17708
Patterns of Psychotropic Medication Use Among Children Referred for Autism Spectrum Disorder Evaluation
Background: About 30-60% of individuals with Autism Spectrum Disorder (ASD) take psychotropic medications, and there is also evidence that many children are prescribed these medications even before they receive an ASD diagnosis (Aman et al., 2005 and Mandell et al., 2008). National trends in psychotropic polypharmacy among children increased from 22% (1996-1999) to 32% (2004-2007) (Comer et al., 2010). Little is known about the specific types of medications individuals with ASD are getting before ASD diagnosis. Objectives: To determine prevalence and type of psychotropic medication use in a tertiary care clinic sample of children referred for Autism Spectrum Disorder (ASD) diagnostic evaluation. Methods: Retrospective cohort study of 585 children (mean age 5 years, range 1.4 - 17.5 years) who received ASD diagnostic evaluation and intellectual evaluation at an interdisciplinary clinic between 2006 and 2009. Records regarding psychotropic medication use prior to formal ASD diagnostic evaluation and insurance status were reviewed for each participant. Results: Of the 585 participants, 54% met criteria for ASD (52% with autism, 39% with PDD-NOS, and 9% with Asperger syndrome) based on evaluations utilizing the ADOS, ADI-R, and clinical opinion. The leading diagnoses in non-spectrum group (NS) (46%) were communication disorder (30%), developmental disorder or intellectual disability (22%), and multiple developmental and/or behavioral diagnoses (34%). Eighty three percent of the sample was male and 68% was white non-Hispanic. Mean FSIQ for participants was 80.8 (range 31-126). Within our sample, 23.4% were taking psychotropic medications (18.5% in ASD group and 29% in NS group) prior to diagnostic evaluation and of these, 12% had already tried more than one class of psychotropic medications (10% in ASD group and 15% in NS group) before the formal ASD evaluation; 17% tried stimulants (13.4% in ASD group and 20% in NS group) and 10% of participants had tried atypical antipsychotics (9% in ASD group and 10% in NS group). In the current study, 51% of participants were covered by Medicaid and 40% were covered by private insurance. Conclusions: Psychotropic medication use is common among young children with and without ASD prior to establishing ASD or NS diagnoses. The rate of atypical antipsychotic use in our sample was comparable between ASD and NS groups. The psychotropic medication use before ASD diagnostic evaluation was more common in NS group, which may be due to their complex non-ASD symptom presentation. Psychotropic medication use is very common in children with ASD and children with other developmental disabilities despite lacking evidence base. Establishing child’s diagnostic status should guide subsequent treatment. Despite the pressure to treat children with ASD and other developmental disabilities with psychotropic medications, risks and benefits need to be carefully considered. |
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