Therapy and Medication Use in Young Children with Autism: A Secondary Data Analysis from the Autism Speaks-Autism Treatment Network

Background:  Guidelines suggest that young children with Autism Spectrum Disorder (ASD) should receive intensive psychosocial interventions.  Additionally, associated symptoms may be treated with psychotropic medications. However, actual intervention use by young children with ASD has not been well characterized.

Objectives:  The aim of this study was to describe interventions received by young children with ASD ≥6 months after diagnosis. The association with socio-demographic factors was also explored.

Methods:  Data were used from the Autism Speaks- Autism Treatment Network (AS-ATN), a research registry of children with ASD which includes 17 sites in the U.S. and Canada. AS-ATN participants undergo a standardized diagnostic evaluation and receive treatment recommendations from Autism specialists.  Parents report services and medications being used at follow-up visits. This study used data from 12/2007 to 12/2013 and included 1354 subjects aged 36-72 months.

Results:  Most young children (91%) received psychosocial interventions but only 36% received behavioral-based therapy. The median total hours per week of therapy was only 5.0 hours (range 0-65; interquartile range 1.5-14) and of those who received behavioral-based therapies, the median hours per week received was only 4.6 hours  (range 0.1-50, interquartile range: 2-12). 50% of subjects received <5 hours per week of therapy and only 18% reported receiving >20 hours per week of therapy. Demographic factors found to be associated with increased total therapy intensity included younger age, non-Hispanic/ Latino ethnicity, higher parental educational level and geographic location in the Northeast or Southern U.S. Additionally, 22.4% of subjects were on ≥1 psychotropic medication and the most commonly prescribed medications were α-agonists Demographic factors found to be associated with increased psychotropic medication use included older age, Black/ African American race, lower parental education and living in Canada.

Conclusions:  Relatively few young children with ASD diagnosed at high quality academic centers are receiving evidence-based behavioral therapies and few are receiving psychosocial interventions at the recommended intensity. There is significant regional and socio-demographic variability in psychosocial intervention and psychotropic medication use. Additionally, the class of medications most commonly prescribed has not been extensively studied in this population. Further research is needed to support current prescribing practices and to improve access to evidence-based treatments for young children with ASD.