One in 20 Ontario children and youth have attention deficit hyperactivity disorder and many are prescribed antipsychotic drugs, despite having no other mental health diagnoses, researchers have found.
A study by the Institute for Clinical Evaluative Sciences found almost 12 per cent of kids and youth with attention deficit hyperactivity disorder, or ADHD, were prescribed antipsychotics like Risperdal, Zyprexa and Seroquel.
"When we looked at the information on the children and youth with ADHD who were prescribed antipsychotics, a very, very small number of them had a condition where you would expect the use of an antipsychotic — conditions such as bipolar disorder or schizophrenia," said senior author Dr. Paul Kurdyak, head of the mental health and addictions program at ICES.
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As its name suggests, ADHD causes such symptoms as difficulty concentrating on tasks and restlessness, which can have major implications for school achievement, no matter a young person's intellectual capabilities, Kurdyak said.
To conduct the study, published Wednesday in the Canadian Journal of Psychiatry, researchers took a random sample of health records for 10,000 Ontarians aged one to 24 and examined data relating to ADHD and other diagnoses, prescribed medications and health services utilized.
Prescription of antipsychotics to kids with ADHD 'surprising'
They found about five per cent — or 536 — of the children and youth had a diagnosis of ADHD. Eight per cent of them were male and almost three per cent were female.
About 70 per cent of the young people with ADHD were being treated with drugs like Ritalin and Adderall, which are considered standard, first-line therapy for the common condition. About 20 per cent had also been prescribed antidepressants, "which isn't terribly surprising because depression and anxiety commonly co-occur with ADHD," Kurdyak said.
"But the surprising finding to us was the 12 per cent of kids with ADHD who were prescribed an antipsychotic," he said, explaining that the medications have a sedating effect, which could help reduce disruptive behaviour.
However, these drugs can have adverse effects, such as causing significant weight gain. One study found kids gained almost 19 pounds on average after 10 weeks on the drugs — and the risk of developing pre-diabetes or diabetes.
'Not a lot of evidence that they work for ADHD'
"We don't know why these children and youth with ADHD are on antipsychotics, but there is a risk associated with early antipsychotic exposure, so we need to know more about why they are being used, so that the benefits can be weighed against the risks."
Mark Henick, national director of strategic initiatives at the Canadian Mental Health Association, said it's known that some doctors prescribe antipsychotic medications for ADHD, and he's concerned about the high level of use in young people with the disorder.
"They're not indicated for ADHD and there's not a lot of evidence that they work for ADHD," he said Wednesday. "In fact, there's good evidence that they could be harmful."
The ICES study shows that people who go to a psychiatrist for treatment are more likely to be prescribed an antipsychotic, noted Henick, who was not involved in the research. "But it's often not appropriate in these kinds of cases, where we know psychotherapy is quite effective for ADHD."
Arranging psychotherapy often difficult, costly
However, he said it can be difficult for many families to arrange psychotherapy for a child with ADHD. Psychiatrists' services are covered by provincial health insurance, but they often have long wait lists as a result. Psychologists and other psychotherapists are typically far more accessible, but their services are not covered and must be paid for out of pocket.
"So you'd be looking at anywhere from $100, $150, $200, $250 an hour for psychotherapy for ADHD -- and most families can't afford that."
Kurdyak said children and youth who experience continued ADHD-related behavioural issues that are making school and home life difficult need to have an integrated therapeutic plan beyond medications.
"You'd certainly want a child in that situation to have access to behavioural therapies that provide children and their families with coping skills so that they can manage their behaviours," he said.
"We would like to see situations where kids, who are more complex, that the treatment they receive is comprehensive and aligned with their need and not simply the addition of an antipsychotic with all its risks."