Psychotropic Drug Use and CAM in ASD: Prevalence and Correlates in the Ohsu ATN Site

Background:  High rates of psychotropic drug use have been described in samples of ASD. An array of complementary alternative medicines is also commonly used in the management of children with ASD. Predictors of each approach have rarely been studied simultaneously in the same study.

Objectives:  To investigate the prevalence of psychotropic drug use and use of complementary medicines (CAM) in ASD children, and to identify factors  associated with their use.

Methods:  Data were collected at the Oregon Health and Sciences University (OHSU) site of the Autism Treatment Network (ATN). Data on 426 ASD subjects (83.5% male; mean age: 5.4 years; range: 2.0 -16.9 years) were analyzed. Psychotropic drug  and CAM use at diagnosis was recorded on a standardized form used for data collection through the ATN. Other data were available collected by professionals (diagnosis, autism severity, verbal level, cognitive assessments, Vineland Adaptive Behavior Scales) or parents (socio-demographic background, CBCL).

Results:  The prevalence for any psychotropic drug was 32.6%, with 6.6% children on 2 or more drugs. For specific classes of drugs, figures  were: 6.3% for amphetamine derivatives, 1.2% for atomoxetine, 3.5% for alpha2-adrenergic drugs, .7% for anticonvulsants, 2.6% for SSRIs, 3.1% for atypical neuroleptics, and 22.1% for melatonin.The prevalence of any CAM use was 27.9% in the entire sample, with figures of 2.3% for chiropractics, 2.3% for high dosing vitamin B6, 2.9% for essential fatty acids, 12.8% for other vitamin supplements, 9.6% for gluten-free diet, 6.3% for probiotics, 9.9% for casein free diet,1.3% for digestive enzymes, 2.1% for no processed sugars, and 9.6% for other CAMs. 14.6% children were on 2 or more CAMs. Children taking psychotropic drugs were more likely (p=.047) to take CAMs as well.

Psychotropic drug use was unrelated to child gender, autism severity, verbal level, ethnicity, parental education, and adaptive functioning.  There was a strong relationship with age with psychotropic drug use rising continuously from 17.7% (under age 3) up to 60.5% (over age 10) (p<.001). Parent concerns about communication difficulties (p=.03), sleep problems (p=.02), aggressive behaviors (p=.05),hyperactivity (p=.02) and attentional difficulties (p<.01) predicted psychotropic drugs use. Other parental concerns (GI or neurological or eating problems, sensory issues, internalizing problems, social deficits, repetitive behaviors, SIB or loss of skills) did not.

For CAM use, differences of predictors were as follows. There was no age relationship (p=.91). Parental education was associated with CAM use (p=.03) with the lowest use (20.9%) amongst less educated. In contrast to psychotropic drugs, CAM use was strongly associated with high CBCL t-scores for anxiety (p=.002) and internalizing problems (p=.02) whereas all CBCL t-scores for disruptive behaviors (oppositional, aggressive, attention deficits) and the total scores were unrelated to it. CAM use was not related to sleep, language, disruptive behaviors parental concerns, but was uniquely associated with concerns for GI (p=.001) and anxiety (p=.06) problems.

Conclusions: Use of medicines is prevalent in the ASD population despite a weak knowledge base on their efficacy. Specific predictors for either psychotropic drug use or CAM use could be identified.