2025 HEDIS Measures in Pediatric Behavioral Health

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM):

• HEDIS Measure: The percentage of children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing. (Martin’s Point monitors blood glucose and cholesterol testing.)

We continue to track this important measure through 2025 because of the profound importance of preventing metabolic complications in young patients. One 2024 monitoring insight is that providers may overlook the need to monitor for both first-generation antipsychotics (FGA) and second-generation antipsychotics (SGA). This measure applies to the treatment of tic disorders with medications like haloperidol, pimozide, or fluphenazine; and for treatment of disruptive behavior disorders or mood problems with aripiprazole, risperidone, lurasidone, or other SGAs.

Follow-Up Care for Children Prescribed ADHD Medication (ADD):

• HEDIS Measure: The percentage of children newly prescribed ADHD medication who had at least three follow-up care visits within a 300-day (10-month) period, one of which was within 30 days of when the first ADHD medication was dispensed.

We continue to track this measure in 2025 to help detect the many comorbid conditions surrounding this diagnostic category. ADHD represents a heterogeneous group of associated problems sharing common symptoms. Therefore, children who initially present with similar behavioral profiles may exhibit widely divergent longitudinal courses. Regular follow-up is essential to detect and treat comorbid psychiatric disorders, enabling improved outcomes.

Depression and anxiety disorders in children under age 13 often present differently than in teens and adults. There can be substantial overlap with ADHD and disruptive mood dysregulation disorder. In these cases, adding psychotherapy or treatment with SSRI medications can greatly improve learning and behavior in the school setting. Over time, this can have a profound impact on a child’s development.

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP):

• HEDIS Measure: The percentage of children and adolescents 1–17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment.

Although antipsychotic medications may effectively treat a narrowly defined set of psychiatric disorders in children, they are often prescribed for nonpsychotic conditions such as ADHD and disruptive behaviors, conditions for which safer psychosocial interventions are considered first-line treatment.

When addressing behavioral health concerns in children and teens, best practice is always to initiate psychosocial interventions prior to starting antipsychotic medication treatment. In extreme cases, these interventions may need to be initiated simultaneously, usually in the acute care setting.

Disruptive behavior often indicates that a child is suffering from adverse circumstances in their life. Interventions that can address these circumstances will lead to behavioral improvement. On the other hand, sedative treatment often pathologizes the child for the distressing circumstances they may be reacting to, which can serve to perpetuate the adverse situation.