Antipsychotic Drug Prescriptions for Transition-Age Youth on the Autism Spectrum

Research questions included: (1) What are rates of on- versus off-label prescribing among transition age youth and young adults on the autism spectrum (with and without intellectual disability [ID]) compared to similar-aged youth with ID and a comparison group? (2) What types of antipsychotics are prescribed to transition-age youth, and what factors are associated with prescribing ?

We conducted a cross-sectional analysis of 2019 U.S. Medicaid data from all states, DC, and Puerto Rico to evaluate antipsychotic prescribing in four transition-age groups aged 14-29y: autistic youth with ID (n = 108,892) and without ID (n = 218,484), an ID-only group (n = 193,733), and a comparison group without autism or ID (n = 269,819).

Almost half of autistic youth with ID were prescribed an antipsychotic (45%), compared to 22% of autistic youth, 19% of youth with ID, and 3% of youth with no autism or ID. Among youth taking any antipsychotic, off-label prescribing was highest for autistic youth with ID. Autistic youth with ID were more likely to be prescribed both typical and atypical antipsychotics compared to youth without autism or ID. Young adults 18-29y were significantly more likely to be prescribed atypical and typical antipsychotics compared to youth 14-17y.

Prescribing of antipsychotics for individuals with developmental disabilities is high, particularly for those with ID. Additional research on prescribing reasons and prescriber characteristics is needed. Well-controlled longitudinal studies evaluating the short-term and long-term consequences of antipsychotic prescribing on autistic people across the lifespan is required.