Psychotic Toddlers?

A recent New York Times article by Alan Schwartz reveals a very disturbing trend in regards to the growing use of neuroleptics in youngsters under the age of five, even two years or younger. In his article he discusses Andrew, who at five months of age was diagnosed with seizures.

Andrew was prescribed anti-convulsants. In a year or so, the toddler became increasingly aggressive and “violent”. The neurologist treating him prescribed the antipsychotic Risperdal, for what some refer to as behavioral dyscontrol.

As a class of psychotropics, they reveal very disturbing side-effects and adverse events. They are not approved at all for children under the age of eight. They have never been researched in this age group because of clinical and ethical concerns. They are usually approved for mania and psychosis in persons with schizophrenia.

According to the article, the use of neuroleptics in toddlers reveals a 50% increase in their use, along with a 23% jump in antidepressants and ADHD prescriptions. All psychotropic agents for ADHD are Schedule 2 controlled agents, are highly addictive, and can trigger psychosis. The U.S. consumes 85% of the world’s market!

Major side-effects include rapid weight gain, diabetes, rapid lowering of white blood cells to name just a few. As far as adverse events, these include tardive dyskinesia (TD), which are painful and irreversible movements and tremors of major muscle groups. Worst yet, they can trigger neuromalignant syndrome, that is amplified TD with death.

The reporter discusses this situation with child experts in the field. One of them is Dr. Ed Tronick, who is professor of developmental brain science at the University of Massachusetts. Dr. Tronick is very clear that these agents will impact the developing brain in ways that we cannot predict. We know that protracted and high dose use in adults, destroys brain tissue and neurons. And in fact, Dr. Tronic voices that the use of the above agents are “nuts”.

I agree with him based on my 43 years of clinical experience.

Both he and I know that physicians often prescribe “off label”, which means that they are not approved by the FDA for certain disorders. And all prescribing done in this manner also seriously deviates from all best, consensual clinical practices. This includes the American Association of Pediatrics.

By the way, antipsychotics are over prescribed in youngsters with autism who show “autistic irritability”. We are also overprescribing them to the aged who develop Alzheimer’s disease. It is my professional opinion that should always be prescribed with written informed consent, as I consider all psychotropics to be pervasive in regard to psychokinetic actions.

Ethically, all clinicians take an oath to “do no harm”. I’ve added a second obligation, that “when clinically necessary, do the least harm possible”. Finally, both Dr. Tronick and I know that a number of psychosocial interventions are known to be efficacious in the intervention of the above disoders, and show very few side-effects and no adverse events.

I strongly encourage parents and others who are concerned about toddlers to become much more aware and informed of these psychotropic agents. When used for the right disorders, and used within clinical guidelines, they reduce suffering, and even save lives.


Schwartz, Alan. (Dec 10, 2015). Still in a Crib, Yet Being Given Antipsychotics. New York Times.

Image via Sergey Novikov / Shutterstock.

Richard Kensinger, MSW

Richard Kensinger, MSW, has over forty years of clinical experience in behavioral healthcare as a psychotherapist, trainer, consultant, and faculty member in the Psychology Department, Mount Aloysius College. He has also taught at Penn State, University of Pittsburgh, and Temple University. He is also a lover of "football", known in the USA as soccer. He is currently associated for over 30 years with youth "football", 26 as a referee.
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