Pharmacotherapy in Children with ASD: Baseline Findings from the New Jersey Autism Study

Background: Though behavioral and educational interventions are the mainstays of treatment, children with Autism Spectrum Disorders (ASD) are also prescribed psychoactive medicines. The extent to which pharmacotherapy plays a role in the treatment of autistic children is not well understood. The few surveys of this topic have not established representative epidemiologic estimates. Objectives: This study was undertaken to estimate of the number, proportion and demographic distribution of children with ASD receiving pharmacotherapy with psychoactive drugs, in a large and diverse New Jersey population-based sample and to describe the frequency of psychoactive treatment by drug type. Methods: Data were collected as a part of the New Jersey Autism Study (NJAS), a population-based ASD surveillance investigation carried out in Essex, Union, Hudson and Ocean Counties, a diverse, populous, metropolitan region. Baseline findings represent 8-year olds (1992-born), in 2000. ASD ascertainment was by an active, retrospective, multiple-source, case-finding method, developed by the Centers for Disease Control and Prevention (CDC), based on review and analysis of information contained in health and education records. Demographic variables and case-specific data, including information on the prescription of psychoactive medicines were analyzed. The socioeconomic status (SES) of ASD cases was represented by the District Factor Group (DFG) ranking, a community-level index. Chi-square test was used to test associations. Results: 295 children with ASD were identified from a total 8-year old population of 29,748. 97 of the 295 ASD children (32.8%) were prescribed one or more psychoactive drug, at any time before or during their eighth year. Stimulants were by far the most frequently prescribed drug type, being provided to 69 children (23% of the total ASD cohort). Anti-depressants (7%), anti-psychotics (7%), α-2 adrenergic agonists (6%), sedatives (2%) and other psychoactive drugs (10%) were prescribed less frequently. Overall, the frequency of psychoactive prescription did not vary significantly by sex, race/ethnicity or SES. When analyzing the prescription of medicine by drug type, however, white children were found to be prescribed antidepressants more frequently than children of other races (p<0.05) and children from high SES communities were more frequently prescribed anti-depressants than children from lower and mid SES towns (p<0.001). Conclusions: In 2000, one third of 8-year old ASD children in our region had been treated with psychoactive medicines. The frequent prescription of stimulants to children with ASD underscores the importance of attention deficits as an associated feature of ASD. The greater frequency of anti-depressant prescription to white children and affluent children may suggest a subtle disparity in the provision of pharmacotherapy. Continued monitoring of children with ASD in the region by a population-based method may disclose trends in the frequency and pattern of psychoactive treatments provided to children with ASD.