The claim that American children are broadly overmedicated with psychiatric drugs is not supported by national prescribing data. CDC MMWR data (Danielson et al., 2023, MarketScan commercial claims, enrollees aged 5-64) show prescription stimulant fills rose from 3.6% in 2016 to 4.1% in 2021, with the increase concentrated among females aged 15-44 and males aged 25-44, each rising more than 10% during 2020-2021, while use remained stable or declined among children and adolescents overall. In national prescribing data covering 6,351,482 young people (Sultan et al., Journal of Child and Adolescent Psychopharmacology, 2018), only 0.8% of children aged 3-5 filled a prescription for any stimulant, antidepressant, or antipsychotic in a year, and antipsychotic use peaked at just 1.3% at age 16. The genuine pediatric overprescribing signal is narrower and involves a different drug class: among 187,563 commercially insured youths aged 3-24 with a new ADHD diagnosis (Sultan et al., JAMA Network Open, 2019, MarketScan 2010-2015), 2.6% started an antipsychotic within a year, and 47.9% of those had never filled a stimulant first. Only 52.7% had any FDA-indicated or evidence-supported diagnosis for antipsychotic treatment. The problem in youth psychopharmacology is miscalibration rather than volume: the right patient, right diagnosis, right sequence, right monitoring, and periodic reassessment.

Washington says kids are overmedicated. The prescribing data says something stranger.

On May 4, 2026, the Department of Health and Human Services announced a Make America Healthy Again action plan to curb what it called psychiatric overprescribing in children, including a federal working group to examine prescribing patterns for stimulants, SSRIs, antipsychotics, and mood stabilizers in young people. The American Psychiatric Association pushed back. So did a lot of parents whose kids are doing well on medication and who felt, again, that they were being told they'd done something wrong.

I want to make an unpopular argument: both sides of that fight are answering a question that doesn't have a useful answer.

Here's a number that rarely makes it into the coverage. In national prescribing data covering 6,351,482 young people, the share of American children aged 3 to 5 who filled a prescription for any stimulant, antidepressant, or antipsychotic over a full year was 0.8%. Eight children in a thousand. At ages 6 to 12 it's 5.4%, and at 13 to 18 it's 7.7%. Antipsychotics, the class that worries me most, peak at 1.3%, and they peak at age 16, not in preschool.

Those are not the numbers of a country medicating its toddlers into submission. They're roughly in line with, or below, community estimates of how many kids actually have these conditions.

And yet I've seen children I'd describe as overmedicated. Not many. But the ones I've seen weren't overmedicated in the way the debate imagines. They were on the wrong drug, started in the wrong order, with nobody tracking whether it helped.

The stimulant increase is mostly adults, and mostly women

The CDC analyzed commercial insurance claims for enrollees aged 5 to 64 between 2016 and 2021. Overall stimulant prescription fills went from 3.6% to 4.1%. That's a real increase, and it's worth understanding. But the growth wasn't evenly spread. Fills among females aged 15 to 44 and males aged 25 to 44 each rose by more than 10% during 2020 and 2021. Among children and adolescents as a whole, use was stable or declining.

One honest caveat, because the age bands matter and people keep collapsing them. The fastest-growing female band starts at 15, which means adolescent girls are inside that increase. It is not accurate to say nothing changed for anyone under 18. What's accurate is that the national rise is dominated by adults and young adults, and within younger people it shows up in teenage girls rather than in small children.

That distinction should change the policy conversation completely. A federal effort framed around overmedicated kids is pointed at a population where prescribing has been flat.

Why did adult prescribing climb? Telehealth expanded fast during the pandemic, and the requirement for an in-person visit before a stimulant prescription was relaxed. Recognition of adult ADHD improved. Recognition of ADHD in women and girls improved a great deal, which matters because the inattentive presentation without disruptive behavior was missed for decades in exactly that group. Some of the increase probably reflects prescribing that wouldn't survive a careful diagnostic interview.

All of those can be true at once. What none of them establishes is that the prescribing is wrong. A rise in volume tells you the number changed. It doesn't tell you whether the people receiving the drug needed it. Those are separate questions and the public argument keeps merging them.

