psychiatric drugs for children on medicaid: what the numbers actually say

every state hands cms the same three numbers about children and psychiatric medication: whether a child got talking treatment before an antipsychotic, whether a child on an antipsychotic got the blood tests the label asks for, and whether a child starting an adhd medicine was seen again within a month. those three numbers are public, they are state by state, and almost nobody quotes them. they are also the only place where the question "is my child being treated properly" turns into something you can look up and ask about. here they are, with what they cannot tell you, and four questions to take to an appointment.

the three numbers every state reports

these come from the medicaid and chip child core set, 2025 reporting year: states send their own rates to cms, mathematica compiles them, cms publishes the file. every figure below was read out of that file on 28 september 2026.^[1][2][3] they are age-banded, which matters, because the youngest children do worst on two of the three.

minnesota is worth holding in mind because it is not a simple story. on the measure that asks whether a child got talking treatment before a powerful drug, minnesota is first in the country. on the measure that asks whether a child starting an adhd medicine gets seen again within a month, it is below the bottom quartile. the same state, the same year, the same children.^[1][3]

what to ask, with the number that makes it a fair question

four asks. each one is paired with a figure a state or a federal file already publishes, so none of them is an accusation — it is a request that your child be on the right side of a number somebody is already keeping.

hydroxyzine is not a benzodiazepine

this is the single most useful distinction on the page, and it is the one most often lost. hydroxyzine is a first-generation antihistamine, chemically a relative of the old allergy drugs. the fda label gives it an anxiety indication — “for symptomatic relief of anxiety and tension associated with psychoneurosis” — and, unusually, it gives paediatric dosing right down the age range: “children under 6 years, 50 mg daily in divided doses”.^[18] it is not a controlled substance. a benzodiazepine is: it carries physical dependence, a withdrawal syndrome, and a different risk conversation entirely.

the two get merged because drug classification systems group by what a drug is used for, so an antihistamine used for anxiety sits in the same bucket as a benzodiazepine. that is how a child on an antihistamine becomes, in a summary table, a child on “anti-anxiety medication”. the scale is not trivial: in 2024 medicaid paid for 8,675,297 hydroxyzine prescriptions across all ages, against 11,753,095 for the whole benzodiazepine class.^[5] in british columbia, hydroxyzine was “the earliest and most frequently prescribed drug affecting the central nervous system in children under the age of 5 years”, at 1.1 percent prevalence.^[17]

none of which makes hydroxyzine harmless. the same canadian study found repeat prescriptions in preschoolers associated with later tic disorder, anxiety and conduct disturbance codes, with odds ratios between 1.34 and 1.55, and its authors asked for “the shortest possible duration for hydroxyzine use in preschool-age children” while stating plainly that causation is not proven.^[17] and the label itself says the drug’s effectiveness for anxiety beyond four months “has not been assessed by systematic clinical studies”.^[18] the point is not that one drug is fine and the other is not. the point is that a parent told “an anti-anxiety medicine” has been told almost nothing.

where FDA approval for young children exists, and where it does not

it is not true that none of these drugs is approved for young children, and it is not true that most of them are. the labels are specific, and the specifics are the whole answer.

• stimulants: from age 3. the amphetamine label says amphetamines “are not recommended… in children under 3 years of age with Attention Deficit Disorder with Hyperactivity”, which is an age floor, not an absence of approval. the same label says long-term effects in children “have not been well established”.^[19]
• risperidone: from age 5, for one thing. irritability associated with autistic disorder, efficacy established in three short-term trials in children aged 5 to 17. for schizophrenia it starts at 13 and for bipolar at 10, and the label says effectiveness below those ages has not been established.^[20]
• aripiprazole: from age 6, for one thing. irritability associated with autistic disorder, two 8-week placebo-controlled trials in 212 children aged 6 to 17. schizophrenia from 13.^[21]
• hydroxyzine: dosing written for children under 6. for anxiety, with a four-month evidence ceiling stated on the label.^[18]
• below those floors, it is off-label. an antipsychotic for a three-year-old, a stimulant for a two-year-old, an antipsychotic for behaviour that is not autism-related irritability: all off-label. off-label prescribing is legal, is ordinary in paediatrics because children are under-studied, and is not in itself evidence that anyone did anything wrong. it does mean nobody ran the trial.

