Use of Psychotropic Drugs among Children and Adolescents with Autism Spectrum Disorders in Denmark: A Nationwide Drug Utilization Study

Abstract

Children with autism spectrum disorder (ASD) have a considerable use of psychotropics. Leveraging nationwide registry data, we aimed to describe the use of psychotropics among children and adolescents with ASD in Denmark. Use of melatonin and attention-deficit/hyperactivity disorder (ADHD) medication increased from 2010 to 2017, while there were limited changes in use of antidepressants and antipsychotics. Thirty percent of the identified children used psychotropics in 2017 most commonly ADHD medication (17%) and melatonin (13%). Methylphenidate, sertraline and risperidone were most often prescribed. Most children filled more than one prescription and, across drug classes, at least 38% received treatment two years after treatment initiation. Use of psychotropics followed psychiatric comorbidities. Comorbidities did not affect age at treatment initiation. Use of psychotropics varied according to age and sex with limited use in the youngest children. In summary, psychotropic drug use has increased in children with ASD mainly due to an increase in the use of ADHD medication and melatonin. In accordance with previous studies, use seems to follow comorbidities. The long treatment duration underlines the need to investigate long-term effects of psychotropic drug use in children with ASD.

Do autistic patients change healthcare services utilisation through the transition age? An Italian longitudinal retrospective study

“…Even if the current evidence for the effectiveness of antipsychotic drugs in ASD is only moderate,6 neuroleptic drugs were frequently used in this cohort of ASD patients and their consumption remained stable across ages; moreover, our findings were similar to frequencies reported in other studies 39. ADHD drugs were less prescribed (less than 0.6%) with respect to other reported prescription rates in ASD patients (about 15%) even considering the patients’ age47; this may reflect a generally low consumption in Italy of such drugs in childhood 48…”

New Users of Antipsychotics Among Children and Adolescents in 2008–2017: A Nationwide Register Study

“…The prescribing of psychotropic drugs in children and adolescents has increased in many countries during the last decade (1)(2)(3)(4). This change is mainly due to the growing use of stimulants (2), but the use of antipsychotic drugs is also on the rise (2,3,(5)(6)(7).…”

Methylphenidate in Autism Spectrum Disorder: A Long-Term Follow Up Naturalistic Study

“…To date, no medications have been approved for the clinical use specifically for ASD, but, in clinical settings, psychotropic drugs were largely prescribed for comorbid symptoms. Stimulants were among the most prescribed medications: a large study of 2800 children recruited from the Autism Treatment network in North America displayed that stimulants were often prescribed in ASD (13%), followed by SSRIs (8%) and SGA (8%) [ 30 ]; data from a study in the United Kingdom, using a representative primary care database, revealed that psychotropic drugs are prescribed to about a third of children and adolescents with ASD and found sleep medications (9.7%), stimulants (7.9%) and antipsychotics (7.3%) to be the most commonly prescribed categories of drugs for ASD [ 32 ]; a recent study, based on the Danish national database registry, described psychotropic drugs prescription trends from 2010 to 2017 in 23,935 ASD children and adolescents, born between 1992 and 2011, confirming that 30% of the sample used psychotropics, most commonly ADHD medications (17%) and melatonin (13%), followed by antipsychotics (5%) and antidepressants (5%) [ 29 ].…”

“…Epidemiological studies suggested that at least 50% of subjects with ASD receives psychotropic medication during their whole lifespan, and, in pediatric population, the range varies from about 10% to 30% [ 29 , 30 , 31 , 32 ].…”

“…Indeed, no psychotropic medications have been currently approved by any regulatory agencies for the treatment of ASD core symptom, even if thousands of clinical trials are ongoing [ 33 , 34 ]. For the treatment of associated symptoms, a psychopharmacological approach (antipsychotics, serotonergic agents, stimulants, melatonin) may be beneficial, but data on this topic are not conclusive [ 10 , 29 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Among second generation antipsychotics (SGA), risperidone and aripiprazole are approved by the Food and Drug Administration for the treatment of irritability associated with ASD, and risperidone has been approved for the same purpose by the European medicines agency.…”