Physician Practices in Management of Second Generation Antipsychotic (SGA) Medications and Their Side Effects in Children and Adolescents with Autism Spectrum Disorders

Friday, May 15, 2015: 11:30 AM-1:30 PM
Imperial Ballroom (Grand America Hotel)
D. L. Coury1, E. S. Matheson2, R. Baum2 and P. Vora2, (1)Nationwide Children's Hospital, Columbus, OH, (2)The Ohio State University College of Medicine, Columbus, OH

 Physicians prescribing second generation antipsychotic (SGA) medications to pediatric autism spectrum disorder (ASD) patients should monitor potential metabolic and neurologic side effects for optimal outcomes and quality of life. An increase in SGA prescribing has raised questions concerning how physicians monitor for and manage metabolic and neurologic SGA side effects. 


The objective of this study was to determine how physicians monitor and respond clinically to metabolic and/or neurologic side effects of SGA prescribed to pediatric ASD patients and to determine if an effective and evidence based standard of care might be formulated based on patterns in side effect occurrence and appropriate monitoring and management. 

Methods: A data query at a large children’s hospital resulted in 151 inpatient and outpatient pediatric patients diagnosed with Autism, Asperger’s, PDD-NOS, Autism Spectrum Disorder, or Pervasive Developmental Disorder seen between August 2010 and July 2014 who received SGA medications (Risperidone, Olanzapine, Aripiprazole, Paliperidone, Quetiapine, and Ziprasidone) for over 30 days. A chart review was performed to analyze neurologic and metabolic adverse effects of SGA (BMI, glucose and lipid panel values, and Abbreviated Abnormal Involuntary Movement Scale (A-AIMS)) throughout the time these patients received SGA. Documentation regarding patient status and complaints, the clinician’s management plan, and responses to adverse effects was reviewed.   


We reviewed 151 patients and 1053 visits. BMI was measured at 986 visits and the A-AIMS performed at 775 visits. 135 patients had labs drawn during their care. Physicians reported positive A-AIMS in 9 patients and metabolic concerns of increased BMI and/or abnormal lipids in 83 patients. At 11 visits with positive A-AIMS, 27.3% weaned SGA, 18.2% decreased the dose, 36.4% continued the dose, and 9% switched to a different class of medication. At 63 visits with abnormal lipids providers chose to refer to nutrition specialists (28.6%), discuss exercise (19%), discuss diet (19%), continue SGA with no change in care (19%), ordered repeat labs (14.3%), refer to a cardiology lipid clinic (9.5%), prescribe metformin (9.5%), wean patient off SGA (6.3%), recommended diet counseling (4.8%), increase the dosage (4.8%), and change to a different SGA (3.2%). At 112 visits for increased BMI, 41% ordered labs, 35.71% gave advice on diet, calories and food selection, 33% continued SGA with no change, 25.9% referred to nutrition, 24% recommended physical activity, 11.6% decreased the dose, 8% changed to a different SGA, 7.1% prescribed metformin, 6.3% stopped the SGA, 5.4% increased the dose.


 In our institution, SGA monitoring for adverse effects was done in the majority of patients. Clinician management of these effects was variable and reflected risk-benefit decisions made with patient and family input. Development of best practices may help promote better outcomes for these patients.