Trends in Psychotropic Medication Use for Canadian Children and Youth with ASD from 2012 to 2016: A Pharmacoepidemiologic Study

Background: The majority of children and youth with autism spectrum disorder (ASD) experience a co-occurring mental health issue, such as anxiety or depression. Pharmacological interventions are commonly used to manage and treat these psychiatric issues, as well as aggression or self-injurious behaviours that are common in individuals with ASD. While psychotropic medications are used quite extensively, these drugs often have variable treatment response, and the US Food and Drug Administration (FDA) has only approved two drugs, risperidone and aripiprazole, for use in individuals with ASD. Although it is well established that children and youth with ASD are a highly medicated group in various countries, no study has examined recommendations for psychotropic medication in Canadian children and youth with ASD exclusively, nor described how these patterns may be changing over time.

Objectives: The objective of this study is to describe the frequency and psychotropic prescription trends for behavioural challenges and mental health issues in children and youth with ASD in Canada from 2012 to 2016.

Methods: The present study used data from IQVIA’s Canadian Disease and Therapeutic Index (CDTI), which is survey-based dataset that collects treatment data from a representative sample of office-based physicians related to drug recommendation, indication and patient demographics. Quarterly, during a 48-hour period, participating Canadian physicians complete an anonymized record of all patient visits including patient age, gender, drug recommendation (prescribed medication), and reason for recommendation. Statistical weighting adjustments are made to the sample-based estimates to extrapolate drug recommendations to national totals.

Results: The analysis will focus on drug recommendations for antidepressants and ADHD medications for children and adolescent (under 18 years of age) with ASD from 2012 to 2016, and for antipsychotics from 2010 to 2016. Data has been collected and the analysis will be completed in Winter 2019. Preliminary data analysis showed that within the three medication classes, antipsychotics were the most commonly prescribed psychotropic medications in children with ASD. Risperidone was the most commonly recommended medication, followed by aripiprazole. Between 2010 and 2016, drug recommendations for antipsychotics grew steadily, from 35,010 recommendations in 2010, to 90,288 recommendations in 2016. The use of antidepressant medications remained fairly steady between 2012 and 2016, with a total of 26,053 drug recommendations in 2016; sertraline was the most commonly recommended antidepressant. ADHD medication use also remained steady between 2012 and 2016, with a total of 52,929 drug recommendations in 2016. Clonidine and methylphenidate were the most commonly recommended medications in this class.

Conclusions: Psychotropic medication is used extensively with children and youth with ASD. This is the first study to show an increase in antipsychotic use in Canadian children and youth with ASD. Findings will help to inform prescription guidelines for psychotropic medications, and highlight the importance of medication monitoring.