A system can undertreat and overtreat at the same time

This is the part that gets lost. Overprescribing and underprescribing aren't opposite ends of one dial. They're two failure modes that coexist happily in the same health system, often in the same clinic, sometimes in the same child.

At any diagnostic threshold you pick, a restrictive line misses people who would have benefited, and a permissive line pulls in people with less impairment and less to gain. No threshold sorts perfectly. Where you should put it depends on how effective the treatment is and how much burden it carries.

There's a real-world illustration of this in the treatment literature. As ADHD prescribing expanded, the measured protective association between medication and serious outcomes like unintentional injury, traffic crashes, and crime got smaller, though it stayed statistically significant. In an editorial I wrote with David Saunders and Jeremy Veenstra-VanderWeele in JAMA Psychiatry in 2025, we noted that this attenuation wasn't fully explained by shifting demographics.

That's the threshold effect showing up in real data. When treatment reaches people who were less severely impaired to begin with, the average absolute benefit falls, because there was less catastrophic risk to prevent. That's arithmetic, not evidence that the drug stopped working. Think about statins. Give them to people who've already had a heart attack and the benefit per patient is large. Give them to people with mildly elevated cholesterol and no other risk factors and the benefit per patient shrinks, because most of them weren't going to have a heart attack this year. Nobody concludes from this that statins are ineffective. They conclude that where you draw the line changes what you get.

So when the volume of ADHD prescribing rises and the average effect size falls, that's expected. It's an argument for better targeting. It is not an argument for treating fewer people, and it's certainly not an argument that the medication doesn't work.

Here's the prescribing problem nobody's arguing about

In 2019 my colleagues and I published a cohort study in JAMA Network Open using MarketScan commercial claims from 2010 to 2015. We followed 187,563 young people aged 3 to 24 who had a new ADHD diagnosis and no recent diagnosis of any condition for which antipsychotics are FDA-indicated.

In the year after diagnosis, 2.6% started an antipsychotic. Of those, 47.9% (95% CI, 46.5% to 49.3%) had not filled a single stimulant prescription between the ADHD diagnosis and the antipsychotic. Only 52.7% (95% CI, 51.3% to 54.1%) ever received a diagnosis for which antipsychotics have an FDA or evidence-supported indication.

Nearly half the children who got a powerful metabolic-risk medication for behavior never tried the safer, better-studied, more effective first-line option.

Two honest limitations. The data run from 2010 to 2015, so they describe the middle of the last decade rather than today. And claims data can't see severe aggression, symptom severity, adherence, what the family was managing at home, or the full clinical reasoning. Some of those prescriptions were probably defensible decisions made by careful clinicians facing a crisis at 4:45 on a Friday. But 47.9% is not a rounding error, and the pattern was strongest in the youngest children. I've written up the full breakdown of that study, including the drug-by-drug and age-by-age findings, separately.

Note what this is and isn't. It isn't a claim that antipsychotics have no place in children. They do: irritability in autism, bipolar disorder, psychotic disorders, Tourette disorder, and severe aggression that hasn't responded to first-line care. It's a claim about sequence. We can undertreat ADHD and simultaneously overtreat its behavioral surface with a heavier drug.

Not all psychiatric medications carry the same risk

Lumping every psychotropic into one moral category is the single most damaging habit in this conversation, and both critics and defenders do it.

Stimulants are among the most studied medications in all of child psychiatry. They're not risk-free, and anyone who tells you otherwise is selling something. Appetite suppression is common. Sleep onset gets delayed. Heart rate and blood pressure rise modestly. Some kids get irritable as a dose wears off. There are measurable effects on growth trajectory. Misuse and diversion are real, especially in adolescents and college students. Rare serious events exist. But these effects are largely dose-related, they're detectable at a routine visit, and they reverse when the medication stops.

