Evidence of Frequent Psychotropic Medication Use Among Children with Autism Spectrum Disorders and Their Family Members

Background: Autism spectrum disorders (ASDs) affect a large and heterogeneous group of children and their
families. Despite increasing interest in and attention to ASDs, most research studies to-date have included
only small or narrow clinical samples of children, without an understanding of how findings generalize to
children with ASDs more broadly. In particular, it is unknown how the use of psychotropic medications
among children diagnosed with ASDs, and that of their families, compares to children and families without
ASDs.

Objectives: Using a large, existing administrative dataset, we compare the use of psychotropic medications
among children with ASDs and their family members to those of children without ASDs and their families.

Methods: This is a retrospective study using medical, behavioral health and pharmacy data and health
plan enrollment information from a large US research claims database from January 2001 to December
2009. Descriptive analyses were conducted for six main samples: children with ASDs, a randomly selected
comparison group of children without ASDs, parents of children with and without ASDs, and siblings of
children with and without ASDs. Children 0 to 20 years old with Autism, Asperger’s Syndrome, or Pervasive
Developmental Disorder not otherwise specified (PDD-NOS) were included; children with Rett Syndrome and
Childhood Disintegrative Disorder were not included in the sample of children with ASDs. All study subjects
were required to have at least six months of health plan continuous enrollment.

Results: We identified a large sample of children with ASDs (46, 236 children) their siblings (57,056), and
parents (80,164) as well as a comparison group of 138, 876 children and their family members (428,097).
Children with ASDs averaged 41.8 months of continuous enrollment, and the comparison group averaged
30.5 months of enrollment. Preliminary, unadjusted analyses indicate that 59% of children with ASDs had at
least one claim for a psychotropic medication: 41% received medication for attention deficit disorder, 30%
received an antidepressant, 25% received an atypical antipsychotic (17% Risperidone specifically), 17%
received an anticonvulsant, and 14% received an anxiolytic. In comparison, 11% of children without ASDs
had at least one claim for a psychotropic medication, with the greatest number receiving an attention deficit
disorder medication (5%) or an antidepressant (4%). Eleven percent of siblings of children with ASD received
a medication for attention deficit disorder, and 8% received an antidepressant. Thirty-one percent of parents
of children with ASDs received an antidepressant, and 21% received an anxiolytic. Additional analyses will
assess the degree of concomitant polypharmacy among children with ASDs.

Conclusions: Many children with ASDs received a psychotropic medication. Evidence of select psychotropic
medication use among their family members was also noteworthy. Further research is needed to assess
patterns of psychotropic medication use, including polypharmacy, among children with ASD and their family
members.