ARTICLESPredictors of Polypharmacy and Off-Label Prescribing of Psychotropic Medications A National Survey of Child and Adolescent PsychiatristsKEARNS, MARCIA A. Med, MA; HAWLEY, KRISTIN M. PhD Author Information KEARNS and HAWLEY: Department of Psychological Sciences, University of Missouri, Columbia Conflicts of interest and source of funding: This project was supported in part by University of Missouri Research Council Grant and NIMH Grant MH077752 awarded to Dr. Kristin Hawley. The authors declare no conflicts of interest. Please send correspondence to: Marcia A. Kearns, MEd, MA, Department of Psychological Sciences, 210 McAlester Hall, Columbia, MO 65211-2500. [email protected] Journal of Psychiatric Practice: November 2014 - Volume 20 - Issue 6 - p 438-447 doi: 10.1097/01.pra.0000456592.20622.45 Buy Metrics Abstract We employed a national survey of child psychiatrists to examine typical prescribing practices for children with anxiety, depression, and disruptive behavior disorders. We examined the extent to which polypharmacy and off-label prescribing occur in routine practice and the degree to which child characteristics, child psychiatrist characteristics, and medication availability may influence these prescribing practices. We found that child psychiatrists most often prescribed medications that were on-label according to U.S. Food and Drug Administration (FDA) guidelines, and that they were progressively less likely to choose medications with partial approval (i.e., medications having pediatric approval but not for the patient’s age or problem type), and then medications with no pediatric approval. We also found that prescribing multiple concomitant medications was the norm. We employed best subsets regression to determine the best theoretically relevant predictors to explain polypharmacy and off-label prescribing and found that the best fitting model only included number of child diagnoses. These findings suggest that comorbidity is an important issue in the pharmacotherapy of children with mental health disorders and one that must be addressed in future clinical trials. (Journal of Psychiatric Practice 2014;20:438–447) Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.