Second-generation antipsychotics are a different proposition in a developing body. Weight gain can be substantial and fast. Dyslipidemia, insulin resistance, and elevated type 2 diabetes risk follow. Prolactin can rise. Sedation is common enough to affect school. And there's a family of movement effects that need to be named precisely, because they get blurred together constantly:

A monitored stimulant trial in a child with impairing ADHD and a premature antipsychotic for the same child's behavior are not the same clinical decision. Treating them as interchangeable examples of overmedication is how you end up with policy that discourages the safer drug while leaving the sequencing problem untouched.

Most stimulant prescriptions don't come from psychiatrists

Here's the mechanism nobody talks about, and it's in the same national dataset. Psychiatrists and child psychiatrists wrote 51.7% to 70% of antipsychotic prescriptions to young people, but only 30.4% to 36.2% of the stimulant prescriptions.

Roughly two-thirds of stimulant prescribing for young people happens outside psychiatry, mostly in primary care and pediatrics, in visits that are frequently fifteen minutes long. That's not a criticism of pediatricians. There are around 7,000 child and adolescent psychiatrists in the United States for a population of roughly 70 million children. The math doesn't work, and pediatricians absorbed the shortfall because someone had to.

But it explains the shape of the problem better than any theory about pharmaceutical marketing or lazy parents. Careful diagnosis takes time. Rating scales from parents and teachers take time to collect and interpret. Structured reassessment takes a scheduled visit that nobody's paying for. When the system gives fifteen minutes, you get pattern-matching. Sometimes pattern-matching is right. Sometimes it produces a child on a second and third medication because the first one was aimed at the wrong target and nobody went back to check.

If you want to fix miscalibration, fund the assessment and the follow-up. Restricting the prescription pad without doing that just moves the failure somewhere less visible.

"Just do therapy instead" assumes therapy is available

Whenever prescribing comes up, someone suggests behavioral treatment as the obvious alternative, as though it were sitting on a shelf, free, and equally effective for everything.

It isn't. Behavioral parent training for ADHD works, and for preschool-aged children the American Academy of Pediatrics recommends it before medication, which I agree with and follow. But it requires a trained therapist within driving distance, an insurance plan that covers it, a copay the family can absorb, a caregiver who can leave work repeatedly during business hours, and homework done consistently between sessions. In much of the country at least one of those is missing. Waitlists of several months are ordinary. In rural areas the provider may not exist at all.

There's also a specificity issue people gloss over. For core ADHD symptoms in school-aged children, medication has the strongest evidence and the largest effect size. Behavioral and educational interventions do things medication doesn't: they improve parenting practices, classroom behavior, organizational skills, and family functioning. Those are different outcomes, not lesser ones. The two approaches are complements, not substitutes, and pretending a parent-training course will fix core inattention the way a stimulant does sets families up to fail and then blames them for it.

For depression and anxiety the balance shifts. Psychotherapy is genuinely first-line for milder presentations, combined treatment tends to outperform either alone in moderate to severe cases, and severity, suicidality, chronicity, patient preference, and plain access all move the decision.

Leaving it untreated isn't the neutral option

The framing that worries me most is the one where doing nothing is the safe default and medicating is the risk you take. Both directions carry risk.

In a study I published in the Journal of Adolescent Health in 2021, we looked at 6,483 adolescents in a nationally representative sample. 9.5% met criteria for ADHD, and 69.5% of those had at least one comorbid mental health condition. Compared with peers, adolescents with ADHD were more likely to have attempted suicide (aOR 2.9, 95% CI 1.3 to 6.6), to have perpetrated physical aggression (aOR 2.3, 95% CI 1.7 to 3.2), and to have been expelled from school or fired from a job (aOR 3.3, 95% CI 1.7 to 6.5).

I need to be careful about what that study can and can't support, because it gets misquoted, including on my own site. It did not contain detailed treatment data. It cannot tell you what medication did or didn't do, and it cannot establish that ADHD caused these outcomes or even that the ADHD came first. It describes the burden that travels with the diagnosis. That's all.

For treatment effects you need a different literature, and the useful studies there are the within-person designs, which compare the same individual during medicated and unmedicated periods and so remove the stable differences between people that confound everything else. A Swedish within-patient study found ADHD medication associated with a 41% reduction in criminal convictions in women and 32% in men. US insurance data showed 31% lower risk of substance-related emergency events in women and 35% lower in men. More recent work has found lower rates of self-harm, unintentional injuries, traffic crashes, and criminal arrests during medicated periods.

