Abstract
Objective
We examined caregiver’s knowledge, attitudes, and concerns about their child’s psychotropic medication regimen and the potential side effects, describe how they seek information regarding treatment, and ascertain their perspectives toward deprescribing.
Methods
We surveyed 48 caregivers of children 6–17 years old treated with two or more psychotropic medications or an antipsychotic medication, analyzing outcomes using descriptive statistics.
Results
Almost all (N = 44, 92%) participants reported feeling very knowledgeable about why medications were prescribed, but only one-third (N = 16, 33%) reported feeling very knowledgeable about potential problems with long-term use or polypharmacy. Half of respondents (N = 24, 50%) reported asking their provider about reducing/stopping medications due to concerns about harmful effects, and nearly half (N = 20, 42%) reported stopping medications earlier than recommended.
Conclusions
Interventions to engage caregivers in shared decision-making about complex medication regimens and to support prescribers to safely deprescribe psychotropic medications are needed to address caregivers’ concerns regarding psychotropic medication use.
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References
American Academy of Child and Adolescent Psychiatrists. (2005). AACAP position statement on oversight of psychotropic medication use for children in state custody: A best principles guideline. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/systems_of_care/FosterCare_BestPrinciples_FINAL.pdf
American Academy of Child and Adolescent Psychiatrists. (2015). Recommendations about the use of psychotropic medications for children and adolescents involved in child-serving systems. Retrieved from https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/systems_of_care/AACAP_Psychotropic_Medication_Recommendations_2015_FINAL.pdf.
Barnett, E. R., Trepman, A. Z., Fuson, H. A., Acquilano, S. C., McLaren, J. L., Woloshin, S., & Leyenaar, J. K. (2019). Deprescribing psychotropic medications in children: Results of a national qualitative study. BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2019-010033
Bellonci, C., Huefner, J. C., Griffith, A. K., Vogel-Rosen, G., Smith, G. L., & Preston, S. (2013). Concurrent reductions in psychotropic medication, assault, and physical restraint in two residential treatment programs for youth. Children and Youth Services Review, 35(10), 1773–1779. https://doi.org/10.1016/j.childyouth.2013.08.007
Burcu, M., Safer, D. J., & Zito, J. M. (2016). Antipsychotic prescribing for behavioral disorders in us youth: Physician specialty, insurance coverage, and complex regimens. Pharmacoepidemiology and Drug Safety, 25(1), 26–34. https://doi.org/10.1002/pds.3897
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine, 44(5), 681–692.
Chovil, N., & Panagiotopoulos, C. (2010). Engaging families in research to determine health literacy needs related to the use of second-generation antipsychotics in children and adolescents. Journal of the Canadian Academy of Child & Adolescent Psychiatry, 19(3), 201–208.
Connor, D. F., & McLaughlin, T. J. (2005). A naturalistic study of medication reduction in a residential treatment setting. Journal of Child and Adolescent Psychopharmacology, 15(2), 302–310. https://doi.org/10.1089/cap.2005.15.302
Delman, J., Clark, J., Eisen, S., & Parker, V. (2015). Facilitators and barriers to the active participation of clients with serious mental illnesses in medication decision making: The perceptions of young adult clients. The Journal of Behavioral Health Services & Research, 42(2), 238–253. https://doi.org/10.1007/s11414-014-9431-x
dosReis, S., Yoon, Y., Rubin, D. M., Riddle, M. A., Noll, E., & Rothbard, A. (2011). Antipsychotic treatment among youth in foster care. Pediatrics, 128(6), e1459-1466. https://doi.org/10.1542/peds.2010-2970
Essock, S. M., Covell, N. H., Leckman-Westin, E., Lieberman, J. A., Sederer, L. I., Kealey, E., & Finnerty, M. T. (2009). Identifying clinically questionable psychotropic prescribing practices for Medicaid recipients in New York State. Psychiatric Services, 60(12), 1595–1602. https://doi.org/10.1176/ps.2009.60.12.1595
Fontanella, C. A., Warner, L. A., Phillips, G. S., Bridge, J. A., & Campo, J. V. (2014). Trends in psychotropic polypharmacy among youths enrolled in Ohio Medicaid, 2002–2008. Psychiatric Services, 65(11), 1332–1340. https://doi.org/10.1176/appi.ps.201300410
Gupta, S., & Cahill, J. D. (2016). A prescription for “deprescribing” in psychiatry. Psychiatric Services, 67(8), 904–907. https://doi.org/10.1176/appi.ps.201500359
Huefner, J. C., Griffith, A. K., Smith, G. L., Vollmer, D. G., & Leslie, L. K. (2014). Reducing psychotropic medications in an intensive residential treatment center. Journal of Child and Family Studies, 23(4), 675–685. https://doi.org/10.1007/s10826-012-9628-7
Kutz, G. D. (2011). Foster children: HHS guidance could help states improve oversight of psychotropic prescriptions (gao-12-270t). US Government Accountability Office.
