Pharmacoepidemiology of Antipsychotic Use in Youth with ADHD: Trends and Clinical Implications

Although concern has been raised about antipsychotic prescribing to youth with attention-deficit/hyperactivity disorder (ADHD), the available database is limited to individual studies. Therefore, in order to provide a synthesis of prevalence and time trends, we conducted a systematic review and pooled analysis of pharmaco-epidemiologic data on antipsychotic use in ADHD youth. Of 1806 hits, 21 studies (N) were retained that reported analyzable data for three separate populations: 1) antipsychotic-treated youth (N?=?15, n?=?341,586); 2) ADHD youth (N?=?9, n?=?6,192,368), and 3) general population youth (N?=?5, n?=?14,284,916). Altogether, 30.5?±?18.5 % of antipsychotic-treated youth had ADHD. In longitudinal studies, this percentage increased over time (1998–2007) from 21.7?±?7.1 % to 27.7?±?7.7 %, ratio?=?1.3?±?0.4. Furthermore, 11.5?±?17.5 % of ADHD youth received antipsychotics. In longitudinal studies, this percentage also increased (1998–2006) from 5.5?±?2.6 % to 11.4?±?6.7 %, ratio?=?2.1?±?0.6. Finally, 0.12?±?0.07 % of youth in the general population were diagnosed with ADHD and received antipsychotics. Again, in longitudinal studies, this percentage increased over time (1993–2007): 0.13?±?0.09 % to 0.44?±?0.49 %, ratio?=?3.1?±?2.2. Taken together, these data indicate that antipsychotics are used by a clinically relevant and increasing number of youth with ADHD. Reasons for and risk/benefit ratios of this practice with little evidence base require further investigation.