Mental Health Issues in Children and Youth with Autism Spectrum Disorder: Medication Use, Side Effects, and Monitoring

Background: Mental health issues are common in children and youth with autism spectrum disorder (ASD), and can cause significant interference in daily functioning. Approximately 70% of children and adolescents with ASD experience mental health symptoms, and 40% to 50% of these individuals meet diagnostic criteria for 2 or more mental health conditions. Psychopharmacological interventions are often used to manage or treat these mental health issues in children and youth with ASD, with as many as 39% taking a psychotropic medication (e.g., antipsychotic, antidepressant, etc.). There is also a small number of children and youth with ASD, that are taking more than three medications at the same time (polypharmacy). Despite the high prevalence of medication use and polypharmacy in this population, little is known about the potential side effects of a) using certain medications to treat mental health issues in this population; and b) using multiple medications concurrently. Similarly, it is unknown the degree to which these medications are monitored or managed by primary care physicians, essential information to minimize and prevent side effects and negative outcomes.

Objectives: The goal of the present study is to examine the: 1) prevalence of mental health issues in children and adolescents with ASD; 2) rates of medication use to manage these issues (class of medication prescribed, rates of polypharmacy, and associated side effects), and 3) service utilization patterns among children and youth with ASD and medical monitoring completed by their primary care physicians.

Methods: The cross-sectional study will involve secondary data analysis from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database. CPCSSN is a multi-disease electronic medical record surveillance system that includes information from electronic medical resources of participating primary care providers across Canada. To be included in the study cohort, individuals must: 1) have had an encounter with a CPCSSN sentinel between January 1^st, 2012 and December 31, 2014; 2) had two or more physician visits with an ICD-9 diagnostic code of ASD; and 3) be 18 years of age or younger.

Using descriptive statistics, we will identify the prevalence of mental health issues in this cohort. Next, we will determine the number of individuals with ASD prescribed medication to manage/treat co-occurring mental or physical health issues, as well as the class of drugs prescribed, rates of polypharmacy, and side effects of medication use. To further understand medical monitoring of medications, we will examine the service utilization patterns of those individuals with ASD prescribed medications.

Results: Data is already collected and analysis will begin in December 2017.

Conclusions: Mental health issues are highly prevalent in children and youth with ASD, and psychopharmacology is frequently utilized to manage and treat these issues. Although psychopharmacological intervention is quite common in this population, it is unknown the degree to which medication use is monitored by their primary health care provider. Implications for the prevention of adverse effects in the context of evidence-based clinical practice for children and youth with ASD and comorbid mental health issues will also be discussed.