Prevalence and characteristics of psychotropic drug use in institutionalized children and adolescents with mild intellectual disability.
Nearly one in three institutionalized kids with mild ID already take psychiatric drugs, and the habit sticks without active medication reviews.
01Research in Context
What this study did
Scheifes et al. (2013) counted how many kids with mild intellectual disability living in institutions were on psychiatric drugs. They looked at the children and teens in French residential schools. Staff filled out a short form about each child's medicine and behavior.
Kids were 6-18 years old. All had IQ scores between 50-70. The team noted any drug used for mood, attention, or behavior.
What they found
Almost 3 out of the kids (29 %) took at least one psychotropic drug. Boys were twice as likely as girls to get the medicines. Children who hit, bit, or had tantrums were also more likely to be medicated.
Most common drugs were ADHD stimulants and antipsychotics. The authors warn that proof these drugs work in mild ID is thin.
How this fits with other research
Klein et al. (2024) found the same 30 % rate in Canadian youth with IDD, but they looked at community clinics, not orphanage-style homes. Their 2024 data show kids often leave the doctor's office with two or more drug classes on the same day — a red flag for polypharmacy.
Nøttestad et al. (2003) followed adults moving out of institutions into group homes. Drug use stayed flat, proving that simply leaving the big building does not fix over-medication. The 2013 child numbers now confirm the problem starts early.
Patton et al. (2020) measured side-effects in adults still inside residential care. They recorded heavy sedation, tremors, and weight gain. Put together, the three studies trace a pipeline: kids enter care, start meds, and carry side-effects into adulthood.
Why it matters
Before you write 'as needed' haloperidol on a behavior plan, check the child's chart. If they already take two psychotropics, request a pharmacy review instead of adding a third. Pair the request with baseline ABC data so the team can see whether the current drugs are helping at all.
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02At a glance
03Original abstract
Psychotropic drugs are a cornerstone in the treatment of psychopathology and/or behavioral problems in children with intellectual disability (ID), despite concerns about efficacy and safety. Studies on the prevalence of psychotropic drug use have mainly been focused on adults with ID or children without ID. Therefore the aim of this cross sectional study was to assess the prevalence and characteristics of psychotropic drug use in children with mild ID who were institutionalized in specialized inpatient treatment facilities in The Netherlands. Demographic data, psychiatric diagnoses, the nature of the behavioral problems, level of intellectual functioning, and medication data were extracted from medical records using a standardized data collection form. Adjusted relative risks (ARR) for the association between patient characteristics and psychotropic drug use were estimated with Cox regression analysis. Of the 472 included children, 29.4% (n=139) used any psychotropic drug, of which 15.3% (n=72) used antipsychotics (mainly risperidone), and 14.8% (n=70) used psychostimulants (mainly methylphenidate). Age, sex, and behavioral problems were associated with psychotropic drug use. Boys had a 1.7 (95%CI 1.1-2.4) higher probability of using psychotropic drugs, compared to girls adjusted for age and behavioral problems. Having any behavioral problem was associated with psychotropic drug use with an ARR of 2.1 (95%CI 1.3-3.3), adjusted for sex and age. The high prevalence of psychotropic drug use in children with ID is worrisome because of the lack of evidence of effectiveness (especially for behavioral problems) at this young age, and the potential of adverse drug reactions.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.06.009