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Psychotropic Medication Use Among Children with and without Autism Spectrum Disorders in 2010
Autism diagnoses have increased alarmingly in recent decades. No known medications can cure the underlying disorder, but a range of psychotropic medications are used to alleviate associated symptoms and behaviors. There is a lack of recent data on use in large pediatric populations.
Objectives:
We examined psychotropic medication use among children with autism spectrum disorders (ASD) in 5 geographically diverse nonprofit US health plans, comparing results to a matched population without ASD. We describe prevalence and intensity of use by therapeutic class, age, gender, diagnostic severity (autistic disorder vs other ASD), and psychiatric comorbidity.
Methods:
All subjects were continuous members in 2009-2010. ASD status (N=8,363) required 2 separate ICD-9 diagnoses in claims 2009-2010; age- and gender-matched peers had no ASD diagnoses in 2009-2010 (N=83,575). We determined comorbidities with a single diagnosis in either year. We analyzed psychiatric drug utilization in 2010 among children aged 1-17, the relative odds of psychotropic treatment associated with ASD status, predictors of use among ASD patients, and frequencies of specific therapeutic combinations and entities.
Results:
Most children with ASD (73.3%) and 17.3% of non-ASD children had other psychiatric diagnoses. Among children with ASD, 46.3% received a psychiatric medication in 2010, compared to 7.4% of non-ASD children; the odds of use were 11.7 higher among children with ASD. Stimulants (21.6%), antipsychotics (19.6%), and antidepressants (17.0%) were the most commonly used psychiatric drug therapies among children with ASD. Among users for these 3 classes, the average annual supply dispensed ranged from 11.5 months to 9.5 months, respectively. Psychotropic treatment was consistently far more prevalent among children with ASD, whether or not a relevant comorbidity diagnosis was present.
Conclusions:
The intensive use of psychotropics we observed is consistent with earlier reports and highlights the complexity of treatment for children with autism. Nevertheless, published evidence supporting the effectiveness of these treatments in ASD remains scarce. Substantial additional research investment in evaluating the use of psychotropics for ASD is justified by high rates of use in the community.