Rates and Predictors of Psychotropic Medication Use in Children with Autism Spectrum Disorder Ages 2-18 Years Old in a National Population-Based Sample: 1994-2009

Background: Psychotropic medication use in children with Autism Spectrum Disorders (ASD) is an emerging area of interest. However, little is currently known about changes over time in the use of psychotropics in children with ASD, or the role of socio-demographic factors or comorbid conditions in psychotropic medication use for this population.

Objectives: In a U.S. population-based sample of pediatric outpatient medical visits from 1994-2009, we: 1) Determine rates of psychotropic medication use among children diagnosed with ASD, and 2) Determine if rates of psychotropic medication use in children diagnosed with ASD vary by socio-demographic factors, comorbid behavioral and developmental conditions, and time period.

Methods: Data for children aged 2-18 years (N=158,488) from the 1994–2009 National Ambulatory and National Hospital Ambulatory Medical Care Surveys was used to estimate the weighted percentage (%) of visits with coded ASD diagnoses.  In addition, we calculated rates of using any psychotropic medication among children with ASD for the sample overall, and in specific socio-demographic groups and time intervals (with time effects examined in 4 year blocks: 1994-97, 1998-2001, 2002-05, and 2006-09). Multivariate logistic regression was performed to identify predictors of psychotropic medication use in children with ASD. This study was exempted from review by the Cincinnati Children’s Hospital Institutional Review Board.

Results: The rate of having an ASD diagnosis among U.S. pediatric outpatient medical visits from 1994-2009 was 0.31% (95% CI 0.24-0.38). Although psychotropic prescription rates at visits for children with ASD increased from 45.2% (95% CI 30.9-59.4) in 1994-1997 to 58.3% (95% CI 49.6-66.9) in 2002-2005 [see Figure], in adjusted analyses 4-year time period was not associated with psychotropic use, nor were gender, race, health insurance status, or demographic region. Among children with ASD, the likelihood of psychotropic prescription was higher in school-age children and teenagers (vs. preschool children), and in those with another behavioral diagnosis (vs. those with no comorbid behavioral diagnosis), while those with comorbid intellectual disability (ID) or developmental delay (DD) (vs. those with no ID/DD) were less likely to receive psychotropic prescriptions [see Table]. The behavioral comorbidities with the highest rates of psychotropic use (per 100 medical visits) in children with ASD were ADHD (86.2; 95% CI 80.5-91.8), mood disorder (85.8%; 95% CI 75.4-96.2), and anxiety disorder (84.4%; 95% CI 72.7-96.1).

Conclusions: Between 1994-2009, children with ASD comorbid with another behavioral diagnosis were more likely to use psychotropic medications, while preschoolers and those with a comorbid ID/DD were less likely to receive psychotropic prescriptions. We did not observe main effects of race, sex, health insurance status, or 4-year time period on psychotropic use in children with ASD.  However, further research is needed to better understand if these factors interact such that changes in psychotropic medication use over time vary by sociodemographic group in children with ASD.