Psychotropic medication use and polypharmacy in children with autism spectrum disorders

Area of Science:

• Pediatric Psychiatry
• Autism Spectrum Disorders (ASD) Research
• Pharmacological Treatments

Background:

• Autism spectrum disorder (ASD) often presents with co-occurring conditions requiring management.
• Psychotropic medication use in children with ASD is common but evidence for efficacy and appropriateness is limited.

Purpose of the Study:

• To determine the prevalence and predictors of psychotropic medication use in children with ASD.
• To investigate the rates and factors associated with multiclass psychotropic polypharmacy in this population.

Main Methods:

• Retrospective analysis of linked administrative medical and pharmacy claims data (2001-2009).
• Utilized a validated algorithm to identify children with ASD.
• Defined psychotropic polypharmacy as concurrent use of medications from ≥ 2 classes for at least 30 days.
• Employed multinomial logistic regression to model psychotropic use categories.

Main Results:

• 64% of 33,565 children with ASD received at least one psychotropic medication.
• 35% exhibited psychotropic polypharmacy (≥ 2 classes), with 15% using ≥ 3 classes concurrently.
• Factors associated with increased psychotropic use and polypharmacy included older age, psychiatrist visits, and co-occurring conditions (seizures, ADHD, anxiety, bipolar disorder, depression).

Conclusions:

• Psychotropic medications are widely used in children with ASD, both as monotherapy and combination therapy, for ASD and associated conditions.
• The findings underscore a critical need for developing evidence-based standards of care for psychotropic prescribing in pediatric ASD.
• Further research is warranted to establish the effectiveness and appropriateness of multidrug regimens in this population.