

“…Evidencebased psychosocial treatments for behavioural disorders and ADHD (Eyberg et al, 2008;Fabiano et al, 2009), depression (Hetrick et al, 2016) and anxiety (Wang et al, 2017) similarly demonstrate efficacy. Further, some evidence-based psychotherapies for children exposed to trauma have positive effects on comorbid symptoms, including depression, anxiety and disruptive behaviours (Cohen et al, 2018) Psychotropic medications that are often used for disorders common in children exposed to trauma have also been studied extensively, but the findings and recommendations are more negative and cautious (McLaren et al, 2018). No psychotropic medications have demonstrated efficacy and received US Food and Drug Administration approval for childhood PTSD, attachment disorders or disruptive behaviour disorders (e.g.…”

“…Psychotropic medications that are often used for disorders common in children exposed to trauma have also been studied extensively, but the findings and recommendations are more negative and cautious (McLaren et al ., 2018). No psychotropic medications have demonstrated efficacy and received US Food and Drug Administration approval for childhood PTSD, attachment disorders or disruptive behaviour disorders (e.g.…”

The pursuit of the magic pill: the overuse of psychotropic medications in children with intellectual and developmental disabilities in the USA

“…Children with IDD often receive numerous psychotropic medications with high rates of long-term use, polypharmacy and off-label use, typically in the absence of adjunctive behavioural interventions (McLaren et al ., 2018). A recent study of more than 5000 children with autism noted that one-third of those receiving antipsychotics were not receiving behavioural interventions (Lake et al ., 2017).…”

“…Risperidone and aripiprazole have been (FDA) approved in the USA to treat irritability associated with autism (Warren et al ., 2011). Risperidone and aripiprazole show a moderate-to-large effect in decreasing irritability and aggression in children with autism spectrum disorders for short-term treatment (McLaren et al ., 2018). Antipsychotics are more often prescribed to children with IDD than children without IDD; specifically, children with autism have the highest rates of antipsychotic treatment of all children (Brophy et al ., 2018).…”

Overmedicating vulnerable children in the U.S

“…families affected by the widespread opioid epidemic), those in the juvenile justice system, those in residential treatment programmes, those who are homeless, those who have psychiatric problems such as depression and suicidality, those who have trauma histories, and many others are at risk for overuse of medications. How many children are vulnerable in these ways is uncertain, but the proportion may be 20% or more (McLaren et al ., 2018).…”