Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Psychotropic use is common and increasing in children with mental disorders but little is known about the long-term patterns of psychotropic use and polypharmacy among commercially insured children with autism spectrum disorders. WHAT THIS STUDY ADDS:Among 33 565 children with autism spectrum disorders, 64% used psychotropic medications and 35% had evidence of polypharmacy. Older children and those who had seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy.abstract OBJECTIVE: The objectives of this study were to examine rates and predictors of psychotropic use and multiclass polypharmacy among commercially insured children with autism spectrum disorders (ASD).METHODS: This retrospective observational study used administrative medical and pharmacy claims data linked with health plan enrollment and sociodemographic information from 2001 to 2009. Children with ASD were identified by using a validated ASD case algorithm. Psychotropic polypharmacy was defined as concurrent medication fills across $2 classes for at least 30 days. Multinomial logistic regression was used to model 5 categories of psychotropic use and multiclass polypharmacy. RESULTS:Among 33 565 children with ASD, 64% had a filled prescription for at least 1 psychotropic medication, 35% had evidence of psychotropic polypharmacy ($2 classes), and 15% used medications from $3 classes concurrently. Among children with polypharmacy, the median length of polypharmacy was 346 days. Older children, those who had a psychiatrist visit, and those with evidence of cooccurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy.CONCLUSIONS: Despite minimal evidence of the effectiveness or appropriateness of multidrug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its cooccurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD. Pediatrics 2013;132:833-840

Child, Parent, and Service Predictors of Psychotropic Polypharmacy Among Adolescents and Young Adults with an Autism Spectrum Disorder

“…In the first study, no association was observed between polypharmacy and poverty level, parent education or marital status (Memari et al, 2013). In the second study, household income, overall, was also mostly unrelated to polypharmacy (Spencer et al, 2013), but, no studies have considered the impact of other parent factors on psychotropic polypharmacy.…”

“…Only four studies of children with ASD (Coury et al 2012, Logan et al 2012, Memari et al 2012, Spencer et al 2013) have examined factors associated with psychotropic polypharmacy, which have primarily focused on child demographic and clinical characteristics. Results of a large US study of 2,853 children and adolescents with ASD identified that greater age, Caucasian race, and nonHispanic/Latino ethnicity were associated with the use of multiple psychotropic medications (Coury et al 2012), along with gastrointestinal and sleep problems.…”

“…Results of a large US study of 2,853 children and adolescents with ASD identified that greater age, Caucasian race, and nonHispanic/Latino ethnicity were associated with the use of multiple psychotropic medications (Coury et al 2012), along with gastrointestinal and sleep problems. In another large US study of 33, 565 children with ASD, older children, those who had a psychiatric visit, those with co-occurring conditions, Hispanic children and those living in southern regions, had higher odds of polypharmacy (Spencer et al 2013). Although age is positively related to psychotropic polypharmacy in youth with ASD (Coury et al 2012, Logan et al 2012, Memari et al 2012, Spencer et al 2013, only two studies have examined factors associated with psychotropic polypharmacy specifically among adolescents and adults with ASD.…”

“…In another large US study of 33, 565 children with ASD, older children, those who had a psychiatric visit, those with co-occurring conditions, Hispanic children and those living in southern regions, had higher odds of polypharmacy (Spencer et al 2013). Although age is positively related to psychotropic polypharmacy in youth with ASD (Coury et al 2012, Logan et al 2012, Memari et al 2012, Spencer et al 2013, only two studies have examined factors associated with psychotropic polypharmacy specifically among adolescents and adults with ASD. Findings from these studies suggest that greater age (Esbensen et al 2009) and aggressive behaviour (Lake et al 2012) predict the use of multiple psychotropic medications.…”

“…Most of the literature to date has examined the relationship between psychotropic polypharmacy and child variables such as demographic and clinical symptoms, with less emphasis on other important potential drivers like service and parent variables. Further, most studies tend to focus on children (e.g., Coury et al 2012;Spencer et al 2013) even though psychotropic polypharmacy is more common in older youth and adults. There is a critical need to study older youth and young adults because of difficulties encountered in the transition from adolescence to adulthood when changes to residence, education, and employment may occur.…”