how often the prescription matches an approved indication is measurable, and it improved: among medicaid children on antipsychotics, the share with a diagnosis matching an fda-approved paediatric indication rose from 38 percent in 2008 to 45 percent in 2016.^[8] which is also to say that in 2016, 55 percent did not.

what the data cannot say

the very young children, and what is known about them

the honest position is that the under-five picture comes from studies, not from a live public file, and the studies are old or local. in medicaid data from 36 states covering two birth cohorts followed to age four, 1.19 percent of children received at least one psychotropic drug: 0.61 percent an adhd medication, 0.59 percent something for depression or anxiety, 0.24 percent something for psychotic illness or bipolar.^[12] in one southeastern state’s medicaid programme, 316 children under six started an antipsychotic in a single year; their mean exposure ran 2.6 years, 27 percent were on one for more than four years, 31 percent received four or more medication classes, and 42 percent got metabolic screening.^[11] among privately insured children aged 2 to 5 on antipsychotics, fewer than half had a mental health assessment, a psychotherapy visit or a psychiatrist visit during the year they were treated.^[13]

the age-of-diagnosis finding is the one that should worry people most: in 16,626 children followed for five years after a first adhd diagnosis, antipsychotic use and polypharmacy climbed over time, and the climb was confined to children diagnosed between 3 and 9. the children diagnosed at 3 had the steepest rise of all. and 39.1 percent of the child-years on three or more psychotropic classes carried no psychiatric diagnosis other than adhd.^[14] that is a trajectory problem, not a single-prescription problem, and no quality measure currently tracks it.

both directions

the case that this is over-treatment. foster children were prescribed psychotropic drugs at rates 2.7 to 4.5 times those of other medicaid children in the five states gao examined in 2008 — in oregon, 19.7 percent of foster children against 4.8 percent of other children on medicaid. hundreds of children in those states were on five or more psychotropic drugs at once, which gao’s experts said no evidence supports; thousands were above the maximum dose in the fda label; and children under one year old were prescribed psychotropic drugs, for which gao’s experts said there is no established use.^[6] in 2009 claims from 44 states, antipsychotic use was 7.4 percent among foster youths against 1.4 percent among other medicaid youths, and foster care remained a strong independent predictor after adjusting for adhd, disruptive behaviour and conduct disorder diagnoses.^[10] children on antipsychotics in tennessee medicaid had three times the diabetes risk of matched children on other psychotropics.^[15]

the case against reading that as a scandal on its own. the children with the most prescriptions are the children with the most going wrong: foster care is the most traumatised population in the system, and the same analysis that found the disparity also found much higher rates of adhd, disruptive behaviour and conduct disorder in that group.^[10] untreated severe behavioural illness in a child is not a neutral state. the trend has gone the right way: antipsychotic use among medicaid children aged 2 to 17 declined substantially between 2008 and 2016 across every group studied, the rapid growth stopped after 2008, and foster children became more likely than other medicaid children to receive psychosocial care and metabolic monitoring, because oversight was built for them first.^[8][9] and the largest mortality study, two million medicaid patients aged 5 to 24, found no increased death risk at doses of 100 mg chlorpromazine-equivalent or less, and none at any dose in children aged 5 to 17; the excess appeared at higher doses in 18-to-24-year-olds.^[16] an off-label prescription is not evidence of wrongdoing, a payment is not a verdict, and a drug given to a distressed four-year-old may be the least bad option in a room with no therapist in it.

