A new study on prescribing patterns for young Ontarians with attention deficit hyperactivity disorder is raising concerns about potentially inappropriate or unnecessary treatments in light of the significant numbers who are taking antipsychotic drugs.
In 2011, 5.4 per cent of Ontarians between the ages of one and 24 had been diagnosed with attention deficit hyperactivity disorder, a study published Wednesday in the Canadian Journal of Psychiatry found. Of those, 70 per cent were prescribed ADHD medication, 20 per cent were prescribed antidepressants and 12 per cent received a prescription for an antipsychotic.
While young people with ADHD are often also diagnosed with depression or anxiety, few had other psychiatric diagnoses that could be treated with antipsychotics. And those drugs come with significant risks.
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“Very rapidly, within the first two to three months, children prescribed antipsychotics gain weight, and a substantial amount of weight,” says Dr. Paul Kurdyak, the study’s senior author and a scientist at the Institute for Clinical Evaluative Sciences and the Centre for Addiction and Mental Health’s Institute for Mental Health Policy Research. Depending on the antipsychotic in question, the weight gain would be about 8.5 kilograms in 10 weeks and blood markers also link these drugs to early signs of diabetes.
“Weight gain is a problem for all sorts of reasons, not least of which is it may affect children’s self-esteem, and particularly children who are vulnerable to self-esteem issues if they’re also suffering from ADHD,” says Kurdyak. “But more problematic is they may not be aware of the development of diabetes which, over the long term, can cause serious health consequences if not properly managed.”
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Kurdyak stresses the study only noted a very high rate of antipsychotic prescriptions and it doesn’t prove whether those medications are necessary or not. The authors think the prescriptions may be unnecessary because parallel studies and “extensive anecdotes” show many children with these conditions have significant difficulty accessing non-pharmacological treatments that can address the root problem.
“The big issue that the high rate of antipsychotic prescription is highlighting is, we speculate, antipsychotics are easy to prescribe and they do sedate kids, which can help with behavioural management, but they’re not a good replacement for behavioural therapies. . .,” says Kurdyak. Ideally, youth would take antipsychotics only when other treatments don’t work “so the benefits of them match the risks.”
He also notes there aren’t many publicly funded therapists, either through family doctors or school boards, for children with ADHD. “Beyond that, it’s luck or ability to pay that gets you access to the kind of non-pharmacological treatment . . ..”