Attention Deficit Hyperactivity Disorder

If you’re a child in Medicaid, you already have a more difficult life than average ahead of you. Children in Medicaid programs have nearly twice the number of mental health problems than other children. But now new research suggests it gets even worse for children in Medicaid, according to an article in The New York Times — they are prescribed four times the amount of atypical antipsychotic medications than other children:

New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.

The problem is simple — there are fewer psychiatrists who take Medicaid payments (which are lower than what private insurance generally pays), so most of these antipsychotic medications are being prescribed by family physicians or pediatricians who simply don’t know better (or think they’re helping when they’re really not). As the article notes, “it is often a pediatrician or family doctor who prescribes an antipsychotic to a Medicaid patient — whether because the parent wants it or the doctor believes there are few other options.”

The worst part? Antipsychotics to treat ADHD? Diagnosing bipolar disorder in children 3 years of age? I feel like I’m in a horror movie that never ends:

The F.D.A. has approved antipsychotic drugs for children specifically to treat schizophrenia, autism and bipolar disorder. But they are more frequently prescribed to children for other, less extreme conditions, including attention deficit hyperactivity disorder, aggression, persistent defiance or other so-called conduct disorders — especially when the children are covered by Medicaid, the new study shows.

You see, once a drug gets pediatric FDA approval for one condition, doctors see that as a green light to prescribe it off-label for any childhood disorder or problem (because, the reasoning goes, it’s been proven “safe”). So while only approved for very serious childhood problems like schizophrenia and bipolar disorder, you’ll see docs turning to it because it’s New and Improved (and hey, covered by Medicaid, so why not?).

Bizarrely, the article notes the “upside” to the over-prescription of atypical antipsychotics for virtually any childhood disorder a doctor feels like:

“Maybe Medicaid kids are getting better treatment,” said Dr. Gabrielle Carlson, a child psychiatrist and professor at the Stony Brook School of Medicine. “If it helps keep them in school, maybe it’s not so bad.”

Really? “Not so bad”?! Does this sound like a researcher who’s received a few grants from pharmaceutical companies over the years? Yeah, if you look at this recent Open Access article, you’ll see the disclosures the New York Times failed to mention to its readers:

Dr. Carlson has received research support or has consulted with the following companies: Abbott Laboratories, Cephalon, Eli Lilly and Company, Janssen, McNeil, Otsuka, and Shire Pharmaceuticals.

Hmmm.

One solution is pretty simple and straightforward — psychiatrists (and related professionals who have prescribing privileges in psychiatry or mental health) are the experts when it comes to choosing the right medication for the right patient. That’s what they’re trained for and that’s what they excel at. When we come to rely on other generalist professionals, we’re bound to get care that — while well-intended — is likely not the best available.

Children, of all people, certainly deserve the best available care, provided by the best professionals to provide it. And children — because their brains are still developing and we have zero long-term studies done on children and these medications — should turn to medications as only one possible solution to these mental health concerns. Psychotherapy is another possible solution and one that should be utilized as much as possible for children, especially for concerns that have a solid empirical research base to support therapeutic interventions (like ADHD).

The Rutgers-Columbia study that found that Medicaid children are prescribed four times the amount of antipsychotic medications compared to non-Medicaid children will be published early next year, in the journal Health Affairs.

Read the full article: Children on Medicaid Found More Likely to Get Antipsychotics