the thing both sides agree on is the gap that the measures expose: talking treatment is supposed to come first and often does not, and the blood test is supposed to happen and usually does not. that is the argument worth having, and it is the one you can act on at your own appointment.

questions people ask

sources

1. CMS Medicaid/CHIP Child Core Set, 2025 reporting year — APP-CH, “Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics: Ages 1 to 17”. Rate definition: “Percentage who had a New Prescription for an Antipsychotic Medication and had Documentation of Psychosocial Care as First-Line Treatment.” Ages 1 to 11: 51 states reporting, mean 60.8, median 59.2, bottom quartile 54.1, top quartile 66.2; lowest reported rate 44.5 (North Carolina), highest 83.5 (Vermont); Minnesota 74.4. Ages 12 to 17: 52 states, mean 64.0, median 63.8; Minnesota 81.6, the highest reported. Ages 1 to 17: 52 states, mean 62.9, median 61.4; Minnesota 79.3 on a denominator of 1,399, the highest reported rate in the country. Source line on every row: “Mathematica analysis of the Quality Measure Reporting (QMR) system reports for the 2025 Core Set as of April 28, 2026.” Dataset revised September 2026; downloaded and read 2026-09-28. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
2. CMS Medicaid/CHIP Child Core Set, 2025 reporting year — APM-CH, “Metabolic Monitoring for Children and Adolescents on Antipsychotics: Ages 1 to 17”. “Percentage with Two or More Antipsychotic Prescriptions that had Metabolic Testing for Blood Glucose and Cholesterol”: ages 1 to 11, 50 states, mean 31.3, median 29.1, lowest 13.2 (Kansas), highest 61.5 (Montana); ages 12 to 17, 52 states, mean 37.0, median 36.3; ages 1 to 17, 52 states, mean 34.8, median 32.9, highest 59.7 (West Virginia). Blood glucose alone, ages 1 to 17: mean 55.1, median 54.4, lowest 26.9 (District of Columbia), highest 83.0 (Wyoming). Cholesterol alone, ages 1 to 17: mean 36.0, median 34.8. Minnesota 2025 reporting: glucose 54.4 on a denominator of 5,812 (43.0 for ages 1 to 11, 59.6 for ages 12 to 17), cholesterol 0.8, both tests 0.6; the ages 1 to 11 cholesterol cell is marked DS, “data suppressed… per the Centers for Medicare & Medicaid Services’ cell-size suppression policy.” In the 2024 reporting year the same Minnesota measures were glucose 53.9, cholesterol 36.4, both 35.3. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
3. CMS Medicaid/CHIP Child Core Set, 2025 reporting year — ADD-CH, “Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication: Ages 6 to 12”. Initiation phase (“Percentage Newly Prescribed ADHD Medication with at Least One Follow-Up Visit During the 30-Day Initiation Phase”): 52 states, mean 47.3, median 47.6, bottom quartile 41.1, top quartile 53.7, lowest 30.2 (North Dakota), highest 64.2 (Maryland); Minnesota 39.1 on a denominator of 7,346. Continuation and maintenance phase (“at Least Two Follow-Up Visits in the 9-Month Continuation and Maintenance Phase”): 50 states, mean 54.6, median 55.5; Minnesota 45.2 on a denominator of 2,970. Minnesota 2024 reporting: 38.4 and 42.3. https://data.medicaid.gov/dataset/14bc26c3-5584-4032-9175-f3a0399cb206
4. CMS Medicaid/CHIP Child Core Set, FFY 2019 — APC-CH, “Percentage on Two or More Concurrent Antipsychotic Medications: Ages 1 to 17”: 42 states reporting, median 2.6, bottom quartile 3.5, top quartile 1.7, lowest reported rate 0.2, highest 6.4. Minnesota did not report this measure. The measure does not appear in the Child Core Set files for the 2020, 2021, 2022, 2023, 2024 or 2025 reporting years, each of which was downloaded and checked on 2026-09-28; no replacement measure of concurrent antipsychotic use is published. https://data.medicaid.gov/dataset/e36d89c0-f62e-56d5-bc7e-b0adf89262b8
5. CMS State Drug Utilization Data 2024 (file sdud2024_updatedJuly2026.csv, 5,308,407 rows, downloaded 2026-09-28). Fields are utilization type, state, NDC, product name, units reimbursed, number of prescriptions and amounts reimbursed. There is no age, no diagnosis and no prescriber field. Summing every row whose product name contains hydroxyzine, Vistaril or Atarax across the 52 reporting states and territories: 8,675,297 prescriptions and $105,553,404 reimbursed; Minnesota 181,096 prescriptions and $2,535,438. Summing every row naming a benzodiazepine (alprazolam, lorazepam, clonazepam, diazepam, chlordiazepoxide, temazepam, midazolam, oxazepam, triazolam, clorazepate, clobazam, estazolam, flurazepam, quazepam, remimazolam and their brands): 11,753,095 prescriptions and $321,772,863; Minnesota 201,440 prescriptions and $2,394,821. These are our own sums of the CMS file by product name, all ages, not a CMS-published statistic. https://data.medicaid.gov/dataset/61729e5a-7aa8-448c-8903-ba3e0cd0ea3c
