Children of disadvantaged families more often prescribed antipsychotic drugs

The research used data from the Australian Institute of Family Studies’ Longitudinal Study of Australian Children (LSAC), cross-matching it with information from Medicare and the Pharmaceutical Benefits Scheme.
 
Lead researcher Amy Kaim, from the Robinson Research Institute, University of Adelaide, said the study looked at antipsychotic prescribing in a large representative sample of Australian children.
 
‘There is approximately 5000 children in two cohorts, so a total of approximately 10,000 children,’ she said.
 
‘At the time of our study, the total age range of children in the first cohort was zero to 11 years.
 
‘And then the range for the [second] cohort was four to 15 years.’
 
Ms Kaim said as part of the LSAC data collection, parents were asked whether they thought the child had attention deficit disorder [ADD] or attention deficit hyperactivity disorder [ADHD], and also anxiety or depression problems.
 
‘The preliminary findings indicate that a larger proportion of children and teens from disadvantaged families are being placed on antipsychotic medication than others in the general population,’ she said.
 
‘A larger proportion of children and teens taking the medication were boys in lower-income families, with an unemployed primary caregiver, who were living in single-parent households.
 
‘Their parents were more likely to report their child had behavioural difficulties, and [the children] were more likely to have repeated a grade in school and have lower school achievement.’
 
Ms Kaim said the study team identified key risk factors that were linked to children being prescribed antipsychotic medication at higher rates.
 
‘The risk factors were being a child or teen in a family that was dealing with stressful life events and financial difficulties,’ she said.
 
‘Other risk factors include parenting practices in the family and whether parents themselves were in psychological distress.
 
‘The social and emotional wellbeing of the individual child and their approach to learning could also compound those risks.’
 
Ms Kaim said the findings strengthen the evidence that children from disadvantaged families are more likely to be prescribed antipsychotics, use more psychological services and have worse health and educational outcomes.
 
‘It highlights the social determinants of mental health, and if we keep this in mind when we are trying to treat children or find clinical ways to treat children with behavioural problems, then I think that’s quite an important step to take,’ she said.
 
Ms Kaim said the researchers will continue to monitor the children and teens’ medication use as they move through adolescence into adulthood.

Dr Michael Fasher, Chair of the RACGP's Child and Young Person's Health Network, told newsGP the results were valuable, but not surprising.
 
‘I argue that the best risk stratification tool for Australian children is their postcode. That is just another way of saying that there is a social gradient in health,’ he said.
 
‘At the population level, all health outcomes are worse in childhood and subsequent adult life if you grow up in a disadvantaged community.’ 
 
Dr Fasher said growing up in a community of intergenerational disadvantage and trauma adversely impacts the developing brain, the developing immune system, the inflammatory system and the way genes are expressed.
 
‘When a child presents with difficult behaviours, it is best practice to ask: "What has happened to you?" before asking "What is wrong with you?”,’ he said.
 
‘In my view, this data again points to the need for health system reform.
 
‘In Australia, few of the disadvantaged children studied here have any opportunity for multidisciplinary team care in the community. It is only quality care in a multidisciplinary team that is able to give such disadvantaged children even half a chance.’
 
Dr Hester Wilson, Chair of the RACGP Specific Interests Addiction Medicine network, told newsGP that complex structures and complex systems are leading to the presentation of young people, but they are being medicated.
 
‘You need to take a broader view around what’s happening for that individual in their families and in their community,’ Dr Wilson said.
 
‘It is a concern that children under the age of 18 are being prescribed antipsychotic medicines. There is limited data on their safety on children.
 
‘… And maybe that it is appropriate or maybe that is appropriate [in the] short-term while we look at more broad approaches to the disadvantaged individual.
 
‘Why is a 13-year-old presenting so distressed? Is it because they have a psychotic illness or is it because there is actually real problems going on for them in their community? And how can we engage in that community in a way that’s going to support that child?’

The study will be presented to the Royal Australian and New Zealand College of Psychiatrists (RANZCP) annual congress in Auckland from 13–17 May.

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