Introduction
General context: antipsychotics in children and adolescents
Available evidence shows that psychiatric consultations for children resulting in prescription of an antipsychotic notably increased about eightfold between 1993 and 2009 in the United States. By 2009, use of atypical antipsychotics became a trend of concern worrying U.S. control authorities since psychiatrists prescribing an antipsychotic do so much more often in children (68%) and adolescents (71%) than in adults (50%) (Olfson et al. 2012a). This increase in the prescription of antipsychotics is also found among very young children (2–5 years). Between 2000 and 2007, a study found that the prevalence of prescriptions in minors rose from 0.78% to 1.58% in extremely varied indications, such as autism spectrum disorders or intellectual disability (28%), attention-deficit/hyperactivity disorder (ADHD; 24%), and disruptive disorders (13%) (Olfson et al. 2010). In that study, more than half of the children had not been assessed by a psychiatrist.
It appears that in the United States, the prevalence of antipsychotic prescriptions is high and often does not comply with Food and Drug Administration (FDA) recommendations. Several estimates calculated from health insurance databases have yielded high figures: 4.2% of prescriptions among children 6–17 years of age (Crystal et al. 2009) and 2.7% of prescriptions among children in the care of Child Welfare (Dosreis et al. 2011). A study by Matone et al. (2012) distinguished age groups between 3 and 18 years and found prevalences of 0.4% between 3 and 5 years, 2.1% between 6 and 11 years, and 3.7% between 12 and 18 years. Finally, a study by Olfson et al. (2012a) on changes between 1993 and 2009 showed that in 2009, the prevalence of antipsychotic prescriptions was 1.83% in children and 3.76% in adolescents compared to 6.18% in adults. The reasons for this prescription boom are summarized elsewhere (Harrison et al. 2012). The main factors identified include a trend toward greater acceptance of psychotropic drug prescriptions in children, better knowledge of these drugs combined with an awareness of the disorders and frequency of psychological suffering in children, limited access to nonpharmacological treatments, a more pressing demand for rapid and inexpensive treatment, and a very wide disparity in time available and reimbursement rates for treatment of behavioral...