6. U.S. Government Accountability Office, GAO-12-270T (13 December 2011), the testimony presenting the analysis published as GAO-12-201, “Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions”. Medicaid fee-for-service claims, 2008, five states. “Foster children in Florida, Massachusetts, Michigan, Oregon, and Texas were prescribed psychotropic drugs at rates 2.7 to 4.5 times higher” than nonfoster children. Children aged 0 to 17 prescribed at least one psychotropic medication — Florida: foster 22%, nonfoster 8.2%. Massachusetts: 39.1% and 10.2%. Michigan: 21.4% and 9.2%. Oregon: 19.7% and 4.8% (ratio 4.1; ages 13 to 17, 43.3% and 12.0%; ages 6 to 12, 23.4% and 6.2%; Oregon Medicaid paid $14,326,756 for psychotropic medications for foster and nonfoster children in 2008). Texas: 32.2% and 7.1%. Five or more psychotropic drugs concomitantly: 609 foster children and 1,143 nonfoster children across the five states (Oregon 0.13% and 0.01%). Doses above the maximum in FDA-approved labels: “ranged from 1.12 to 3.27 percent among foster children compared with a lower 0.16 to 0.56 percent rate among nonfoster children”; 2,165 foster and 18,800 nonfoster children. Children under 1 year old prescribed a psychotropic drug: Oregon 0.3% of foster and 0.1% of nonfoster children. GAO’s own caveat: “prescription rates are not comparable across states because certain states covered more psychotropic drugs than other states,” and children covered by an HMO in two states were excluded. Maryland was dropped “due to the unreliability of their foster care data.” https://www.gao.gov/products/gao-12-270t
7. Finnerty M, Neese-Todd S, Pritam R, et al. Access to Psychosocial Services Prior to Starting Antipsychotic Treatment Among Medicaid-Insured Youth. Journal of the American Academy of Child and Adolescent Psychiatry 2016;55(1):69-76. Eight state Medicaid programs, 24,372 children and adolescents aged 0 to 20 starting an antipsychotic. “Less than one-half of youth received a psychosocial service before initiating antipsychotic treatment (48.8%)”; by age, 39.2 percent of children aged 0 to 5, 51.5 percent of children aged 6 to 11 and of adolescents aged 12 to 17, 40.1 percent of those aged 18 to 20. By diagnosis, from 35.6 percent (anxiety) to 61.2 percent (stress disorders). PMID 26703912. https://doi.org/10.1016/j.jaac.2015.09.020
8. Bushnell G, Lloyd J, Olfson M, Cook S, Das H, Crystal S. Antipsychotic Medication Use In Medicaid-Insured Children Decreased Substantially Between 2008 And 2016. Health Affairs 2023;42(7):973-980. “This study observed a sizable decline in antipsychotic use among children ages 2-17 between 2008 and 2016… declines were observed across foster care status, age, sex, and racial and ethnic groups studied. The proportion of children with an antipsychotic prescription who received any diagnosis associated with a pediatric indication that was approved by the Food and Drug Administration increased from 38 percent in 2008 to 45 percent in 2016, which may indicate a trend toward more judicious prescribing.” PMID 37406239. https://doi.org/10.1377/hlthaff.2022.01625
9. Crystal S, Mackie T, Fenton MC, et al. Rapid Growth Of Antipsychotic Prescriptions For Children Who Are Publicly Insured Has Ceased, But Concerns Remain. Health Affairs 2016;35(6):974-982. “We found that the trend of rapidly increasing use of antipsychotics appears to have ceased since 2008. Children in foster care treated with antipsychotic medications are now more likely than other Medicaid-insured children to receive psychosocial interventions and metabolic monitoring for the side effects of the medications. However, challenges persist in increasing safety monitoring and access to psychosocial treatment.” PMID 27269012. https://doi.org/10.1377/hlthaff.2016.0064
