The RCPsych Article of the Month for January is ‘Antipsychotic and antidepressant prescribing for 704 297 children and young people with and without intellectual disabilities: record linkage study’ Angela Henderson, Deborah Kinnear, Michael Fleming et al. published in The British Journal of Psychiatry (BJPsych).

We have known for some time that psychotropic medication and antipsychotics in particular are over-prescribed for adults with intellectual disabilities, with negative impacts on their health and well-being. But for children and young people, the picture until now has been less clear. We didn’t know if they had the same level of over-prescribing experienced by adults with intellectual disabilities or if recent calls for improvements in prescribing practices are reflected in more recent practice.

Research carried out by the Scottish Learning Disabilities Observatory set out to close this evidence gap by looking at whether children and young people with intellectual disabilities in Scottish schools were being prescribed anti-psychotics and anti-depressants at higher rates than their peers. In what we think is the first study of its kind, we looked at prescribing records for more than 700,000 pupils between 2010 and 2013 (inclusive) and established how the rate of prescribing varied, breaking this information down by age and sex.

The findings are clear – though their causes are less so. Overall prescribing rates for psychotropic drugs were low but significantly higher for children with intellectual disabilities who were 17 times more likely to be prescribed antipsychotics (1.7% of children and young people with intellectual disabilities) and more than twice as likely to be prescribed antidepressants (1.2% of the population). Rates of prescribing of antipsychotics and antidepressants increased through the course of the study for both groups.  However, the gap between prescribing rates for pupils with intellectual disabilities and other pupils narrowed over the four years of the study, largely driven by a larger increase in prescribing of these drugs in the general (non-intellectual disabilities) population. For both groups of children, boys were more likely to be prescribed antipsychotics and girls more likely to be prescribed antidepressants, with prescribing rates increasing with age, as expected.

What does this tell us? With the information we have, we don’t yet know whether the higher rate of prescribing for children with intellectual disabilities indicates over-prescribing in this group. Indeed, the opposite may be the case: we know that rates of mental illness are higher in children and young people with intellectual disabilities and it may be that the prescribing rates we’re seeing reflect clinically informed prescribing practice. However, these findings could also suggest that children and young people with intellectual disabilities are not getting access to the same diagnostic and treatment advances as other children.  We also don’t know whether this relatively recent snap-shot of prescribing practices represents a lower rate than we might have witnessed a decade or two earlier when there was less awareness of over-prescribing and the negative impacts this can have.

More work is needed to understand these patterns and to inform best prescribing practice, with ongoing surveillance of prescribing trends in children and young people with and without intellectual disabilities. This study provides a useful starting point for that work and a basis for further research.

Read the article: Antipsychotic and antidepressant prescribing for 704 297 children and young people with and without intellectual disabilities: record linkage study

Why I chose this article:

“Henderson et al. examine the prescribing records of all children attending school in Scotland and report that those with intellectual disabilities were more likely to be prescribed antipsychotics and antidepressants compared to those without intellectual disabilities. The relative difference between the two groups of children fell over time, but this was because children without intellectual disabilities were more likely to be prescribed antipsychotics and antidepressants over time, rather than a reduction in the prescribing of these medications to children with intellectual disabilities”.

Professor Peter Langdon, Guest Editor BJPsych