Psychiatric Symptoms and Psychotropic Medication Use In Children with Autism: Findings From the Simons Simplex Collection

Background:

Recent systematic investigation of clinical populations of children with autism spectrum disorders (ASD) has identified the presence of co-morbid psychiatric symptoms which are often the target of clinical intervention, including use of psychotropic medication.  Frequently, these symptoms include inattention and hyperactivity, anxiety, irritability, self-injury, and depression, and in some instances, symptoms of psychotic illness.  Factors such as age and cognitive ability, as well as the presence of co-morbid psychiatric symptoms, appear to be related to medication use; however, no clear recommendations have been provided in the research and clinical literature that guide the use of psychotropic medications in children with ASD and related symptoms.  Understanding the patterns of current medication use is a necessary first step towards developing standards of care for children with ASD. 

Objectives:

Data from the Simons Simplex Collection (SSC) will be presented to characterize the presence of co-morbid psychiatric symptoms in a large sample of children with autism spectrum disorders, to identify which psychotropic medications are used in treating children with autism, and to determine which individual factors are related to psychotropic medication use. 

Methods:

This study focuses on two primary measures from the SSC phenotypic battery, including the Achenbach Child Behavior Checklist and a medical history interview administered to parents.  Descriptive statistics are reported for these measures as a way to characterize level of co-morbid psychiatric symptoms and use of psychotropic medication.  In addition, a series of regression analyses are reported to explore how individual factors are associated with medication use.  A total of 1423 children between the ages of 6 to 17 years are included in this data analysis. 

Results:

Results of this study show that children with ASD experience moderate to high levels of affective, anxiety, and ADHD-related symptoms [CBCL T-scores = 61.6 (SD=8.5), 61.8 (SD=8.7), 61.9 (SD=8.0), respectively], and that children with ASD often take ADHD medications, (25.7%), antidepressant medications (14.4%), and/or mood stabilizers (12.3%).  Regression analysis exploring the relation between individual factors and psychotropic medication use indicates that 1) ADHD medication use is associated with older age and higher levels of ADHD and somatic symptoms, 2) antidepressant use is associated with older age, increased autism severity, and increased levels of affective and anxiety symptoms, and 3) mood stabilizer use is associated with older age, lower nonverbal IQ, and increased levels of anxiety, ADHD symptoms, and conduct problems. 

Conclusions:

Identifying psychiatric and behavioral problems that co-occur with ASD and identifying current patterns of medication use may lead to greater anticipatory guidance for parents and clinicians.  Furthermore, future studies that examine co-morbid psychiatric symptoms in children with ASD may help identify the presence of phenotypic subgroups, and may lead to more precise characterization of the underlying biology of autism, and ultimately improved treatment.