10. Vanderwerker L, Akincigil A, Olfson M, Gerhard T, Neese-Todd S, Crystal S. Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths. Psychiatric Services 2014;65(10):1281-1284. Medicaid claims from 44 states for 2009; 301,894 youths in foster care and 5,092,574 not in foster care, excluding schizophrenia, bipolar disorder, autism and major depression. Foster care youths had higher rates of externalizing disorders (ADHD 17.3% versus 6.5%; disruptive behavior disorder 7.2% versus 2.5%; conduct disorder 2.3% versus 0.5%) “and greater antipsychotic use (7.4% versus 1.4%). Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates, including externalizing disorders (adjusted odds ratio=2.59, 95% confidence interval=2.54-2.63).” PMID 25124057. https://doi.org/10.1176/appi.ps.201300455
11. Lohr WD, Jawad K, Feygin Y, et al. Antipsychotic Medications for Low-Income Preschoolers: Long Duration and Psychotropic Medication Polypharmacy. Psychiatric Services 2022;73(5):510-517. State Medicaid claims 2012-2017, children under 6. “In 2012, 316 children <6 years of age started an antipsychotic medication in a southeastern state.” Diagnoses: ADHD 91 percent, neurodevelopmental disorders 66 percent, anxiety and trauma-related 64 percent, autism spectrum 43 percent. “The mean±SD duration of exposure to antipsychotic medication for children in the cohort was 2.6±1.7 years, but 86 children (27%) had >4 years of exposure. Almost one-third (N=97, 31%) received polypharmacy of four or more medication classes, and 42% (N=131) received metabolic screening.” PMID 34470507. https://doi.org/10.1176/appi.ps.202000673
12. Garfield LD, Brown DS, Allaire BT, Ross RE, Nicol GE, Raghavan R. Psychotropic drug use among preschool children in the Medicaid program from 36 states. American Journal of Public Health 2015;105(3):524-529. Medicaid Analytic Extract data 2000 to 2003, two birth cohorts followed to age 4. “Overall, 1.19% of children received at least 1 psychotropic drug. Medications for attention-deficit disorder/attention-deficit hyperactivity disorder treatment were most common (0.61% of all children), followed by depression or anxiety (0.59%) and psychotic illness or bipolar (0.24%).” Black and Hispanic children had lower odds of a prescription (OR 0.51 and 0.37). PMID 25602884. https://doi.org/10.2105/AJPH.2014.302258
13. Olfson M, Crystal S, Huang C, Gerhard T. Trends in antipsychotic drug use by very young, privately insured children. Journal of the American Academy of Child and Adolescent Psychiatry 2010;49(1):13-23. Privately insured children aged 2 through 5. “The annualized rate of any antipsychotic use per 1,000 children increased from 0.78… (1999-2001) to 1.59… (2007).” Among treated children in 2007 the commonest diagnoses were pervasive developmental disorder or mental retardation (28.2%), ADHD (23.7%) and disruptive behavior disorder (12.9%), and “fewer than one-half of antipsychotic-treated young children received a mental health assessment (40.8%), a psychotherapy visit (41.4%), or a visit with a psychiatrist (42.6%) during the year of antipsychotic use.” Privately insured, not Medicaid. PMID 20215922. https://doi.org/10.1097/00004583-201001000-00005
14. Winterstein AG, Soria-Saucedo R, Gerhard T, Correll CU, Olfson M. Differential Risk of Increasing Psychotropic Polypharmacy Use in Children Diagnosed With ADHD as Preschoolers. Journal of Clinical Psychiatry 2017;78(7):e744-e781. 16,626 children aged 3 to 18 in 28 state Medicaid programs, 1999 to 2006, followed five years from a first ADHD diagnosis. Antipsychotics rose from 7.1 to 14.7 percent and psychotropic polypharmacy from 8.5 to 13.4 percent over the five years, “but this increase was confined to children between ages 3 and 9 at ADHD diagnosis. Children diagnosed at age 3 had the most substantial increase in each outcome.” Also: “39.1% of 9,680 children-years with psychotropic polypharmacy therapy had no psychiatric diagnoses other than ADHD.” PMID 28686819. https://doi.org/10.4088/JCP.16m10884
15. Bobo WV, Cooper WO, Stein CM, Olfson M, Graham D, Daugherty J, Fuchs DC, Ray WA. Antipsychotics and the risk of type 2 diabetes mellitus in children and youth. JAMA Psychiatry 2013;70(10):1067-1075. Tennessee Medicaid, 28,858 recent initiators of antipsychotics and 14,429 matched controls who started another psychotropic. “Users of antipsychotics had a 3-fold increased risk for type 2 diabetes (HR = 3.03 [95% CI = 1.73-5.32]), which was apparent within the first year of follow-up.” Restricted to children aged 6 to 17: HR 3.14 (95% CI 1.50-6.56). Risk rose with cumulative dose and “remained elevated for up to 1 year following discontinuation.” PMID 23965896. https://doi.org/10.1001/jamapsychiatry.2013.2053