Keep four claims distinct, because they get collapsed constantly:

  1. ADHD is associated with an adverse outcome.
  2. Untreated ADHD causally increases that outcome.
  3. Medicated periods show lower rates of the outcome.
  4. Medication causally prevents the outcome.

The evidence for 1 and 3 is strong. 2 and 4 are reasonable inferences that observational data support but can't prove. Within-person designs get us closer than anything else available, and randomizing children to years of untreated ADHD to settle it isn't going to happen, nor should it.

Medication is a clinical question, not a moral one

A quiet cost of the overmedication conversation is that it hands people a vocabulary for judging each other. Medication as a parenting failure. Medication as a shortcut. The kid on stimulants as somehow less authentically himself. I hear versions of this in my office every week, usually from a parent who has already decided they're doing something shameful before they've told me a single symptom.

Scrutinizing safety isn't stigma. Scrutiny is the job, and I've spent a good part of my career publishing exactly that kind of scrutiny. But there's a difference between asking whether a specific medication is right for a specific child and treating the whole category as a moral failing.

Some of the confusion is baked into the words. In a 2018 piece in the Journal of the American Academy of Child and Adolescent Psychiatry, my coauthors and I argued for neuroscience-based nomenclature, because the legacy class names actively mislead. Calling a drug an "antipsychotic" implies the child taking it has psychosis. Calling one an "antidepressant" implies depression. Families hear a diagnosis in the drug name, and so, sometimes, do clinicians. Aripiprazole prescribed for irritability in autism is not evidence of psychosis, but the label says otherwise to anyone reading the bottle.

The questions worth asking are clinical. What condition is being treated? What's the impairment? What evidence supports this intervention for this problem? Is the patient actually benefiting? What risks are being monitored? Would something less burdensome work?

The goal is not more medication or less medication. It is better treatment: the right intervention for the right condition, in the right sequence, with clear targets, careful monitoring, and regular reassessment.

What I'd ask at your kid's next appointment

If you take one thing from this, take this list. These are the questions I'd want a parent asking me.

Ask this Why it matters
What diagnosis is this medication treating? The drug should be aimed at a named condition, not a behavior that annoys adults.
What specific symptoms should change if it works? Without a target you can't tell benefit from wishful thinking.
What did we try before this, and did we skip a first-line option? This is the sequencing question. It's where the antipsychotic problem lives.
How will we measure whether it's working, and by when? Ask for a rating scale and a date, not an impression at the next visit.
What side effects are we watching, and how often? For antipsychotics this should include weight, metabolic labs, and a movement exam.
When will we reassess whether this is still needed? Medications get continued by inertia. Put a review on the calendar.
If my child is on more than one, what is each one for? Polypharmacy accumulates one reasonable-seeming decision at a time.

A clinician who welcomes those questions is doing the job properly. Reluctance to answer them is the warning sign. The prescription itself isn't.

Download the research

These are the peer-reviewed papers behind the numbers in this article. All are free to download.

Sultan RS, Correll CU, Schoenbaum M, King M, Walkup JT, Olfson M. National Patterns of Commonly Prescribed Psychotropic Medications to Young People. Journal of Child and Adolescent Psychopharmacology. 2018;28(3):158-165.
The national prescribing rates by age, sex, and prescriber specialty. Source of the 0.8% preschool figure and the prescriber-specialty split. [PDF]

Sultan RS, Wang S, Crystal S, Olfson M. Antipsychotic Treatment Among Youths With Attention-Deficit/Hyperactivity Disorder. JAMA Network Open. 2019;2(7):e197850.
The 187,563-youth cohort. Source of the 2.6%, 47.9%, and 52.7% figures. [PDF]

Sultan RS, Liu SM, Hacker KA, Olfson M. Adolescents With Attention-Deficit/Hyperactivity Disorder: Adverse Behaviors and Comorbidity. Journal of Adolescent Health. 2021;68(2):284-291.
The burden data, with the published erratum included. Source of the aOR figures. [PDF]

