Pharmacological treatments prescribed to people with autism spectrum disorder (ASD) in primary health care

Abstract

RationaleAutism spectrum disorders (ASDs) affect 1 % of children, having significant impact on health and social outcomes. Psychotropic medication use by individuals with ASD in the USA increased over time, and polypharmacy occurred in >50 % of those prescribed. In the UK, no psychotropic drugs are approved in ASDs, and little is known about patterns of pharmacological treatment in the ASD population and associated co-morbidities.MethodsWe used The Health Improvement Network, a nationally representative primary care database, to assess the prevalence of ASD diagnoses, psychotropic drug prescribing and neuropsychiatric co-morbidities of 0–24 year olds between 1992 and 2008.ResultsASD prevalence increased 65-fold from 0.01 % (1992) to 0.50 % (2008). Psychotropic drugs were prescribed to 29 % (1,619/5,651) of the ASD cohort; the most prescribed drugs were sleep medication (9.7 % of prescribed patients), psychostimulants (7.9 %) and antipsychotics (7.3 %). More patients were given psychostimulants and sleep medications over time from 1.5–6.3 % and 2.2–5.9 % respectively. Thirty-seven per cent of the cohort had ≥1 record of a neuropsychiatric co-morbidity, the most common being developmental difficulties and learning disabilities (12.6 %), behavioural, conduct and personality disorders (11.1 %) and attention deficit hyperactivity disorder (7.5 %).ConclusionsBritish physicians are more conservative in prescribing practice than American colleagues. However, use of psychostimulants and antipsychotics is much higher in those with ASD than in the general population. Polypharmacy was seen in 34 % of prescribed patients in 2008. Additional studies examining use, efficacy, and long-term safety of antipsychotics and psychostimulants in autistic individuals are warranted.

The rare DAT coding variant Val559 perturbs DA neuron function, changes behavior, and alters in vivo responses to psychostimulants

“…The transmitting grandmother was found in standardized assessments of adult ADHD traits to be above the 95th percentile for impulsivity traits. Recently, Bowton et al described the transmission of the DAT Val559 variant to two, unrelated male subjects with ASD (49) that was not seen in matched unaffected subjects, extending the possible disease associations to a third disorder with evidence of DA signaling perturbations (50)(51)(52)(53)(54)(55)(56)(57).…”

Complementary and alternative medicine use in children with autistic spectrum disorder in Mauritius

“…Likewise, it has been suggested that decreased efficacy and more adverse effects are experienced from psychiatric medications, such as behavioral toxicity with tricyclic antidepressants and social; withdrawal and irritability with methylphenidate, by individuals with ASD [9].…”

Authors’ response to Bachmann and Hoffman’s comments on psychopharmacological prescriptions for people with autism spectrum disorder (ASD): a multinational study

“…(5) Regarding the grouping of substances, the authors refer to Murray et al (2014). However, this publication does not report any data on grouping of substances by ATC codes…”

“…We are aware of this limitation; hence, we have specified in the limitation section: BFirstly, as IMS MIDAS is not a patient-based medical record database, we were unable to report the number of patients with ASD who visited physicians in this study.^ We agree that patient-based databases provide more information. Indeed, we used THIN database (electronic patient record database) to evaluate prescribing in patients with ASD in the UK (Murray et al 2014). Unfortunately, as pointed out in Bachmann and Hoffmann's letter, these types of data are rarely available from many other countries.…”