Use of Psychotropic Medication in Children and Adolescents With Autism Spectrum Disorders

PEDIATRICS (Impact Factor: 5.47). 11/2012; 130(Supplement):69-76. DOI: 10.1542/peds.2012-0900D


The goal of this study was to examine rates of psychotropic medication use and identify associated child and family characteristics among children and adolescents with autism spectrum disorder (ASD) enrolled in an autism registry maintained by the Autism Treatment Network (ATN).

The sample, derived from the ATN registry, consists of 2853 children aged 2 to 17 years with diagnoses of ASD supported by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the Autism Diagnostic Observation Schedule with available data on medication use. As part of initial enrollment in the registry, parents completed questionnaires on current psychotropic medication use, psychiatric and medical conditions, and demographics.

Of the 2853 children, 763 (27%) were taking ≥ 1 psychotropic medication; 15% were prescribed 1 medication, 7.4% received 2 medications, and 4.5% received ≥ 3. Among children aged 3 to 5 years, 11% were taking ≥ 1 psychotropic medication; among 6- to 11-year-old children, 46%; and 66% of adolescents aged 12 to 17 years were taking at ≥ 1 psychotropic medication. A parent report of comorbid diagnosis of attention-deficit/hyperactivity disorder, bipolar disorder, obsessive-compulsive disorder, depression, or anxiety was associated with a high rate of use, with 80% receiving ≥ 1 psychotropic medication. Only 15% of children with no comorbid psychiatric disorder were taking psychotropic medication. Psychotropic medication use was also related to sleep and gastrointestinal problems.

The prescription of psychotropic medications in this registry sample is highly related to comorbid psychiatric disorder. Other factors associated with use include medical comorbidities, race, ethnicity, and older age.

