NJPC Family Survey: Increased Use of Psychiatric Medications to Treat Children

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In what county in New Jersey do you currently reside?

What is the biological sex of the child?

What is your relationship to the child?

Biological Parent

Foster/Resource Parent

Adoptive Parent

Kinship Provider

Family Member

Other:

Clear selection

What is the age of the child?

What is the race/ethnicity of the child?

Please select all that apply

African-American

Asian

Caucasian

Hispanic, Latino, or Spanish Origin

Native American

Native Hawaiian or Other Pacific Islander

Other:

What type of medical insurance does the child have?

Please indicate the child's mental health diagnosis:

Please select all that apply

Intellectual Disabilities

Learning Disorder

Communication Disorder

Autism Spectrum Disorder

Schizophrenia

Schizoaffective Disorder

Bipolar I Disorder

Bipolar II Disorder

Cyclothymic Disorder

Disruptive Mood

Dysthymia/Persistent Depressive Disorder

Separation Anxiety Disorder

Generalized Anxiety DIsorder

Social Anxiety Disorder

Obssessive Compulsive Disorder

Reactive Attachment Disorder

Disinhibited Social Engagement Disorder

Oppositional Defiant Disorder (ODD)

Intermittent Explosive Disorder

Conduct Disorder

Attention-deficit/Hyperactivity Disorder(ADD/ADHD)

Substance Use Disorder

Dysregulation Disorder

Major Depressive Disorder/Other Depression

Post-Traumatic Stress Disorder (PTSD)

Acute Stress Disorder

Adjustment Disorder

Unknown Diagnosis

Undiagnosed

No disability

Other:

Please indicate which medication(s) your child is currently taking:

Please select all that apply

Alprazolam (Xanax)

Amitriptyline (Elavil)

Aripiprazole (Abilify)

Asenapine (Saphris)

Atomoxetine (Strattera)

Bupropion (Wellbutrin)

Buspirone (BuSpar)

Carbamazepine (Tegretol)

Chlorpromazine (Thorazine)

Clomipramine (Anafranil)

Clonazepam (Klonopin)

Clonidine (Kapvay, Catapres)

Clozapine (Clozaril)

Desvenlafaxine (Pristiq)

Dextroamphetamine (Dexedrine, Adderal, Vyanse, Procentra)

Diazepam (Valium)

Diphenhydramine (Benadryl)

Duloxetine (Cymbalta)

Escitalopram (Lexapro)

Eszopiclone (Lunesta)

Fluoxetine (Prozac)

Fluphenazine (Prolixin)

Fluvoxamine (Luvox)

Guanfacine (Tenex, Intuniv)

Haloperidol (Haldol)

Iloperidone (Fanapt)

Imipramine (Tofranil)

Lamotrigine (Lamictil)

Lithium (Lithium carbonate, Eskalith)

Lorazepam (Ativan)

Lurasidon (Latuda)

Methylphenidate (Ritalin, Metadate, Concerta, Daytrana, Focalin)

Mirtazapine (Remeron)

Nefazodone (Serzone)

Nortriptyline (Pamelor)

Olanzapine (Zyprexa)

Oxcarbazepine (Trileptal)

Paliperidon (Invega)

Paroxetine (Paxil)

Phenelzine (Nardil)

Quetiapine (Seroquel)

Risperidone (Risperdal)

Sertraline (Zoloft)

Thioridazine (Mellaril)

Thiothixene (Navane)

Tranylcypromine (Parnate)

Trazodone (Desyrel)

Trifluoperazine (Stelazine)

Valproic Acid (Depakote, Depakene)

Venlafaxine (Effexor, Pristiq)

Zaleplon (Sonata)

Ziprasidone (Geodon)

Zolpidem (Ambien)

No Medication

Other:

Who initially prescribed the child's medication?

Neurologist

Psychiatrist

Pediatrician

Psychologist

Psychiatric Nurse

Primary Care Physician

Unknown

Not Applicable

Other:

Clear selection

Who currently provides refill prescriptions for the child's medication?

Neurologist

Psychiatrist

Pediatrician

Psychologist

Psychiatric Nurse

Therapist

Social Worker

Counselor

Case Manager

Unknown

Not Applicable

Other:

Clear selection

The child currently is involved in and/or receives services from the following systems:

Please check all that apply

Mental Health

Perform Care

Unified Care Management Organization (UCM)

Care Management Organization (CMO)

Youth Case Management (YCM)

Mobile Response & Stabilization Services (MRSS)

Family Support Organization (FSO)

Private Mental Health Provider

Child Welfare DCP&P (DYFS)

Juvenile Justice

Family Success Center

Social Services / Welfare / TANF

Special Education

Division of Developmental Disabilities

Unknown

Not Applicable

Other:

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