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Medication Growth Following Diagnosis of Intellectual and Developmental Disabilities at Varying Ages Throughout
Robert B Christian1,2, Izabela E Annis3,4, Neal A deJong2
1Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
Insights
Children with intellectual and developmental disabilities (IDD) diagnosed young show rapid increases in psychotropic medication and polypharmacy. This highlights a need for further research into long-term psychiatric medication effects in this population.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Disabilities Research
- Pharmacological Studies
Background:
- Intellectual and developmental disabilities (IDD) affect a significant number of children.
- Longitudinal data on psychotropic medication and polypharmacy patterns in children with IDD are limited.
- Understanding age-related prescribing trends is crucial for optimizing treatment and care.
Purpose of the Study:
- To investigate age-related trajectories of psychotropic medication and polypharmacy use in children newly diagnosed with IDD.
- To identify patterns in longitudinal prescribing over time.
- To address the evidence gap in long-term medication use for this population.
Main Methods:
- Retrospective longitudinal cohort study using commercial insurance claims (2011-2021).
- Included 938 children aged 2-17 years newly diagnosed with IDD.
- Analyzed psychotropic medication use (≥1 fill/year) and polypharmacy (≥2 classes concurrently for ≥60 days) using generalized linear mixed models with natural cubic splines.
Main Results:
- 40.1% of children initiated psychotropic medication within 3 years of diagnosis; 9.4% had sustained polypharmacy.
- Children diagnosed before age 12 showed significant increases in medication and polypharmacy use over time.
- Adolescent-diagnosed children had higher initial use but less growth; psychiatric comorbidities increased with time, especially in younger children.
Conclusions:
- Younger age at IDD diagnosis is associated with substantial increases in psychotropic medication and polypharmacy over time.
- Sustained exposure to polypharmacy is a concern for children diagnosed with IDD at younger ages.
- Further research is essential to evaluate the long-term benefits and risks of psychiatric medication in children with IDD.
Purpose:
To characterize age-related trajectories in psychotropic medication and polypharmacy use among children newly diagnosed with intellectual and developmental disabilities (IDD), addressing an evidence gap in longitudinal prescribing patterns.
Methods:
This study uses a retrospective longitudinal cohort design and commercial insurance claims from the southeast (2011-2021) to study children newly diagnosed with IDD, aged 2-17 years (N = 938). Psychotropic medication use was defined as ≥ 1 prescription fill per year; polypharmacy as ≥ 2 classes used concurrently for ≥ 60 days. Generalized linear mixed models with natural cubic splines describe longitudinal growth trajectories as a function of age at first IDD diagnosis and follow-up year, adjusting for gender, cohort year and region of residence.
Results:
Within 3 years of diagnosis, 40.1% of children initiated psychotropic medication, and 9.4% experienced sustained polypharmacy. Medication use increased with each follow-up year among children diagnosed before age 12. For example, children diagnosed at age 2 had a 2.34-fold increase in medication use by year 3 versus year 1 (95% CI: 1.56-3.53) and nearly a sixfold increase in polypharmacy (OR = 5.89; 95% CI: 2.89-11.99). In contrast, children diagnosed during adolescence showed higher initial use but minimal growth. Psychiatric comorbidities also increased with time, particularly among younger children.
Conclusion:
Children diagnosed with IDD at younger ages experience steep increases in psychotropic medication use over time, including sustained exposure to polypharmacy. Additional research on long-term benefits and harms of psychiatric medication use is needed.
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