Most U.S. teens with mental disorders are not taking psychiatric medications, finds a large new study that counters a widespread perception.

Just 14% of teens with any mental disorder take medications designed to alter emotions or behavior, the study finds. In most cases, the medications are those considered appropriate for their conditions, says the report published online Monday in the Archives of Pediatrics & Adolescent Medicine. For example, teens with attention deficit hyperactivity disorder (ADHD) are most likely to take stimulants and teens with depression are most likely to take anti-depressants.

The study is based on more than 10,000 interviews with teens ages 13 to 18 between 2001 and 2004 and contradicts "a lot of anecdotal reports that suggest kids are being overmedicated or mis-medicated," says lead author Kathleen Merikangas, a researcher from the National Institute of Mental Health, Bethesda, Md.

Merikangas says this is the most representative study on the issue, but it is limited by the fact that data is several years old. It also doesn't include younger children.

There is evidence that some subgroups of children and teens in the USA are being medicated at much higher rates, with unknown consequences for their health, some other experts say.

"Medication use by the average population of typical kids in America could be low," partly because many families with private insurance can't find or afford any mental health treatment, says David Rubin, a pediatrician and researcher at the Children's Hospital of Philadelphia.

But use among children on Medicaid appears much higher, he says, with one study showing 12% of foster children on Medicaid taking anti-psychotic medications - powerful drugs that are a growing concern. Medicaid may make it easier for children with behavior problems to see doctors but those doctors often lack the time to do anything more than write prescriptions, Rubin says. He wrote an editorial accompanying the study.

In the new study, just 1% of teens with any disorder took anti-psychotics. The highest use, 7.6%, was among those with developmental disorders, such as autism. Merikangas says it is likely those numbers would be higher if the study were done today, but she does not believe that's true for other classes of drugs.

Among other findings:

• Medication use was highest among teens with ADHD (31%), followed by those with mood disorders (19.7%), eating disorders (19.3%), behavior disorders (19.3%), substance use disorders (14.4%), and anxiety disorders (11.6%).
• Psychiatric medications were used by 2.5% of teens with no current disorder picked up in the interview, but most of those teens had histories of "psychological distress" or other mental health issues, the paper says.
• Medication use declined with age, especially for ADHD, with 29% of teens 13-14 yet just 13% of those 17-18 taking stimulants such as Ritalin for that condition.
• Just 25% of teens with any disorder got treatment from mental health specialists.

The study does not show whether the "right number" of teens got medication but it does "tell us that overall, it's really challenging for families with mental health disorders to access appropriate treatment," says William Cooper, professor of pediatrics at Vanderbilt University, Nashville. He adds: "I still have concerns about what appears to be a recent increase in use in some medications, including anti-psychotics, because we know so little about their effectiveness and side effects. "

Some anti-psychotic medications can cause substantial weight gain and increase the risk of type 2 diabetes, Cooper says. Stimulants for ADHD can interfere with sleep and suppress appetite. Some antidepressants might increase the risk of suicidal thinking and behavior in young people, but research suggests benefits outweigh risks for teens with major depression, according to the mental health institute.

It's important for families to know about potential benefits, as well as risks, Merikangas says. "We certainly don't intend to say that all of these children should be on medication," she says. Many will do best with behavioral therapy and other interventions. But, she says, "my concern has been that parents and kids have become afraid of using these medications."

USA Today