Twenty-two percent of U.S. doctors prescribing initial treatment for children with new diagnoses of anxiety or depression during a recent six-year period chose medications that are not federally approved for use in children or were inconsistent with guidelines issued by professional associations, a Yale study found. This off-label prescribing pattern, termed “red-flag prescribing,” exposed patients to greater risk of poor outcomes. When doctors deviate from guidelines in initial treatments, adolescent patients have higher probability of self-harm, are more likely to visit the emergency room, and have higher cumulative medical costs after two years compared with patients initially treated more appropriately.
The study analyzed health insurance claims from a large national insurer covering 2012 to 2018 for more than 45,000 children aged 10 to 17 nationwide treated for anxiety, depression, or adjustment disorders. Researchers divided treatments into three groups: FDA-approved drugs for children (22% of clinicians), off-label drugs consistent with professional guidelines (55% of clinicians), and “red-flag” prescribing neither FDA-approved nor guideline-consistent (22% of clinicians).
Outcome Differences
More than 33% of children prescribed red-flag drugs had to visit a medical facility over the following two years, compared to about 27% prescribed FDA-approved drugs and about 19% whose doctors followed professional guidelines. Probability of self-harm was 5.7% for children who received red-flag treatments, 4.9% in the group treated with off-label medications recommended in professional guidelines, and 3.8% in the group treated with FDA-approved drugs. Average medical costs over two years were $1,745 for patients whose doctors prescribed off-label using professional guidelines, much lower than either $9,557 for red-flag drugs or $9,656 for FDA-approved drugs.
The study showed that a large majority of doctors follow professional guidelines or prescribe FDA-approved treatments. However, the sizeable minority engaging in red-flag prescribing raises concerns. Parents might familiarize themselves with guidelines or request a second opinion if unsure about prescribed treatments for their child.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://news.yale.edu/2026/02/04/guideline-based-treatment-linked-better-outcomes-kids-anxiety-and-depression