Medication Use in Adolescents and Adults with ASD: The Role of Clinical, Parent, and Service Need Factors

Background: Mental health and behavioural issues are common in individuals with autism spectrum disorders (ASD), and primarily treated through pharmacology. Recent studies estimate that over one half of adults with ASD are prescribed psychotropic medications, with over one quarter taking three or more (Aman, et al., 2003; Lake et al., 2012; Langworthy-Lam, et al., 2002). Psychiatric support, greater age, group home residence, and more severe symptoms of autism are all associated with increased medication use (Aman, et al., 2003; 2005; Lake et al., 2012). Despite this, few studies have examined what predicts medication use in adolescents and adults with ASD, particularly from a service utilization, clinical need, and parent need perspective.  

Objectives: To identify profiles and predictors of medication use in terms of clinical need, parent need, and service utilization factors.  

Methods: As part of an online survey examining health service utilization patterns among individuals with ASD, 463 parents completed demographic and clinical measures related to their child’s service use, comorbid medical and psychiatric conditions, medication use, risk behaviours, severity of ASD, history of previous hospitalizations, and parental wellbeing (e.g., burden, worry, knowledge).

Results: Preliminary analyses revealed that 53% of adolescents and adults with ASD were taking at least one psychotropic medication, with over one half of this group prescribed antipsychotics. Approximately 50% of those taking psychotropic medications were taking antidepressants, 33% stimulants, and 19% anxiolytics. Over one half of adolescents and adults prescribed psychotropic medications were taking 2 or more of these drugs (polypharmacy), and 36% of these individuals had no other diagnosis in addition to ASD. At the bivariate level, both clinical need (psychiatric comorbidity, aggression, and self-injury) and service utilization (forensic involvement, having a family physician, and past emergency department visitation) were associated with polypharmacy. Parent variables associated with polypharmacy included receiving family therapy/counseling support. Findings related to other parent variables (e.g., burden, worry, knowledge) will be explored.

Conclusions: Over one quarter of the current sample was prescribed 2 or more psychotropic medications, with antipsychotics prescribed most often. A number of clinical, parent, and service utilization variables were associated with psychotropic medication use and polypharmacy. Findings from this study are relevant to improving the mental health care of adolescents and adults with ASD by providing clinicians, individuals with ASD, and caregivers of individuals with ASD, with current, evidence-based information on medication use in this population. Knowledge may also help families, clinicians and individuals with ASD anticipate the use of medication, explore strategies to best monitor medication use, and consider alternative or adjunctive treatments.