Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

OptumInsight, Life Sciences, Eden Prairie, Minnesota
PEDIATRICS (Impact Factor: 5.47). 10/2013; 132(5). DOI: 10.1542/peds.2012-3774
Source: PubMed


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).

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.

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 co-occurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy.

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 co-occurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD.

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    • "Only antihypertensive medications that had evidence for the treatment of hyperactivity, inattention, or impulsivity, such as clonidine or guanfacine (Posey et al. 2004; Arnsten et al. 2007) were categorized as psychotropic medication, as was done by others (Langworthy-Lam et al. 2002; Aman et al. 2003; Logan et al. 2012; Lake, Weiss, Dergal & Lunsky 2014). Similarly, the distinction between mood stabilizers and anticonvulsants was made by classifying medications (e.g., valproate and carbamazepine) as mood stabilizers for all individuals who did not have a diagnosis of seizure disorder, as has been done previously (Esbensen et al. 2009; Lake et al. 2012; Spencer et al. 2013). Parents were also asked if their child had experienced side effects as a result of medication use (yes, no, don't know), what side effects their child had experienced (open ended), and what effect they felt medication(s) had on their child's psychological well-being (good or mostly good, neutral, bad or mostly bad). "
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    ABSTRACT: Psychotropic medications are frequently used to treat mental health and behavioral issues in adolescents and adults with an autism spectrum disorder (ASD). Although parents of individuals with ASD frequently take on medication management for their child, there is limited literature on parent perspectives of their child's medication use or their views about the healthcare services they receive, particularly in adulthood. The current study examined and compared parents of adolescents and of young adults with ASD regarding their child's psychotropic medication use and their views about healthcare services. One hundred parents of adolescents and young adults with ASD (ages 12-30 years) completed an online survey about their experience with their child's healthcare services and medication use. Parents of young adults were less likely to use nonpharmacological services before using a psychotropic medication than were parents of adolescents. Parents of young adults were also less likely to believe that their prescribing healthcare provider had adequate expertise in ASD, and were less satisfied with how their prescriber monitored their child's medication use. Findings highlight the need to build capacity among healthcare providers supporting individuals with ASD as they transition into adulthood. There is also a need for improved medication monitoring and increased awareness of the different mental health challenges that individuals with ASD encounter as they age.
    Full-text · Article · Mar 2015 · Journal of child and adolescent psychopharmacology
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    • "Spencer et al. (2013) examined psychotropic medication use and polypharmacy in children with ASD, revealing that 64 % cases had a filled prescription for at least one psychotropic medication, 35 % had evidence of psychotropic polypharmacy (≧ 2 classes), and 15 % used medications from ≧ 3 classes concurrently. Based on the relevant findings, the development standards of care for the prescription of psychotropic medications to children with ASD is necessary (Spencer et al. 2013). "
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    ABSTRACT: This paper aims to examine health care utilization and expenditure in the provision of medical care to understand the medical care burden of children with autism spectrum disorders based on recent literature reviews. This article reviews the recent literature in Medline, PubMed, and Google by using key terms that are relevant to autism spectrum disorder (ASD) and health care (medical care) utilization, medical care costs, and expenditures. I also hand-searched the reference lists of all of the included articles and recent narrative and systematic reviews related to medical care utilization and the costs of ASD to identify potentially relevant articles. The literature on medical care utilization and expenditures related to ASD highlights the fact that the disorder imposes high medical care burdens on families and on society. It is necessary to initiate appropriate, comprehensive, and accessible medical care services for individuals with ASD, particularly for those with comorbid conditions. Future studies should examine the impact of such improvements in the management of children with ASD on medical care utilization and costs.
    Preview · Article · Jun 2014
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    ABSTRACT: Adolescents and adults with an autism spectrum disorder (ASD) who do not have an intellectual impairment or disability (ID), described here as individuals with high-functioning autism spectrum disorder (HFASD), represent a complex and underserved psychiatric population. While there is an emerging literature on the mental health needs of children with ASD with normal intelligence, we know less about these issues in adults. Of the few studies of adolescents and adults with HFASD completed to date, findings suggest that they face a multitude of cooccurring psychiatric (e.g., anxiety, depression), psychosocial, and functional issues, all of which occur in addition to their ASD symptomatology. Despite this, traditional mental health services and supports are falling short of meeting the needs of these adults. This review highlights the service needs and the corresponding gaps in care for this population. It also provides an overview of the literature on psychiatric risk factors, identifies areas requiring further study, and makes recommendations for how existing mental health services could include adults with HFASD.
    Full-text · Article · Sep 2014
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