Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders

ArticleinPEDIATRICS 132(5) · October 2013with11 Reads
DOI: 10.1542/peds.2012-3774 · Source: PubMed
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 co-occurring 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 co-occurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD.
    • "Second, diagnosing ASD is difficult because of cooccurring mental disorders, such as mood and anxiety disorders or ADHD (Tsakanikos et al. 2006; Matson & Shoemaker 2009; White et al. 2009; Matson & Williams 2014; Cervantes & Matson 2015), as well as neurological co-morbidities, like epilepsy and visual impairments (Hoevenaars-van den Boom et al. 2009; Matson & Shoemaker 2009; De Vaan et al. 2013). Furthermore, ASD may not be recognised because of the use of antipsychotic medication in ID (Spencer et al. 2013). Additionally, there is often a lack of detailed information about the person's past medical history. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Identification of Autism Spectrum Disorder (ASD) in persons with intellectual disability (ID) is challenging but essential to allow adequate treatment to be given. This study examines whether the combination of two ASD screening instruments specifically developed for persons with ID, namely, the Diagnostic Behavioral Assessment for ASD-Revised (DiBAS-R) and the Autism Checklist (ACL), improves diagnostic accuracy when used in combination compared to the application of the single instrument. Method: A clinical sample of adults with ID who are suspected of having ASD (N =148) was assessed using two ID specific screening scales (DiBAS-R and ACL). The diagnostic validity of the single instruments and of their combination was assessed. Results: While both instruments showed acceptable diagnostic validity when applied alone (DiBAS-R/ACL: sensitivity: 75%/91%; specificity: 75%/75%; overall agreement: 75%/83%), specificity increased when two positive screening results were used (88%), and sensitivity increased (95%) when at least one positive screening result was used. Conclusions: Different combinations of the ASD screening instruments DiBAS-R and ACL lead to improvements in sensitivity and specificity. The complementary use of the ACL in addition to the sole use of the DiBAS-R improves overall accuracy. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.
    Article · May 2016
    • "Clearly, further safety studies with a neurodevelopmental context are imperative before integrating tDCS into clinical practice of child and adolescent psychiatry. However, the safety profile of tDCS may be favorable when compared with common approaches as with polypharmacy, which despite widespread use in practice, still lack evidence of safety and effectiveness in children and adolescents (Spencer et al. 2013; Feinstein et al. 2015). Our aim was to review the current literature regarding the use of tDCS in children and adolescents with psychiatric disorders, considering that studies with tDCS in child and adolescent psychiatry are still quite limited and that there are currently no specific guidelines for optimum stimulation parameters. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that consists of applying a weak electric current over the scalp to modulate cortical excitability. tDCS has been extensively investigated in adults with psychiatric disorders. The aim of this study was to review the current literature regarding the use of tDCS in children and adolescents with psychiatric disorders. Methods: We searched MEDLINE and EMBASE databases for studies evaluating the safety and efficacy of tDCS in children and adolescents from age 0 to 18 years with psychiatric disorders. Results: We found six studies that evaluated patients with different psychiatric disorders, with diverse study designs and stimulation parameters, including three small randomized clinical trials (RCTs), one evaluating childhood-onset schizophrenia, one RCT with patients with autism spectrum disorders (ASD), and one study in attention-deficit/hyperactivity disorder (ADHD); three open-label studies, two evaluating patients with ASD, and one study of feasibility of the technique in children and adolescents with language disorders and diverse psychiatric disorders, including ASD, intellectual disability, and ADHD. We also found three studies of dosage considerations in the general pediatric population. The technique was well tolerated, with no reports of serious side effects. Conclusion: Preliminary research suggests that tDCS may be well tolerated and safe for children and adolescents with psychiatric and neurodevelopmental disorders. Nevertheless, because the literature regarding tDCS in child and adolescent psychiatry is scarce and there exist limited numbers of randomized controlled trials, it is not possible to draw definite conclusions. Future studies should investigate the technique with regard to specific psychiatric conditions in comparison with standard treatments. In addition, long-term efficacy and safety should be monitored.
    Article · Mar 2016
    • "Most children with ASD are often prescribed psychotropic medications, [176] primarily risperidone and aripiprazole [177], because these drugs have been known to reduce general disruptive and aggressive behaviors. However, these drugs have shown no effect on the core symptoms of ASD [178][179][180]and often have frequent adverse effects, such as weight gain, sedation, tremor, movement disorders and drooling [181] and increase the risk for unwanted drug interactions [182]. A recent review also concluded that the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are not effective in ASD and frequently lead to hyperactivation [183]; in fact, one such drug, citalopram, was deemed to be detrimental [184]. "
    Article · Jan 2016
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