Beyond the Label: Antipsychotic Prescribing Practices at a Paediatric Neurodisability Service in Australia.
Ella May Huber, Monica Sophie Cooper
PMID 40256974WHAT IT FOUND
In 147 children with neurodisability, most antipsychotic prescriptions were for challenging behaviours, not psychosis.
Risperidone was common, often off-label, and most prescribing encounters also included another psychotropic drug. This paper does not show whether medicines worked.
Key findings
01In 147 children newly prescribed antipsychotics, challenging behaviours were the recorded indication in 74% of encounters, and no psychotic disorders were diagnosed.
02Risperidone was the most common new antipsychotic, and 62% of new risperidone prescriptions were off-label.
03Concurrent psychotropic medication was documented in 78% of prescribing encounters, with up to 7 agents used at once.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The records could not confirm that prescribed medicines were dispensed or taken. Concurrent medication counts relied on prescriptions, medication lists and notes, so they may be incomplete if records were not updated. The study could not determine how long medicines were used or whether non-drug supports were tried. Effectiveness and safety were not assessed because consultation notes rarely recorded benefits or side effects. Mental health diagnoses may be under-recorded in children with neurodisability, because communication and intellectual differences can make formal criteria hard to apply. Some diagnosis categories with fewer than five children were grouped for confidentiality, so detail is limited. It describes one specialist service in Melbourne, so the prescribing mix may not match other settings.
Declared interests
The authors declared nothing to report.
The easy way to misread this
Do not conclude from these records that antipsychotics are unsafe or ineffective, or that off-label prescribing is automatically wrong. The study counted prescriptions and other medicines, not whether children took them or how they responded.