High Medication Rates for Children with Autism

Autistic children taking psychotropic medications at high rates

(RxWiki News) Children with autism may also be diagnosed with other mental health conditions. These children, and those with only autism, may be prescribed mental health medications, too.

A recent study found that mental health medication use was high among children with autism spectrum disorders (ASD).

In fact, more than half of autistic children in this study had taken at least one psychotropic medication, and a third had taken more than one at once.

Psychotropic drugs are medications usually prescribed for mental health conditions, ranging from depression or bipolar disorder to schizophrenia or attention deficit hyperactivity disorder (ADHD), among others.

There is not a lot of good information about the safety and effectiveness of mental health medications for young children.

"Discuss your child's medication needs with their doctor."

This study, led by Donna Spencer, PhD, of OptumInsight Life Sciences in Eden Prairie, Minnesota, looked at how common it was for autistic children to take psychotropic medications between 2001 and 2009.

The researchers investigated the health records of 33,565 children who had an autism spectrum disorder.

Part of the study also looked at how common it was for children with autism to take more than one psychotropic medication. This measure was defined as filling a prescription for at least two different types of psychotropic medications within a month.

Among all the children studied, 64 percent had filled a prescription for at least one psychotropic medication during the course of the study.

More than a third of the children (35 percent) had filled prescriptions for at least two psychotropic medications within 30 days of each other.

A smaller but still substantial percentage (15 percent) of the children had filled prescriptions for at least three psychotropic medications at once.

The average length of time that autistic children took multiple psychotropic medications was about 18 months, though some went much longer or much shorter.

For the children taking more than one mental health medication at the same time, about half took the medications for more than a year. The other half took the multiple medications for less than 11.5 months.

The most commonly prescribed psychotropic medication combinations were antidepressants with attention deficit hyperactivity disorder (ADHD) medications — which 38 percent of the children took — and antipsychotics with ADHD medications, which 28 percent of the children took.

In addition, one in five of the children (20 percent) took antipsychotics and antidepressants at the same time.

Meanwhile, almost one in five children (18 percent) took antipsychotics, antidepressants and ADHD medications all at the same time.

Autistic children were more likely to be prescribed a psychotropic medication, or multiple ones, if they had either visited a psychiatrist or were older.

Yet, a third of the children (33 percent) aged 2 to 10 had been prescribed more than one medication, and 10 percent of children under age 1 had been prescribed multiple psychotropic medications.

Autistic children were also more likely to be prescribed one or more psychotropic medications if they had been diagnosed with other conditions, including seizures, ADHD, anxiety, bipolar disorder or depression.

The researchers explained that they did not try to match up children's medication types with diagnoses the children may have had.

"The appropriate reasons and indications for antipsychotic medications and antidepressants, however, are less clearly defined," they wrote. "These medications could have been given for a wide variety of symptoms among children with autism spectrum disorders, without proven benefit or safety."

The researchers mentioned that safety and effectiveness data for multiple psychotropic medications in children is sparse.

"Despite minimal evidence of the effectiveness or appropriateness of multi-drug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its co-occurring conditions," the researchers wrote.

"Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD," they wrote.

Glen Elliott, MD, PhD, a clinical professor at the Stanford University Department of Psychiatry and Behavioral Sciences, said the authors in this study have offered important data and make a reasonable conclusion in discussing how little is known about the safety and effectiveness of many of these medications for children. 

"That said, as they also note, although no medications yet available treat autism itself, many with this disorder have other behavioral issues for which medications may provide much-needed relief," Dr. Elliott said.

"It is unlikely to be a coincidence that the rate of medication use and especially of polypharmacy [multiple medications at once] rises with patient age:  adult-sized adolescents with autism plus other disorders such as anxiety, depression, self-injurious behaviors, and aggression can pose a genuine treatment conundrum for which medications may seem the only reasonable option, even in the absence of strong proof of efficacy and safety," he said.  "Monitoring definitely is needed, but a call for more research does not help parents and physicians facing crises now.”

This study was published October 21 in the journal Pediatrics. The authors declared no conflicts of interest.

The research was funded by the National Institute of Mental Health, the National Institutes of Health and the US Department of Health and Human Services.

Review Date: 
October 20, 2013