Antipsychotic Medications for Low-Income Preschoolers: Long Duration and Psychotropic Medication Polypharmacy

Objective: This study aimed to evaluate prescribing patterns of antipsychotic medication and factors that predict duration of use among low-income, preschool-age children. Methods: State Medicaid claims from 2012 to 2017 were used to identify antipsychotic medication use for children,6 years old. ICD-9 and ICD-10 codes were used to describe child diagnoses. Descriptive and multivariable an-alyses were used to determine patterns of antipsychotic medication use and factors that predicted duration of use. Results: In 2012, 316 children,6 years of age started an antipsychotic medication in a southeastern state. Most were non-Hispanic White (N5202, 64%) and boys (N5231, 73%). Diagnoses included attention-deficit hyperactivity disorder (N5288, 91%), neurodevelopmental disorders (N5208, 66%), anxiety and trauma-related diagnoses (N5202, 64%), and autism spectrum disorders (ASDs) (N5137, 43%). The mean6SD duration of exposure to antipsychotic medication for children in the cohort was 2.661.7 years, but 86 children (27%) had .4 years of exposure. Almost one-third (N597, 31%) received polypharmacy of four or more medication classes, and 42% (N5131) received metabolic screening. Being male, being in foster care, and having a diagnosis of ASD or disruptive mood dysregulation disorder were significantly associated with duration of use of antipsychotic medications; race-ethnicity was not significantly associated with duration of use. Emergency department visits (N5277, 88%) and inpatient hospitalizations (N5107, 34%) were observed during the study period. Conclusions: Many preschoolers received antipsychotic medications for substantial periods. Further research is needed to identify evidence-based practices to reduce medication use and improve outcomes.