TABLE 4.

Pediatric psychotropic polypharmacy in diagnosed populations.

Data source, Study period, References	Other	Age, years	Diagnosed population	Psychotropic concomitants	Outcome
Southern state, 1996–2005, McIntyre and Jerrell (41)	Cross-sectional	0–17	N = 1,544 w/ Depression diagnosis, continuously enrolled 9/12 months	≥2 psychotropic medications	Polypharmacy increased from 6.7% (1996) to 41.6% (2005)—a 6-fold increase & is largely off-label. Polpharmacy increased with increased comorbidity.
US privately insured, 2001–2009, Spencer et al. (21)	Polypharmacy prevalence	<20	Autism Spectrum Disorder (ASD), w/ ≥6 months continuous enrollment, N = 33,565	≥2 or ≥3 classes with ≥30 days overlap	Among the diagnosed cohort, 35% had ≥2 classes, 15% had ≥3 concomitant classes. The median duration of polypharmacy was 346 days.
MAX, 2001, 50 states + D.C., Mandell et al. (22)	Polypharmacy prevalence	<21	Autism Spectrum Disorder, N = 60,641 with ASD diagnosis & psychotropic rx	≥3 medications with ≥30 days overlap	20% of foster care psychotropic medicated youth had ≥3 concomitants among 6 psychotropic classes compared with 7% for poverty subgroup and 11% with disability status.
MAX, 41 states,2000–2003, Schubart et al. (42)	4 year trend analysis, x-sectional	3–17	N = 12,843–18,562 with Autism Spectrum Disorder diagnosis	≥60 day overlap for pairs of psychotropics	26–30% had pairs in 6 groupings.
Southern State ASD treatment program,2000–2008, Logan et al. (43)	Polypharmacy prevalence	8	The state is part of a CDC Autism Spectrum Disorder surveillance program. N = 629	Six 2-class combinations with ≥30 days overlap	Among the 60% (~377) with a dispensed psychotropic, 41% (~150) had 2-class combinations. Unfortunately, the extent of 3 or 4 or more class concomitant use is not known.
MAX, 28 states, 1999–2006, Winterstein et al. (17)	1–5 year follow up (f/u) study	0–17	Attention Deficit Hyperactivity Disorder (ADHD), 3–18 years old, N = 16,626 w/ f/u for new users of stimulantc.	≥3 classes, any days overlap	Psychiatric polypharmacy of ≥3 classes increased from 8.5% (year 1) to 13.4% (year 5) for children 3–9 years old at initiation of stimulant. Any ≥3 classes in a subsequent year affected 25.35%.