Why do poor children get more antipsychotic medication?

The use of anti-psychotic medication has been increasing at a stunning rate in recent years, for children and adults. Perhaps you have recently seen television ads promoting the use of Abilify if an adult depression has not “responded” to standard anti-depressant medication. Abilify and similar so-called second generation antipsychotic medications have begun to be used for a wide variety of diagnostic situations in childhood, including depression, anxiety, and ADHD. The possibility that these medications are being overused greatly concerns Lucy Daniels Center clinicians because the side effects of these medications are significant, even potentially (and maybe commonly) harming life-long physical health.

A December 2009 study from a team of researchers from Columbia University and Rutgers University provided a disturbing perspective on the use of anti-psychotic medication. The following is from the New York Times, on-line edition, Dec. 11, 2009:

“New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.

Those findings, by a team from Rutgers and Columbia, are almost certain to add fuel to a long-running debate. Do too many children from poor families receive powerful psychiatric drugs not because they actually need them — but because it is deemed the most efficient and cost-effective way to control problems that may be handled much differently for middle-class children?

The questions go beyond the psychological impact on Medicaid children, serious as that may be. Antipsychotic drugs can also have severe physical side effects, causing drastic weight gain and metabolic changes resulting in lifelong physical problems.”

There are clear and good reasons to use antipsychotic medication with children. At the Lucy Daniels Center, we do not hesitate, for example, to provide this relief in the rare instance of childhood schizophrenia, or those few occasions when one can confidently make a diagnosis of childhood bipolar illness. Children who are in impoverished circumstances do not have these illnesses at a significantly higher rate! At the very least, this study suggests that factors other than purely medical ones enter into decisions about using anti-psychotic medication in children. Medicaid reimbursements to physicians are structured so that they provide financial incentive for prescribing medications rather than longer sessions in which issues can be talked through with parents and children but for which there is less reimbursement for the time spent.

Other issues may factor in as well; talk therapies take time to show benefit, and poorer families may have difficulty managing such commitments given limited resources and less flexibility with their time. Whatever the explanations - economic, racist, classist, pragmatic – once again, our poorest and most vulnerable are not receiving the care and dignity that others of more means receive. It’s a trend that troubles us at Lucy Daniels Center, and we hope, readers of our blog as well. The Rutgers-Columbia study has been published in 2010 in the Journal Health Affairs.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood and posted on the Carolina Parent Magazine's website, the Triangle's family resource - in print for over 21 years!  And online at www.carolinaparent.com.