Choosing Wisely:

Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.

Rationale and Comments: Recent research indicates that use of antipsychotic medication in children has nearly tripled in the past 10 to 15 years, and this increase appears to be disproportionate among children with low family income, minority children, and children with externalizing behavior disorders (i.e., rather than schizophrenia, other psychotic disorders and severe tic disorders). Evidence for the efficacy and tolerability of antipsychotic medications in children and adolescents is inadequate and there are notable concerns about weight gain, metabolic side effects, and a potentially greater tendency for cardiovascular changes in children than in adults.
Sponsoring Organizations:
  • American Psychiatric Association
  • Sources:
  • Cochrane Database of Systematic Reviews
  • American Academy of Child and Adolescent Psychiatry guidelines
  • Disciplines:
  • Psychiatric and Psychologic
  • Pediatric
  • References: • Correll CU. Monitoring and management of antipsychotic-related metabolic and endocrine adverse events in pediatric patients. Int Rev Psychiatry. 2008;20(2):195-201.
    • Findling RL, Drury SS, Jensen PS, Rapoport JL; AACAP Committee on Quality Issues. Practice parameter for the use of atypical antipsychotic medications in children and adolescents [Internet]. American Academy of Child and Adolescent Psychiatry. [cited 2013 Mar 3]. Available from: Medications_Web.pdf.
    • Loy JH, Merry SN, Hetrick SE, Stasiak K. Atypical antipsychotics for disruptive behaviour disorders in children and youths. Cochrane Database Syst Rev. 2012 Sep 12;9:CD008559.
    • Zito JM, Burcu M, Ibe A, Safer DJ, Magder LS. Antipsychotic use by Medicaid-insured youths: impact of eligibility and psychiatric diagnosis across a decade. Psychiatr Serv. 2013 Mar 1;64(3):223-9.

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