Is Stimulant Treatment in Children and Adolescents with Mood Dysregulation Associated with Adverse Outcomes?

The aim of this paper is to examine effects of stimulant treatment in children and adolescents with high levels of emotional dysregulation in a psychiatric outpatient clinic. Subjects were referred children and adolescents 6-17 years of age who presented to a child psychiatric outpatient clinic between September 2016-November 2021 and received a prescription for a stimulant medication. Children were stratified into those with low and high levels of emotional dysregulation as defined by an aggregate T-score of <180 or ≥210 on the combined Attention Problems, Aggressive Behavior, and Anxious/Depressed subscales of the Child Behavior Checklist (CBCL; CBCL-AAA). We analyzed patient prescription, diagnosis, and hospital visit data extracted from the electronic medical record from any time prior to referral through three months after referral. Patients with higher CBCL-AAA scores at clinic intake had a significantly different medication and diagnosis profile and were more likely to have a higher dosage of stimulants than patients with lower scores. These patients also were more likely to receive an additional medication class during follow-up, which was driven by second-generation antipsychotics (SGAs). Emergency room visits and inpatient psychiatric admissions were rare but present only in the group with higher CBCL-AA scores. These results suggest that stimulant treatment affects youth with high versus low levels of emotional dysregulation adversely with a need for higher stimulant doses and treatment augmentation with SGAs. The CBCL may be a useful tool for identifying poor outcomes with stimulant treatment.