16. Ray WA, Fuchs DC, Olfson M, et al. Antipsychotic Medications and Mortality in Children and Young Adults. JAMA Psychiatry 2024;81(3):260-269. 2,067,507 Medicaid patients aged 5 to 24 without severe somatic illness or psychosis. “Mortality was not associated with antipsychotic doses of 100 mg or less (RD, 3.3; 95% CI, -5.1 to 11.7 per 100 000 person-years; HR, 1.08…) but was associated with doses greater than 100 mg (RD, 22.4; 95% CI, 6.6-38.2; HR, 1.37; 95% CI, 1.11-1.70)… Mortality for children aged 5 to 17 years was not significantly associated with either antipsychotic dose, whereas young adults aged 18 to 24 years had increased risk for doses greater than 100 mg.” PMID 38019523. https://doi.org/10.1001/jamapsychiatry.2023.4573
17. Gober HJ, Li KH, Yan K, Bailey AJ, Carleton BC. Hydroxyzine Use in Preschool Children and Its Effect on Neurodevelopment: A Population-Based Longitudinal Study. Frontiers in Psychiatry 2022;12:721875. “We identified the first-generation antihistamine hydroxyzine as the earliest and most frequently prescribed drug affecting the central nervous system in children under the age of 5 years in the province of British Columbia, Canada (1.1% prevalence).” Repeat prescriptions versus a single prescription were associated with tic disorder (OR 1.55, 95% CI 1.23-1.96), anxiety (1.34, 1.05-1.70) and disturbance of conduct (1.34, 1.08-1.66) up to age 10. The authors: “Controlled studies are required in order to prove a causal relationship… For the time being, we suggest the shortest possible duration for hydroxyzine use in preschool-age children.” British Columbia, not the United States. PMID 35153845. https://doi.org/10.3389/fpsyt.2021.721875
18. FDA label, hydroxyzine hydrochloride tablets, retrieved from openFDA 2026-09-28. Indications: “For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested.” Dosage: “adults, 50 to 100 mg q.i.d.; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses.” Also: “The effectiveness of hydroxyzine as an antianxiety agent for long term use, that is more than 4 months, has not been assessed by systematic clinical studies.” Hydroxyzine is an antihistamine; it is not a benzodiazepine and is not a controlled substance. https://api.fda.gov/drug/label.json?search=openfda.generic_name:%22hydroxyzine+hydrochloride%22
19. FDA label, amphetamine sulfate tablets, retrieved from openFDA 2026-09-28. Pediatric Use: “Amphetamines are not recommended for use as anorectic agents in children under 12 years of age, or in children under 3 years of age with Attention Deficit Disorder with Hyperactivity described under INDICATIONS AND USAGE.” The label also says: “Long-term effects of amphetamines in children have not been well established,” and “Drug treatment is not indicated in all cases of Attention Deficit Disorder with Hyperactivity and should be considered only in light of the complete history and evaluation of the child.” https://api.fda.gov/drug/label.json?search=openfda.generic_name:%22amphetamine%22
20. FDA label, risperidone tablets, retrieved from openFDA 2026-09-28. Irritability associated with autistic disorder: “Efficacy was established in 3 short-term trials in children and adolescents (ages 5 to 17 years).” Schizophrenia: adolescents 13 to 17; “Safety and effectiveness of risperidone tablets in children less than 13 years of age with schizophrenia have not been established.” Bipolar I: ages 10 to 17; “Safety and effectiveness… in children less than 10 years of age with bipolar disorder have not been established.” https://api.fda.gov/drug/label.json?search=openfda.generic_name:%22risperidone%22
21. FDA label, aripiprazole tablets, retrieved from openFDA 2026-09-28. Irritability associated with autistic disorder: “Safety and effectiveness in pediatric patients demonstrating irritability associated with autistic disorder were established in two 8 week, placebo-controlled clinical trials in 212 pediatric patients aged 6 to 17 years.” Schizophrenia: “a 6 week, placebo-controlled clinical trial in 202 pediatric patients aged 13 to 17 years.” https://api.fda.gov/drug/label.json?search=openfda.generic_name:%22aripiprazole%22