Lazaratou, H., Anagnostopoulos, D. C., Alevizos, E. V., Haviara, F., & Ploumpidis, D. N. (2007). Parental attitudes and opinions on the use of psychotropic medication in mental disorders of childhood. Annals of General Psychiatry, 6, 32. https://doi.org/10.1186/1744-859x-6-32
McLaren, J. L., Barnett, E. R., Concepcion Zayas, M. T., Lichtenstein, J., Acquilano, S. C., Schwartz, L. M., Woloshin, S., & Drake, R. E. (2018). Psychotropic medications for highly vulnerable children. Expert Opinion on Pharmacotherapy, 19(6), 547–560. https://doi.org/10.1080/14656566.2018.1445720
Olfson, M., King, M., & Schoenbaum, M. (2015). Treatment of young people with antipsychotic medications in the United States. JAMA Psychiatry, 72(9), 867–874. https://doi.org/10.1001/jamapsychiatry.2015.0500
Scholle, O., Banaschewski, T., Enders, D., Garbe, E., & Riedel, O. (2018). Use and characteristics of antipsychotic/methylphenidate combination therapy in children and adolescents with a diagnosis of attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 28(6), 415–422. https://doi.org/10.1089/cap.2018.0024
Seale, C., Chaplin, R., Lelliott, P., & Quirk, A. (2006). Sharing decisions in consultations involving anti-psychotic medication: A qualitative study of psychiatrists’ experiences. Social Science & Medicine, 62(11), 2861–2873. https://doi.org/10.1016/j.socscimed.2005.11.002
Winterstein, A. G., Soria-Saucedo, R., Gerhard, T., Correll, C. U., & Olfson, M. (2017). Differential risk of increasing psychotropic polypharmacy use in children diagnosed with ADHD as preschoolers. The Journal of Clinical Psychiatry, 78(7), 744–781. https://doi.org/10.4088/JCP.16m10884
Acknowledgements
The authors would like to thank all of the research assistants who helped us by administering surveys, conducting literature searches or revising tables, including Chibuzo Aguwa, Kieshan Amarakaran, MacKenzie Cunniff, Emily Hichborn, Brendon Lin, Michaela Ricker, and Miranda Todt. We are grateful for the support and cooperation of the participating clinics and the staff who made this project possible. We would especially like to recognize the parents and caregivers who completed the survey. We deeply appreciate their willingness to take the time to share their thoughts and experiences with us.
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Dr. McLaren reports no financial relationships with commercial interests. Dr. Barnett has no financial or conflict of interest disclosures to report. Ms. Acquilano reports no financial relationships with commercial interests. Dr. Concepcion Zayas reports no financial relationships with commercial interests. Dr. Drake reports no financial relationships with commercial interests. Dr. Leyenaar received consultancy support for research with the American Board of Pediatrics Foundation, unrelated to the current work.
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Author A reports no financial relationships with commercial interests. Author B has no financial or conflict of interest disclosures to report. Author C reports no financial relationships with commercial interests. Author D reports no financial relationships with commercial interests. Author E reports no financial relationships with commercial interests. Author F received consultancy support for research with the American Board of Pediatrics Foundation, unrelated to the current work.
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McLaren, J.L., Barnett, E.R., Acquilano, S.C. et al. Psychotropic Polypharmacy and Antipsychotics in Children: A Survey of Caregiver’s Perspectives. Community Ment Health J 58, 512–516 (2022). https://doi.org/10.1007/s10597-021-00845-2
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DOI: https://doi.org/10.1007/s10597-021-00845-2