Medication Use In Students with Autism Spectrum Disorders Attending a Nonpublic Special Education Program: Implications for Classroom Behavior

Background: The number of children with Autism Spectrum Disorders (ASD) has grown precipitously since the 1990s. Students diagnosed with ASD present significant challenges to classroom teachers. While previous studies have described patterns of psychotropic medication use in children with ASDs, none have focused on the school setting or the implications for classroom behavior management. The Kennedy Krieger Institute, known for its autism research and education programs, operates the largest nonpublic school in Maryland, serving over 400 students with disabilities in grades PreK - 12. Such schools provide a specialized environment in which to measure and describe current practices that have broad implications for all school settings. A research committee was established to identify potential areas of study related to the importance of having accurate and updated information regarding medications taken by students that may impact their daily academic and behavioral classroom performance.

Objectives: Our objective was to describe use of psychotropic and non-psychotropic medications by students attending the Kennedy Krieger School, and to investigate associations between such use and student’s disability status, graduation pathway (diploma vs. certificate), sex, race, age, and grade level.

Methods: This sample included 468 students, aged 5 to 22 years, who attend The Kennedy Krieger School Programs in Maryland, all with significant developmental concerns. Students were classified into one of two groups: those with autism as defined by the Individuals with Disabilities Education Act (IDEA) and those with other disability codes. Medications were coded by type (psychotropic vs. other). Multivariate regression models were used to evaluate predictors of psychotropic and non-psychotropic drug use. Data was maintained in a commercially available student information database, PowerSchool.

Results: In all, 63% of students were taking at least one psychotropic medication and 43% were taking at least one non-psychotropic medication. Students with ASD were taking an average of 1.3 psychotropic and 0.8 non-psychotropic medications, while non-ASD students were taking an average of 1.8 psychotropic and 1.2 non-psychotropic medications. Not having ASD, higher grade level, Caucasian race, and being in LEAP (a specialized program for lower functioning children with ASD) were strongly correlated with greater psychotropic medication use, while sex and graduation pathway were not. Not having ASD was also strongly correlated with non-psychotropic medication use, as was being Caucasian or being in the LEAP program, while grade level, sex, and graduation pathway were not. All positive correlations were above p<0.05.

Conclusions: Data show that an overwhelming number of students attending a nonpublic school are prescribed psychotropic medications. It is interesting to note that, while psychotropic medication use increases with age, non-psychotropic medication use does not. Patterns of medication use were identified that may influence the practice of school administrators. Results demonstrate that further investigation of medication use among older, lower functioning students with ASD is warranted. Findings suggest that the impact of pharmacological interventions on student achievement for students with ASD merits further study.