Concerned about how antipsychotics are being used in children, Washington state officials are working on a plan due by early fall to ensure the meds are properly prescribed for kids on Medicaid, The Tacoma News-Tribune reports. “The data is concerning,” Jeff Thompson, chief medical officer for the state Medicaid program, tells the paper.

State data, in fact, show the use of atypical antipsychotics in children enrolled in Washington’s Medicaid program for low-income people increased about 25 percent between 2004 and 2007. Last year, 4,978 Medicaid participants 18 or younger were taking the drugs, and 187 were 5 or younger. Some were on two or more drugs at the same time.

The most recent data available show that the state Medicaid program spent about $9 million last year on the drugs for children 18 or younger, up from $4.96 million in 2004. Stats on use of the drugs in Washington children not taking part in Medicaid are unavailable, the paper adds.

There are indications, Thompson tells the paper, that the drugs are sometimes being used when not needed, in doses sometimes too high, and in children who are too young for them. Thompson, by the way, is leading a work group in the state Department of Social and Health Services to ensure the drugs are prescribed to Medicaid children in Washington only when truly needed and at proper doses.

The plan requires expert second opinion if the drugs are prescribed outside of certain parameters: such as to very young kids, or in combination, or in very high doses. Some kids are on “doses that are far beyond any reasonable maximum dose,” Chris Varley, a University of Washington professor of child and adolescent psychiatry and member of the DSHS work group, tells the paper.

Among those who question the widespread use of atypical anti-psychotics in children and the popularity of bipolar diagnosis of kids is John Holttum, a Tacoma child psychiatrist who treats 300 to 400 children a year, almost all referred by family doc and general psychiatrists for additional help.

“At times, yes, (atypical anti-psychotics) help,” Holttum tells the paper. “Kids do get psychotic, and they do have mania, but both are very rare.”

What he sees more in his practice, he continues, are violent or aggressive children who are labeled as bipolar, but who do not show the traditional signs of mania, depression and delusions of grandeur that are hallmarks of the traditional definition of bipolar disorder in adults, the News-Tribune writes.

He and others say the definition of bipolar disorder is expanding and now captures children who 10 or 15 years ago might have been seen as troubled or irritable, and more likely treated with counseling, parenting training for their caregivers or other social interventions.

“We absolutely need some oversight” of atypical anti-psychotic use in children, Holttum tells the paper. “Some of the kids who walk into my office have been grossly mismanaged.” Atypical anti-psychotics “are aggressive medications,” he adds, and their potential long-term side effects on developing brains worry experts.