Polypharmacy and Medication Monitoring Among Children and Youth with ASD

Background: Pharmacotherapy is commonly used to treat individuals with autism spectrum disorder (ASD). Polypharmacy however—the use of two or more medications simultaneously (psychotropic or non-psychotropic)—remains a relatively underexplored area, and yet as many as 87% of children with ASD may be prescribed polypharmacy intervention (Wink et al. 2017). Despite this high prevalence, it is unknown if and how health practitioners are monitoring the use and associated side effects of multiple medications.

Objectives: A systematic literature review was conducted to establish polypharmacy trends among children and youth with ASD, identify specific factors associated with multiple medication use, and to determine if and how medication use, and commonly experienced side effects are monitored over time.

Methods: Five different electronic databases: PsycINFO, Medline, CINAHL, Embase, and Cochrane were used. A total of 16 studies encompassing over 300,000 children and youth with ASD were included after being evaluated for scientific strength using the Joanna Briggs Institute Prevalence Critical Appraisal Checklist (Joanna Briggs Institute, 2014).

Results: Overall, the majority of participants were male, 25 years of age or younger, and rates of polypharmacy varied from 9% to 87%. While rates of polypharmacy use were similar between males and females, medication type differed by sex. Whereas males were prescribed stimulants more often, females were regularly prescribed antidepressants or mood stabilizers. Factors commonly associated with higher rates of polypharmacy included psychiatric co-morbidities, self-injurious behavior, physical aggression, and age.

Conclusions: This systematic review highlights the considerable number of children and youths with ASD taking multiple psychotropic and non-psychotropic medications, and yet only one study addressed medication monitoring and the possible long-term effects of polypharmacy. Findings emphasize the importance of medication monitoring among children and youth with ASD receiving polypharmacy.