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State variation in psychotropic medication use by foster care children with autism spectrum disorder
David M Rubin1, Chris Feudtner, Russell Localio
1Division of General Pediatrics, Children's Hospital of Philadelphia, PolicyLab, Center to Bridge Research, Practice, and Policy,Safe Place, Philadelphia, Pennsylvania 19104, USA. rubin@email.chop.edu
Insights
Children in foster care with autism spectrum disorder (ASD) are more than twice as likely to use multiple psychotropic medications concurrently than those with disabilities. State variations highlight potential policy differences impacting medication access for these children.
Area of Science:
- Pediatric Psychiatry
- Health Services Research
- Autism Spectrum Disorder Research
Background:
- Children with autism spectrum disorder (ASD) often require psychotropic medications for co-occurring conditions.
- Concurrent use of multiple psychotropic medications is common but carries risks.
- Understanding disparities in medication use between vulnerable child populations is crucial.
Purpose of the Study:
- To compare the concurrent use of three or more psychotropic medications among children with ASD in foster care versus those with disabilities receiving Supplemental Security Income.
- To examine state-level variations in the concurrent use of multiple psychotropic medications for children with ASD in foster care.
Main Methods:
- Analysis of 2001 Medicaid claims for 43,406 children aged 3-18 with at least one annual ASD claim.
- Comparison of concurrent use of >=3 psychotropic medication classes between children in foster care and those with disabilities.
- Multilevel logistic regression controlling for demographics and comorbidities, with state-level clustering to assess variation.
Main Results:
- Children in foster care with ASD had a 20.8% concurrent use of >=3 psychotropic medication classes, compared to 10.1% for children with disabilities.
- A 5% increase in multi-medication use in a state's disabled population correlated with an 8.3% increase in foster care children's multi-medication use.
- Significant state-level variation was observed, with 43% of states exceeding 1 SD and 14% exceeding 2 SDs from the adjusted mean.
Conclusions:
- Children with ASD in foster care are significantly more likely to be prescribed concurrent multiple psychotropic medications than those with disabilities.
- Substantial state-level disparities in medication use suggest that policy and program differences influence treatment patterns.
- Further investigation into state-specific factors is warranted to address potential inequities in psychotropic medication management for children with ASD in foster care.
Objective:
The objective of this study was to compare on a national cohort of children with autism spectrum disorder (ASD) the concurrent use of >or=3 psychotropic medications between children in foster care and children who have disabilities and receive Supplemental Security Income, and to describe variation among states in the use of these medications by children in foster care.
Methods:
Studied was the concurrent use of >or=3 classes of psychotropic medications, identified from the 2001 Medicaid claims of 43406 children who were aged 3 to 18 years and had >or=1 annual claim for ASD. Medicaid enrollment as a child in foster care versus a child with disabilities was compared. Multilevel logistic regression, clustered at the state level and controlling for demographics and comorbidities, yielded standardized (adjusted) estimates of concurrent use of >or=3 medications and estimated variation in medication use within states that exceeded 1 and 2 SDs from the average across states.
Results:
Among children in foster care, 20.8% used >or=3 classes of medication concurrently, compared with 10.1% of children who were classified as having a disability. Differences grew in relationship to overall use of medications within a state; for every 5% increase in concurrent use of >or=3 medication classes by a state's population with disabilities, such use by children in a state's foster care population increased by 8.3%. Forty-three percent (22) of states were >1 SD from the adjusted mean for children who were using >or=3 medications concurrently, and 14% (7) of the states exceeded 2 SDs.
Conclusions:
Among children with ASD, children in foster care were more likely to use >or=3 medications concurrently than children with disabilities. State-level differences underscore policy or programmatic differences that might affect the receipt of medications in this population.
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