Psychotherapeutic Medication Use In Children with Autism In the State of Kentucky

Background:  Autism prevalence has increased dramatically in recent years, as has use of psychotherapeutic drugs (PTD) to treat behavior problems associated with autism.

Objectives:  To assess the prevalence of ASD among Kentucky Medicaid children and determine usage of PTD in this population.

Methods:  Kentucky Medicaid claims data were reviewed to identify children with an ASD diagnosis (ICD-9 code 299.XX) in 3 different age groups from 2005 -2008 and to assess use of PTD in this population. PTD use is defined as at least 1 prescription per year.

Results:  Both the prevalence of children diagnosed with ASD and the use of PTD increased among all age groups over the last 4 years with the highest increases noted in the last two years (Tables 1 and 2). In 2008, 1 in 250 children was diagnosed with ASD.  PTD use accounted for 70% of medications prescribed for children with ASD and included atypical neuroleptics such as risperidone, aripiprazole, and quetiapine, as well as SSRI's, atomoxetine and lisdexamfetamine.

Conclusions:  The increased prevalence of ASD among children receiving  Kentucky Medicaid insurance parallels national trends and may be due to improvements in diagnosis and early identification across levels of the ASD spectrum.  The overall prevalence of children diagnosed with ASD in this population is below national estimates of 1 in 100.  However, PTD use is much higher than in prior reports, especially in children 1 to 5 years old.  Increased medication use may be compensatory for perceived inadequacies of comprehensive educational and behavioral services for these children.  More data are needed to determine the safety and efficacy of PTD usage, alone and in combination with other therapies, in children with ASD.

Table 1:  Prevalence of ASD Diagnoses in the Kentucky Medicaid Population

(per 1,000 children)

                                                Age Group (years)

Year                        1-5                          6-12                           13 -18

2005                        1.2                           4.4                               2.3

2006                        1.2                           4.8                               2.3

2007                        1.5                            6.4                              3.1

2008                        1.6                            7.9                              3.7 

Table 2:  Prevalence (%) of PTD Use in Children with Autism

                                                Age Group

Year                           1-5                            6-12                       13-18

2005                          73                               88                             91

2006                          67                               87                             89

2007                          78                               90                             94

2008                          79                               92                             95