Atypical Antipsychotic Use Among Medicaid-Insured Children and Adolescents: Duration, Safety, and Monitoring Implications

Objective: Over the last two decades, the increased use of atypical antipsychotic medications, often for unlabeled indications including attention-deficit/hyperactivity disorder (ADHD), has been profound. This study aims to characterize duration of atypical antipsychotic use by age group and Medicaid eligibility category, and among youth with noncomorbid ADHD. Methods: Administrative data on 266,590 youth 2-17 years of age, and continuously enrolled in a mid-Atlantic state Medicaid program in 2006, were assessed in terms of median days of atypical antipsychotic use using bivariate analyses and multivariable quantile regression. Also, in a subanalysis of youth diagnosed with ADHD without any reported psychiatric comorbidities (i.e., noncomorbid ADHD), age-specific adjusted odds and adjusted median days of atypical antipsychotic use by Medicaid eligibility category were assessed. Additionally, patterns of use of single atypical antipsychotic regimens and two concomitant atypical antipsychotic regimens were described. Results: Overall, the median annual duration of atypical antipsychotic use was 180 days (interquartile range: 69-298 days). Children (2-12-year-olds) had longer durations of use than did adolescents (13-17-year-olds) (median 192 vs. 179 days), respectively. In the absence of any comorbid psychiatric diagnosis, ADHD-diagnosed foster care youth had more than threefold greater adjusted odds of atypical antipsychotic use than did youth enrolled in income-eligible Medicaid categories. Nearly one third of such ADHD-diagnosed foster care youth received atypical antipsychotics regardless of age group, with annual duration of use >250 median days in 2-12-year-olds. In concomitant atypical antipsychotic regimens, risperidone, aripiprazole, and quetiapine were the most common. Conclusions: Exposure to atypical antipsychotics in Medicaid-insured youth, in particular for children in foster care and those diagnosed with ADHD, was substantial, warranting outcomes research for long-term effectiveness, safety, and oversight for appropriate cardiometabolic monitoring.