Parents trust their children’s doctor to prescribe medication appropriately, but a recent hearing on doctor practices by the Vermont State Legislature’s Mental Health Oversight Committee shows otherwise.

The use of powerful antipsychotic medications like Risperdal to control bipolar disorder, schizophrenia and other behavioral problems continues to climb. However, the Vermont hearing showed that the climb isn’t necessarily safe, and that doctors follow recommended prescription guidelines maybe half the time. Moreover, a fair number of prescriptions occur without FDA approval, so their use is “off-label.”

Dr. David C Bettew, Director of the Pediatric Psychiatry Clinic at University of Vermont’s College of Medicine, said during the hearing that according to survey findings, while the number of child-directed prescriptions for antipsychotics in Vermont was coming down, the percentage of doctors following guidelines was dropping, too.

According to Bettew, prescription guidelines provided by the American Academy of Child and Adolescent Psychiatry (AACAP) were only followed by Vermont doctors around 51 percent of the time, and FDA recommendations for giving antipsychotic medications to youth only 27 percent of the time.

How these findings compare to other states is an unknown.

Risks of Antipsychotics for Children

In the same vein of overprescribing antibiotics, it would appear antipsychotics get the same casual treatment. Bettew testified, “The main reason best practice guidelines were not followed was much more related to a lack of labwork monitoring rather than prescribing these medications for mild problems or before other pharmacological and nonpharmacological treatments had been tried first.”

Moreover, Bettew found that only 15 percent of children received “evidence-based” psychoanalysis and therapy before being prescribed medication like Risperdal or Abilify, and that history of prior treatment was often lacking.

The concern of overuse of drugs to treat behavioral problems in youth is not an uncommon cry. Like all medications, usage comes with side effects and risk. If you look up the side effects of many antipsychotics, you’ll see a list that includes anxiety, dizziness, balance issues, fatigue and weight gain. Parents and doctors have been voicing concerns for years of exposing children to these and more unnecessary side effects, saying that the focus should be on working to understand the cause of their behavior.

The critics’ drug concerns were heard, and led to a number of studies. One study in the Archives of General Psychiatry from August 2012 looked at 484,000 individuals. Their research showed that prescriptions for antipsychotics increased for children and adults, but that doctors prescribed drugs like Risperdal more frequently to children and adolescents (68 and 72 percent, respectively) than to adults (50 percent). Additionally, researchers found that psychiatrists give minors an antipsychotic to address their behavior 33 percent of the time.

Following up on that study, in the summer of 2013, the Office of the Inspector General (OIG) at the Department of Health and Human Services( DHHS), started an investigation of antipsychotic drug use by Medicaid recipients age 17 and under. Their findings emphasized off-label usage and reiterated concerns.

Risperdal Side Effects a Concern for Boys

Developed in the 1980s, Risperdal (risperidone) is an antipsychotic medication to treat brain-based disorders. Released until 1993 to treat schizophrenia, it was the only drug approved to treat schizophrenic adolescents (aged 10-17), and was eventually approved to treat children in 2006.

While Risperdal and other antipsychotics can facilitate improvement in children with severe aggressive behaviors, it can also impact the brain, the body and emotional development. And in the case of Risperdal the additional side effect of gynecomastia, or the development of breast tissue, comes into play.

Gynecomastia is at the heart of a growing number of Risperdal breast growth lawsuits filed men who took Risperdal when they were younger, and by parents of young boys who developed male breasts.

Many of these Risperdal users mistook breast tissue growth for weight gain, and by the time the actual cause was figured out, victims were often at the point of needing breast reduction surgery. Among the boys and men who are plaintiffs, the emotional distress this caused is added to their already existing psychological issues.