your own state

every figure above is a national median, and no child lives in the median state. the same file reports each state separately, and there is now a page for each one: its own three rates, its denominators, its rank among the states that reported, what medicaid paid for hydroxyzine and benzodiazepines there in 2024, and the four asks above rewritten with that state’s numbers.^[1][2][3][5] start at all 51 states ranked on the three measures, or go straight to yours: Alabama · Alaska · Arizona · Arkansas · California · Colorado · Connecticut · Delaware · District of Columbia · Florida · Georgia · Hawaii · Idaho · Illinois · Indiana · Iowa · Kansas · Kentucky · Louisiana · Maine · Maryland · Massachusetts · Michigan · Minnesota · Mississippi · Missouri · Montana · Nebraska · Nevada · New Hampshire · New Jersey · New Mexico · New York · North Carolina · North Dakota · Ohio · Oklahoma · Oregon · Pennsylvania · Rhode Island · South Carolina · South Dakota · Tennessee · Texas · Utah · Vermont · Virginia · Washington · West Virginia · Wisconsin · Wyoming.

related: does hydroxyzine work for anxiety · how childhood ADHD got counted · risperidone: the legal and safety record · what each drug is actually approved for

nothing here is a reason to start, stop or change a child’s medication. it is a set of questions to bring to the person who prescribes it.

adam