Psychotropic Medication Use in Children Before Autism Spectrum Diagnosis Is Made

Background: It has been reported that about 45% of individuals with ASD take psychotropic medications (Aman at al., 2003 and Langworthy-Lam et al., 2002), and there is also evidence that many children are prescribed these medications even before they receive ASD diagnosis. Very little is known about the specific types of medications individuals with ASD are getting before they receive a formal ASD diagnosis, and given the significant implications of these medications, this is an important area to explore.  Based on Alabama Medicaid data, more than 50% of individuals less than 5 years of age who were prescribed atypical antipsychotics did not have FDA approved diagnosis (Littlejohn, 2011).

Objectives: To determine prevalence and type of psychotropic medication use in a tertiary care clinic sample of children before formal ASD diagnosis was made.

Methods: Thirty-one children (ages 2.0 - 13.0 years) with ASD received diagnostic and intellectual evaluations at an interdisciplinary clinic. Records regarding psychotropic medication use prior to formal ASD diagnosis were reviewed for each participant. 

Results: Of the 31 participants, 51% met criteria for PDD-NOS, 23 % met criteria for Asperger syndrome, and 26% met criteria for autism based evaluations utilizing the ADOS, ADI-R, and clinical opinion.  Eighty percent of the sample was male and 48% was white non-Hispanic. Mean FSIQ for participants was 80.6 (range 52-118). Of our sample, 38.7% were taking psychotropic medications prior to diagnostic evaluation and of these, 19.3 % had already tried more than one class of psychotropic medications before the formal ASD diagnosis was given. Twenty-nine percent tried stimulants and 16% of participants had tried atypical antipsychotics.

 Conclusions: Preliminary results suggest that a large subgroup of individuals with ASD seek treatment before receiving a comprehensive ASD evaluation and diagnosis, and often this treatment is in the form of psychotropic medications. In the current sample, stimulants and atypical antipsychotics were the most common medications used in individuals with ASD prior to evaluation. Further investigation of this phenomenon in a larger sample based on racial disparities, severity of ASD, and its implications to ASD treatments in general is suggested. Review of clinical files is ongoing, and it is anticipated that this dataset will include 100 individuals by May 2012. Further, we anticipate including individuals who were evaluated but did not receive ASD diagnosis as a comparison group to explore possible differences in these groups regarding types or prevalence of medication use. The insights gained from these investigations will extend the understanding of treatment of ASD leading to recommendations concerning medical management of ASD in certain populations.