title: Trends in Atypical Antipsychotics Prescribed to Children Six Years of Age or Less on Medicaid in Kentucky.
abstract: OBJECTIVE
  Studies have shown an increase in the use of antipsychotics to preschoolers for disruptive behavior and aggression. This study investigated the use of atypical antipsychotics in children ≤6 years of age in Kentucky who were on Medicaid.
  
  
  METHODS
  Kentucky Medicaid prescription claims data between 2001 and 2010 were examined for all children ≤6 years of age who had received an atypical antipsychotic. Drug type, diagnosis codes, and geographic trends were analyzed using descriptive statistics.
  
  
  RESULTS
  A total of 70,777 prescriptions were written to 6915 distinct children ≤6 years of age. The use of atypical antipsychotics in this age group increased over the years 2001-2010 with a peak ∼ 1.0% in 2004, and averaged 0.75% in 2010. Older male children were more likely to receive atypical antipsychotics, and risperidone accounted for two thirds of the prescriptions written. Mood disorders, primarily bipolar disorder, accounted for almost 75% of the diagnoses provided. Only 32% of the prescriptions were written by child psychiatrists. Geographic analysis showed significantly higher use in the Western part of the state (more than three times the state mean in some counties).
  
  
  CONCLUSIONS
  The use of atypical antipsychotics in children ≤6 years of age has declined from its peak, but remains substantial. The prescription rates for atypical antipsychotics by providers other than child psychiatrists, and the marked geographic variation in use across the state of Kentucky suggest that improved systems of mental healthcare for this population are needed.
authors.affiliation: Department of Pediatrics, University of Louisville School of Medicine , Louisville, Kentucky.
authors.forename: W David
authors.initials: WD
authors.lastname: Lohr
authors.affiliation: Department of Pediatrics, University of Louisville School of Medicine , Louisville, Kentucky.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Chowning
authors.affiliation: Department of Pediatrics, University of Louisville School of Medicine , Louisville, Kentucky.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Stevenson
authors.affiliation: Department of Pediatrics, University of Louisville School of Medicine , Louisville, Kentucky.
authors.forename: Patricia Gail
authors.initials: PG
authors.lastname: Williams
mesh_terms: D000367:Age Factors; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007629:Kentucky; D008297:Male; D008484:Medicaid; D019964:Mood Disorders / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012737:Sex Factors; D014481:United States
chemical_list: D014150:Antipsychotic Agents