Correlating Psychotropic Use to Major Depressive Disorder and ADHD Research Diagnoses: Trends in a Prospective Pediatric Cohort From Ages 3 to 21

Miranda U. Liang, BS; Natchanan Charatcharungkiat, MD; Rebecca Tillman, MA; Hetal M. Patel, MD; Alecia C. Vogel, MD, PhD; Joan L. Luby, MD

J Clin Psychiatry 2022;83(6):21m14331

ABSTRACT

Objective: To examine the associations of psychotropic usage to clinical characteristics in a pediatric research cohort with research diagnoses and severity scores.

Methods: The cohort (N = 348) was enriched for children with mood and externalizing symptoms. Prospective longitudinal data were collected from ages 3 to 21 (September 2003–December 2019). At up to 10 time points, data on psychotropic medication use were collected by caregiver- and self-report from the MacArthur Health and Behavior Questionnaire, Parent Version and as part of the diagnostic interview, and research diagnoses (DSM-IV and DSM-5) and disease severity scores were acquired using an age-appropriate standardized research interview (Preschool Age Psychiatric Assessment, Child and Adolescent Psychiatric Assessment, Kiddie-Schedule for Affective Disorders and Schizophrenia).

Results: The percentage of children with attention-deficit/hyperactivity disorder (ADHD) taking ADHD medications was preschool, 20.7%; school-age, 65.4%; and adolescence/early adulthood, 84.0%. The percentage with major depressive disorder (MDD) who were taking antidepressants was preschool, 0%; school-age, 21.6%; and adolescence/early adulthood, 42.6%. Antipsychotic use in children with research diagnoses of ADHD or MDD peaked in school-age: ADHD, 30.8%, and MDD, 21.6%. Children who were taking an antipsychotic concurrently with an ADHD medication or antidepressant had more comorbid conditions and higher disease severity than those taking ADHD medications or antidepressants without concurrent antipsychotics. Black children with MDD used antidepressants significantly less than White children with MDD (Black = 12.1%, White = 31.9%, FDR P = .0495).

Conclusions: Concordance between research diagnosis and psychotropic use increased with age. Antipsychotic use was quite high, though more frequent in children with higher disease severity. Both findings suggest that psychotropic use is less tied to discrete diagnoses at earlier ages and that antipsychotic medication use may be motivated by severity/impairment rather than diagnosis.

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