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Powerful antipsychotic drugs used to be reserved for conditions like schizophrenia. Now, they’re being prescribed for aggressive kids with attention-deficit, autism, or bipolar disorders. Some doctors say this trend is disturbing, because of dangerous side effects.

14-year-old Lauren Weinrich has bipolar disorder: Her mood changes between two extremes.

Three years ago, during a fight with her sister, she lost control.

“And I just stomped on her foot and it almost broke her foot,” says Lauren. “That was, like, when I really realized – man, this could get really dangerous.”

Her mom Robin had a choice: live with the fear that Lauren could hurt someone, or turn to a powerful drug, an antipsychotic.

“Granted, it’s brand new and yes, [the] FDA has not said this is good for children,” says Robin, “but I find that they are very slow. And when you are in a situation like we are – were — where you have safety and physical issues, you are going to make the decision that’s right for you.”

Antipsychotics have not been thoroughly tested in kids.

That’s why doctors say they are only for those children who are consistently out of control.

“It’s important not to use these as a knee-jerk thing, to respond to a particular episode of bad behavior,” says Dr. Shannon Croft, a child psychiatrist with the Emory University School of Medicine, “but rather a long pattern of how somebody is doing.”

He says parents should research these medicines on the web, talk to other families, and learn the possible side effects.

“It’s our responsibility to be well informed,” says Robin, “to talk to other people, to make sure our doctors are telling us the right thing, to get second opinions.”

And, doctors say, start with the lowest dose for the shortest time.

Also: know that drugs alone are not enough.

“I would want my child to be in some kind of therapy,” says Dr. Croft, “that would help improve his symptoms — so he could be taken off of the medicine as soon as possible.”

Lauren is in therapy, and taking medicine. The violence has stopped.

“I have the control of being able to think about my reaction,” says Lauren, “and thinking, ‘is this right?’”

What We Need To Know

• Approach the use of antipsychotics for children conservatively. If a parent has any doubt as to whether their child truly needs an antipsychotic, get a second opinion. (Shannon Croft, M.D., Child Psychiatrist, Emory University School of Medicine)
• Before allowing your child to take an antipsychotic, make sure there is no other alternative. The doctor should be able to give you a clear reason why this medicine is being chosen instead of another. Also, the doctor should give you a complete list of all possible side effects. (Shannon Croft, M.D., Child Psychiatrist)
• The clearest reason why a child would need to take an antipsychotic is for hallucinations or alterations in reality. Children with schizophrenia may not have a choice but to take this medicine for the rest of their lives. (Shannon Croft, M.D., Child Psychiatrist)
• Sometimes antipsychotics are used to treat children in the “manic” phase of bipolar disorder – when they are excitable or energetic. Other times, doctors have prescribed antipsychotics to treat kids with autism, who are exhibiting self-injurious behavior. (Shannon Croft, M.D., Child Psychiatrist)
• If antipsychotics are prescribed for any reason other than treating hallucinations, parents should ask the doctor for a timeframe – as to when the child will stop taking the medicine. (Shannon Croft, M.D., Child Psychiatrist)
• Antipsychotics should be reserved for only the most severe mental illnesses. Most of the time, children with ADHD should NOT be given antipsychotics. (Shannon Croft, M.D., Child Psychiatrist)

Resources

• Shannon Croft, M.D., Child Psychiatrist, Emory University School of Medicine
• Ambulatory Pediatrics: Trends in Prescribing of Antipsychotic Medications for U.S. Children
• William Cooper, M.D., Associate Professor of Pediatrics, Researcher, Vanderbilt University School of Medicine

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