Article

A Longitudinal Investigation of Psychotropic and Non-Psychotropic Medication Use Among Adolescents and Adults with Autism Spectrum Disorders

Waisman Center, University of Wisconsin-Madison, rm 561, Madison, WI 53705, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.06). 06/2009; 39(9):1339-49. DOI: 10.1007/s10803-009-0750-3
Source: PubMed

ABSTRACT

Medication use was examined in 286 adolescents and adults with ASD over a 4.5 year period. A total of 70% were taking a psychotropic or non-psychotropic medication at the beginning of the study. Both the number of psychotropic and non-psychotropic medications taken, and the proportion of individuals taking these medications, increased significantly over the study period, with 81% taking at least one medication 4.5 years later. Our findings suggested a high likelihood of staying medicated over time. Thus, adolescents and adults with ASD are a highly and increasingly medicated population.

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    • "Although behavioural and psychosocial interventions are currently the mainstay of treatment and there is no evidence for the effectiveness of any particular drug on the core symptoms of ASD, pharmacotherapy is frequently employed alone or in association with other interventions, to address associated psychiatric disorders (PDs), problem behaviours (PBs) or the effect of other biological and environmental factors. It is reported that around 45 per cent of persons with ASD receive medication (Langworthy-Lam et al., 2002;Esbensen et al., 2009), with an increasing rate by age (Logan et al., 2012). Polypharmacy is also frequent (Murray et al., 2014). "
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    ABSTRACT: Purpose – The management of individuals with autism spectrum disorders (ASDs) requires a multimodal approach of behavioural, educational and pharmacological treatments. At present, there are no available drugs to treat the core symptoms of ASDs and therefore a wide range of psychotropic medications are used in the management of problems behaviours, co-occurring psychiatric disorders and other associated features. The purpose of this paper is to map the literature on pharmacological treatment in persons with ASD in order to identify those most commonly used, choice criteria, and safety. Design/methodology/approach – A systematic mapping of the recent literature was undertaken on the basis of the following questions: What are the most frequently used psychoactive compounds in ASD? What are the criteria guiding the choice of a specific compound? How effective and safe is every psychoactive drug used in ASD? The literature search was conducted through search engines available on Medline, Medmatrix, NHS Evidence, Web of Science and the Cochrane Library. Findings – Many psychotropic medications have been studied in ASDs, but few have strong evidence to support their use. Most commonly prescribed medications, in order of frequency, are antipsychotics, antidepressants, anticonvulsants and stimulants, many of them without definitive studies guiding their usage. Recent animal studies can be useful models for understanding the common pathogenic pathways leading to ASDs, and have the potential to offer new biologically focused treatment options. Originality/value – This is a practice review paper applying recent evidence from the literature.
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    • "The DiBAS-R can be applied to screen for ASD in adult ID samples, in psychiatric or somatic services for adults with ID, in out-and inpatient clinics treating Individuals with ID and others, or to guide referrals to services that specialize in ASD assessment. ASD is a frequent but highly underdiagnosed comorbidity in individuals with ID and leads to high rates of challenging behaviors, additional mental disorders, psychiatric service use, and psychopharmacological treatment (Bhaumik, Tyrer, McGrother, & Ganghadaran, 2008; Esbensen et al., 2009; Matson & Shoemaker, 2009; McCarthy et al., 2010). Identification of the underlying disorder, namely ASD, is necessary to allow for more tailored treatment options, improve mental health, and living up one's personal and professional potentials (Matson & Shoemaker, 2009). "
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    ABSTRACT: Given the strong association between intellectual disability (ID) and autism spectrum disorder (ASD), standardized instruments for the assessment of ASD in adults with ID are desirable. The Diagnostic Behavioral Assessment for ASD – Revised (DiBAS-R) is a DSM-5/ICD-10 based caregiver-report screening tool that consists of 19 Likert-scaled items. This study evaluated the item-validities, item-difficulties, item-variances, part-whole corrected item total-correlations, reliability, and the factorial, diagnostic, and convergent/discriminant validities of the DiBAS-R in a clinical, adult ID sample (N = 219). Factor analysis yielded two consistent dimensions; i.e., social interaction/communication and stereotypy/rigidity/sensory abnormalities. The diagnostic validity was adequate, as reflected by an area under the curve of 0.89 and balanced sensitivity and specificity values of 81%. The DiBAS-R total scores were significantly correlated with the Social Communication Questionnaire (r = 0.52), the Scale for Pervasive Developmental Disorders in Mentally Retarded Persons (r = 0.50), and the Autism-Checklist (r = 0.59), while no significant correlation with the Modified Overt Aggression Scale was observed. The interrater reliability was excellent (ICC = 0.88). These findings indicate that the DiBAS-R is a promising and psychometrically sound instrument for ASD screening of adults with ID.
    No preview · Article · Apr 2014 · Research in Autism Spectrum Disorders
    • "The DiBAS-R can be applied to screen for ASD in adult ID samples, in psychiatric or somatic services for adults with ID, in out-and inpatient clinics treating Individuals with ID and others, or to guide referrals to services that specialize in ASD assessment. ASD is a frequent but highly underdiagnosed comorbidity in individuals with ID and leads to high rates of challenging behaviors, additional mental disorders, psychiatric service use, and psychopharmacological treatment (Bhaumik, Tyrer, McGrother, & Ganghadaran, 2008; Esbensen et al., 2009; Matson & Shoemaker, 2009; McCarthy et al., 2010). Identification of the underlying disorder, namely ASD, is necessary to allow for more tailored treatment options, improve mental health, and living up one's personal and professional potentials (Matson & Shoemaker, 2009). "
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    ABSTRACT: Background: One in four individuals with intellectual disability (ID) are additionally diagnosed with autism spectrum disorders (ASD) that may not be recognized und thus remain untreated until adulthood. Diagnosing ASD in adults with ID is challenging and there is a lack of specific diagnostic measures. Methods: The Diagnostic Behavioral Assessment for ASD (DiBAS) is a DSM-5/ICD-10 based caregiver-report screener consisting of 20 Likert-scaled items. This study evaluates the item validities and -difficulties, and the scale's feasibility and validity in a clinical, adult ID sample (N = 91) from 8/2009 to 12/2011. Results: The DiBAS was applicable in all individuals (100 %) and yielded an adequate diagnostic validity reflected by ROC analysis and an AUC of 0.808. Using a cut-point of 30, the sensitivity and specificity values were 83 % and 64 %, the agreement with the final diagnostic classification was 74 %, and Cohen's kappa was 0.469. Single item analysis revealed 12 valid DiBAS variables that predominantly could be assigned to the social interaction and non-verbal communication domains; item difficulties varied from 0.21 to 0.84. The scale's internal consistency was appropriate (Cronbach's alpha 0.749). Conclusions: The DiBAS is a promising psychometrical sound scale of high feasibility to screen for ASD in adults with ID, which could be further specified by single item analysis.
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