Sultan RS, Saunders DC, Veenstra-VanderWeele J. Protective Effects of ADHD Medication on Real-World Outcomes. JAMA Psychiatry. 2025.
The editorial on treatment-effect attenuation as prescribing expanded. [PDF]

Sultan RS, Correll CU, Zohar J, Zalsman G, Veenstra-VanderWeele J. What's in a Name? Moving to Neuroscience-Based Nomenclature in Pediatric Psychopharmacology. Journal of the American Academy of Child and Adolescent Psychiatry. 2018;57(10):719-721.
Why the legacy drug-class names confuse families and reinforce stigma. [PDF]

Additional reading: CDC MMWR: Trends in Stimulant Prescription Fills, 2016-2021 | All of Dr. Sultan's publications | PubMed: Sultan RS

Frequently Asked Questions

Are children in the United States overmedicated with psychiatric drugs?

Not as a general population statement. In national prescribing data covering 6,351,482 young people, 0.8% of children aged 3 to 5 filled a prescription for any stimulant, antidepressant, or antipsychotic over a year, rising to 5.4% at ages 6 to 12 and 7.7% at ages 13 to 18. Antipsychotic use peaked at 1.3% at age 16. Those figures sit at or below most community estimates of the prevalence of the conditions these medicines treat. But aggregate numbers hide real problems, and a specific overprescribing signal does exist for antipsychotics given before any stimulant has been tried. Both things are true, which is why the single question of whether kids are overmedicated is the wrong question.

Has stimulant prescribing to children actually gone up?

Much less than the public conversation suggests. CDC analysis of commercial claims for enrollees aged 5 to 64 found overall stimulant fills rose from 3.6% in 2016 to 4.1% in 2021, with growth concentrated among females aged 15 to 44 and males aged 25 to 44, each up more than 10% during 2020 to 2021. Among children and adolescents overall, use was stable or declining. Because the fastest-growing female band starts at 15, adolescent girls are part of that increase, so it isn't accurate to say nothing changed under 18. But the bulk of the rise is adults.

Why did adult stimulant prescribing rise so quickly?

Telehealth expanded and the in-person visit requirement before a stimulant prescription was relaxed. Recognition of adult ADHD improved, and recognition in women and girls improved substantially, correcting a pattern in which inattentive presentations were missed in childhood. Some portion may reflect prescribing that wouldn't survive careful diagnostic scrutiny. An increase in volume by itself isn't evidence that the prescribing is inappropriate.

Is it a problem if my child with ADHD is prescribed an antipsychotic?

It depends entirely on why. Antipsychotics have real roles in children: irritability in autism, bipolar disorder, psychotic disorders, Tourette disorder, and severe aggression that hasn't responded to first-line treatment. What's hard to justify is starting one for ADHD or ADHD-related behavior before an adequate stimulant trial and before behavioral treatment has been attempted. Ask what target symptom it's treating, what was tried first, what benefit is being measured, and what metabolic and movement monitoring is scheduled.

Are stimulants riskier than antipsychotics for children?

No, and treating all psychiatric medications as one risk category is one of the most consequential errors in this debate. Stimulant adverse effects are mostly dose-related, monitorable, and reversible on stopping. Second-generation antipsychotics carry substantial weight gain, dyslipidemia, insulin resistance and diabetes risk, elevated prolactin, sedation, and movement effects including drug-induced parkinsonism, akathisia, and tardive dyskinesia. Drug-induced parkinsonism usually improves after the drug is reduced or stopped. Tardive dyskinesia can persist.

What should I ask at my child's next psychiatry appointment?

Ask what diagnosis the medication treats and what target symptoms should change. Ask what was tried before and whether a first-line treatment was skipped. Ask how benefit will be measured and by when, ideally with a rating scale. Ask which adverse effects are monitored and how often, including weight, metabolic labs, and movement examination for antipsychotics. Ask when the medication will be formally reassessed. If your child is on more than one psychotropic, ask what each is for and whether any can come off.

Further Reading