Factors Associated with Psychotropic Medication Use In Autism Spectrum Disorders (ASD)

Background:  

 Individuals with autism spectrum disorders (ASD) often have challenging behaviors and symptoms which are treated with psychotropic medications.  Patterns of use of these medications have suggested that young children with ASD are placed on medications at early ages and often engage in polypharmacy when there is a co-morbid psychiatric disorder.

Objectives:

We examined the use of psychotropic medications in a large population of individuals with ASD to determine factors associated with their use.

Methods:  

The study population consisted of children and adolescents ages 2 – 18 years entered in the Autism Treatment Network (ATN) Registry.  The ATN collects data on children with ASD at fourteen sites across the US and Canada.  Children with a diagnosis of ASD (autism, Asperger disorder, or PDD-NOS), as determined by comprehensive multidisciplinary evaluation, including ADOS, were included in this analysis.  Psychotropic medication use was established by both parent and clinician report at entry into the registry.

Results:  

Medication information was available for 2,053 children.  Of these, 582 (28%) were on at least one psychotropic medication. Commonly prescribed drugs included stimulants, serotonin reuptake inhibitors, and second generation antipsychotics. Twenty percent (20%) of the children without a previous diagnosis of ASD were on psychotropic medications versus 36% with a prior diagnosis of ASD (p-value < 0.001).  Children receiving Medicaid had a higher, yet not statistically significant, rate of being on psychotropic medications compared to children on other public types of insurance or private insurance (private insurance – 28%; public insurance – 28%; Medicaid – 32%; p-value = 0.09). A higher percentage of older children are exposed to these medications (42% no previous diagnosis and 57% previous diagnosis).  Very few children under the age of 3 were taking psychotropic drugs (2%).  Of the 347 children with medication data and a comorbid diagnosis of ADHD,  bipolar disorder, obsessive compulsive disorder, depression or anxiety w, 230 (66%) are on at least one psychotropic medication. The percentages of children on psychotropic medications by diagnosis are as follows: ADHD - 65%; OCD - 46%; Anxiety - 49%: Bipolar - 33%; Depression - 41%.  If a child did not have a comorbid diagnosis (N=1,327) their chance of being on a psychotropic medication was 16%.  If a child had only one psychiatric comorbidity, then their probability of being on a psychotropic medication was 75%.  This increases as the number of comorbidities increases ( p= 0.014, Cochran-Armitage Trend test). Children with 2 – 4 comorbidities have an almost 90% chance of being on a psychotropic medication.

Conclusions:  

:  Overall use of psychotropic medication in this ASD population is lower than prior descriptions from other datasets.  Psychotropic medication use is frequently initiated prior to a formal diagnosis of ASD.  Comorbid psychiatric conditions greatly increase the likelihood of use of psychotropic medications, suggesting that such individuals present with much more challenging behaviors.

Support from ATN-CRT-07-02 (Autism Speaks) and UA3MC11054 (MCHB).