We identified 6,110 Medicaid-enrolled children who started using an antipsychotic from November 1, 2006, through October 31, 2009. The majority of children starting on antipsychotics were boys (64%, N=3,902), white (57%, N=3,471), 12–17 years old (62%, N=3,774), and living in rural communities (66%, N=4,046) (Table 1). More were Medicaid eligible due to income (46%, N=2,837) than due to disability (39%, N=2,383). Relatively few of the children (19%, N=1,176) were diagnosed as having a disorder for which antipsychotics are indicated: 12% of these children were diagnosed as having autism, 7% as having bipolar disorder, and 1% as having schizophrenia. A majority of children receiving antipsychotics had diagnoses for which atypical antipsychotics were not indicated, such as ADHD (30% of children) and depression (26% of children). Eight percent of children (N=457) had been hospitalized in the year prior to starting an antipsychotic. The most common antipsychotics prescribed included aripiprazole (39%, N=1,767), risperidone (26%, N=1,610), quetiapine (25%, N=1,531), and ziprasidone (6%, N=368; data not shown), and duration of antipsychotic use was longer among children receiving concurrent mental health therapy (median=242 days, mean=320 days, CI=312–328) but still substantial among those not receiving concurrent mental health therapy (median=117 days, mean=184 days, CI=177–192).
Sixty-eight percent (N=4,155) of children starting antipsychotics were receiving concurrent therapy (Table 1). Seventy-five percent (N=3,098) of those receiving concurrent therapy had received it prior to starting antipsychotics, and 15% (N=636) started therapy in the 30 days after starting an antipsychotic. The mean±SD number of therapy sessions during the antipsychotic episode was 23.9±42, with a median of 7.0 sessions. After adjustment for other factors, we found that use of concurrent therapy was significantly lower among white children than among children from other racial-ethnic minority groups. Use of concurrent therapy was also significantly lower among 12- to 17- year-old children compared with children ages six to 11 years (63% versus 76%; AOR=.56). Children who were Medicaid eligible due to family income (71%) had higher rates of concurrent therapy compared with children who were Medicaid eligible due to disability (67%) or children in the child welfare system (61%).
We also found that children who were living in urban communities were significantly more likely than those in rural communities to receive concurrent therapy (69% versus 68%; AOR=1.17). Children with a diagnosis for which there is an antipsychotic indication were significantly more likely to receive concurrent therapy compared with those without such a diagnosis (79% versus 65%; AOR=2.16). Children with a psychiatric hospitalization within the year prior to starting an antipsychotic were significantly more likely to receive concurrent therapy than were individuals without such prior hospitalization (85% versus 67%; AOR=1.57). There was no significant difference by gender or by year in receipt of concurrent therapy when controlling for other factors, and the type of antipsychotic was not associated with receipt of concurrent therapy.