Antipsychotics are being widely prescribed to children with behaviour and mood problems, with a significant proportion going to children under nine, new research shows.

Ninety-four per cent of 176 child psychiatrists in Canada surveyed are prescribing powerful drugs known as atypical antipsychotics for a variety of disorders and symptoms, including anxiety, attention-deficit hyperactivity disorder and "poor frustration tolerance."

While most prescriptions were for children 13 and older, a "surprising" number were for the very young: 12% of all prescriptions were for children aged eight or under, including three-year-olds.

None of the drugs has been officially approved for use in children. Risperidone (brand name Respirdal) was the most commonly prescribed atypical antipsychotic to children, followed by olanzapine (Zyprexa) and quetiapine (Seroquel).

All are in a different class from Ritalin, a stimulant used to treat attention deficit disorder in children.

Originally developed to treat schizophrenia and mania, so-called ATAs are now increasingly being used to treat non-psychotic disorders in adults, children and teens.

"These medications are currently being used off-label without clear guidelines for indications, dosing and monitoring," researchers report in the most recent issue of the Canadian Journal of Psychiatry.

"There is an urgent need for more data regarding safety and monitoring of these medications in children."

In the U.S., the number of visits to a doctor that ended with a patient under 20 being prescribed an anti-psychotic soared six-fold between 1993 and 2002.

The new Canadian survey can't answer just how many children or teens in Canada are on antipsychotics. But it shows prescribing by child psychiatrists and pediatricians who specialize in developmental problems is "ubiquitous."

"The trouble with a study like this is, it doesn't tell us whether that's a good thing or a bad thing. We just know it's happening," says lead author Dr. Tamison Doey, head of the division of child and adolescent psychiatry for the city of Windsor and an adjunct professor at the University of Western Ontario.

"Intuitively we all say, Geez, these are young kids to be on medicine. But kids that age are put on drugs for asthma, and they're given antibiotics and different sorts of medication. I think we all get a bit concerned if it's something that affects the brain."

As doctors become more confident with ATAs, the drugs are filling an important niche, Dr. Doey says.

"We have data to show they are helpful. The concern is we also have data showing that when you stop the medication, many times the problems come back. That means you're maybe looking at having to take these drugs for the long term. Then you start to worry, these are kids, what will happen down the road?'"

Most of the specialists surveyed monitored their patients. But the types and frequency of tests performed vary widely.

"The concern is, will other doctors start to use these medicines and how can we guide them to do it appropriately," Dr. Doey says.

Atypical anti-psychotics are considered a significant improvement over older antipsychotics that were used in both adults and children. For one thing, they don't cause the same neurological side effects, such as uncontrolled jerking and twisting.

But they can cause substantial weight gain. Johns Hopkins researchers have warned the drugs might trigger insulin resistance in children, increasing the risk of developing Type 2 diabetes and heart disease when they're older.

The drugs work by blocking dopamine, a brain chemical involved in aggression and impulsivity. Doey says they can make the difference between a having a child in school or not, "or a child having friends or having terrible outbursts every time something doesn't go their way."

They are being used to treat depression, impulsivity and children who frustrate easily.

"That doesn't mean they just get a bit upset. The kids we see will have major aggressive or disruptive episodes for even the slightest reasons," Dr. Doey says. "So if they can't do something in school or someone tells them to turn off the television or you can't run in the corridor, you name it, they proceed to become very angry and aggressive and out of control."

Her team plans to follow children prescribed atypical antipsychotics over a year to look at the effects of the drugs over the longer term.

skirkey@canwest.com