1 Follower
1 Read
    • "T he use of psychotropic medications as one component of treatment for children with autism spectrum disorder (ASD) has grown rapidly, with surveys indicating that * 50% of individuals with ASD take psychotropic drugs or supplements intended to address impairing behaviors (Aman et al. 2005b; Coury et al. 2012). Whereas much use of psychotropic agents in ASD is off label and guided by limited empirical evidence, two agents have United States Food and Drug Administration (FDA) indications for serious behavior problems in children with autistic disorder. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Risperidone has demonstrated efficacy for acute (8 week) and intermediate length (6 month) management of severe irritability and aggression in children and adolescents with autism. Less is known about the long-term effects of risperidone exposure in this population. We examined the tolerability, safety, and therapeutic benefit of risperidone exposure over a 1-2 year follow-up period. In a naturalistic study, 84 children and adolescents 5-17 years of age (from an original sample of 101) were assessed an average of 21.4 months after initial entry into a placebo-controlled 8 week trial of risperidone for children and adolescents with autism and severe irritability. They were assessed at baseline and at follow-up on safety and tolerability measures (blood, urinalysis, electrocardiogram [ECG], medical history, vital signs, neurological symptoms, other adverse events), developmental measures (adaptive behavior, intelligence quotient [IQ]), and standardized rating instruments. Treatment over the follow-up period, after completion of protocol participation, was uncontrolled. Statistical analyses assessed outcome over time with or without prolonged risperidone therapy. Two-thirds of the 84 subjects continued to receive risperidone (mean 2.47 mg/day, S.D. 1.29 mg). At follow-up, risperidone was associated with more enuresis, more excessive appetite, and more weight gain, but not more adverse neurological effects. No clinically significant events were noted on blood counts, chemistries, urinalysis, ECG, or interim medical history. Regardless of drug condition at follow-up, there was considerable improvement in maladaptive behavior compared with baseline, including core symptoms associated with autism. Height and weight gains were elevated with risperidone. Social skills on Vineland Adaptive Behavior Scale (VABS) improved with risperidone. Parent-rated Aberrant Behavior Checklist (ABC) Irritability subscale scores were reduced in those taking risperidone at follow-up. Several other measures of maladaptive behavior (some related to socialization) also showed improved functioning in association with risperidone on the ABC or on the Modified Real Life Rating Scale. Increased appetite, weight gain, and enuresis are risks associated with long-term risperidone. Our data suggest that these risks were balanced by longer-term behavioral and social benefits for many children over 1.8 years of ongoing treatment.
    Journal of child and adolescent psychopharmacology 08/2015; 25(6):482-93. DOI:10.1089/cap.2015.0005 · 2.93 Impact Factor
  • Source
    • "Previous studies have estimated that between 27% and 60% of children and adolescents received at least one medication for ASD treatment in the United States and Canada [Coury et al., 2012; Frazier et al., 2011; Mandell et al., 2008]. In the United Kingdom, a study using a primary care database reported approximately 29% (1,619/5,651) of young people aged less than 25 years with ASD received psychotropic drugs; and the commonly prescribed drug classes were sleep medications (9.7%), stimulants (7.9%), and antipsychotics (7.3%) [Murray et al., 2014]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is significant variation in prescriptions among countries in clinical practice for the treatment of comorbidities associated with autism spectrum disorder (ASD). It has been suggested that many people with mental health disorders in low-/middle-income countries do not receive adequate treatment. Hence, this study investigated psychopharmacological treatment patterns for ASD comorbidities in 30 countries and the association between country's income and prescription rates.The IMS Prescribing Insights database was used to investigate prescription patterns for ASD comorbidity treatment from 2007 to 2012. Data were obtained from 30 countries in continents of Europe, Asia, Oceania, Central America, South America, and Africa. The gross domestic product (GDP) per capita was used as a proxy for each country's income. Spearman correlation was used to examine the association between prescription rate and GDP per capita.The highest prescription rates were found in Western Europe (3.89–36.36/10,000) while the lowest prescription rates were found in Asian countries, such as Turkey, Indonesia, Saudi Arabia, and Pakistan (0.04–0.82/10,000). The most commonly prescribed drug for ASD comorbidity treatment in most of the countries was risperidone, but antidepressants and antiepileptic drugs were also frequently prescribed. There was a significant positive correlation between GDP per capita and prescription rate (Spearman ρ = 0.60; P = 0.0011; 95% confidence interval 0.27–0.81), that is, the higher the GDP per capita, the higher the prescription rate.There are marked international differences in prescription rates, and this is partially accounted by economic factors. Future research should combine more data for ASD comorbidity treatment to explore the disparity of psychopharmacological treatment between countries. Autism Res 2014, ●●: ●●–●●. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.
    Autism Research 10/2014; 7(5). DOI:10.1002/aur.1391 · 4.33 Impact Factor
  • Source
    • "Medication Coury et al. (2012) "
    [Show abstract] [Hide abstract]
    ABSTRACT: Matson and Nebel-Schwalm (Research in Developmental Disabilities 28(4) 341-352, 2007) conducted an overview of comorbid psychopathology with autism spectrum disorder (ASD) in children. The purpose of the current paper is to expand on Matson and Nebel-Schwalm (Research in Developmental Disabilities 28(4) 341-352, 2007) by discussing the relationship between comorbid psychopathology in ASD and other variables. The current paper will include research across the lifespan, from babies and toddlers to children, adolescents, and adults. Topics explored are the prevalence of comorbid psychological disorders, the importance of studying comorbid psychopathology, as well as the measures used to assess comorbid psychopathology in ASD. Research on the relationships between comorbid psychopathology in ASD and parental and sibling stress and well-being, developmental regression, language and communication, adaptive behavior, social skills, autism severity, challenging behavior, gastrointestinal symptoms, sleep problems, epilepsy, sensory issues, and quality of life is also discussed. Age-related variations in comorbid psychopathology are also examined. Finally, recommendations for treatment are given as well as areas where future research is needed.
    06/2014; 1(2):124-134. DOI:10.1007/s40489-014-0012-y
Show more