Preliminary Characterization of Medication Use in a Multicenter Sample of Pediatric Inpatients with Autism Spectrum Disorder

Background:  Inpatient psychiatric hospitalization is indicated for youth with autism spectrum disorder who have serious emotional or behavioral disturbances. Little is known regarding the phenotypic and biological profiles of these patients. Here we present preliminary pharmacological utilization data from an ongoing multisite study of psychiatric inpatients with autism, the Autism Inpatient Collection (AIC)

Objectives:  To describe medication use in youth with autism spectrum disorders (ASD) who were admitted to six specialized inpatient psychiatry units for serious emotional or behavioral disturbances.  

Methods:  One-hundred and eight children were prospectively enrolled from February 2014 to August 2014. Inclusion criteria were a Social Communication Score of ≥ 12 and autism diagnosis by a research-reliable examiner using the ADOS-2.  Psychotropic medications were coded and classified. Descriptive statistics were calculated to characterize medication profiles for all subjects, as well as subgroups based on verbal ability.

Results:  Ninety-eight subjects who had completed basic demographic characteristics, behavioral profiles, and medication data at admission and discharge were included in this analysis of medication profiles (Table 1). The mean age was 12.75 (SD 1.24, Range 4 to 20),24% were female and approximately 18.5% were identified as having current or past seizures. The majority of subjects (56%) were administered Module 1 (single words or less, 48.9%) or Module 2 (phrase speech, 7.1%) of the ADOS-2, indicating very limited verbal ability. The mean ABC-Irritability subscale score decreased from 29.62 (SD 8.01) on admission to 20.92 (SD 8.98) on discharge (t=5.65,p<.001). Subjects were taking on average 2.65 (SD 1.24) psychotropic medications on admission and 2.80 (SD 1.15) on discharge (t=1.2, p=0.23).  Psychotropic medications were utilized at admission by 98% of  the sample, most commonly a neuroleptic (63%), sleep aid (40%), antidepressant (35%), mood stabilizer (34%), psychostimulant (26%) or a non-stimulant ADHD medication (24%)(see Figure 1). 

Conclusions:  This preliminary data on 98 subjects demonstrates that the vast majority of youth with autism spectrum disorders who are admitted to inpatient psychiatry units are treated with more than one psychotropic medication upon admission, including 67% on a neuroleptic. Despite no change in the mean number of medications, there was a significant improvement in irritability at discharge. Future analysis of the complete AIC data set will include examination of specific agents, dosing trends and correlations with clinical outcomes.