Use of Psychotropic Medications for Autism in Children Is Increasing
Gerhard T, Chavez B, Olfson M, and Crystal S. National Patterns in the Outpatient Pharmacological Management of Children and Adolescents With Autism Spectrum Disorder. Journal of Clinical Psychopharmacology.2009;29(3):307-310.
By Kim L. Farina, PhD
The use of psychotropic medications in the outpatient setting among U.S. children diagnosed with autism spectrum disorder (ASD) has increased, according to a new report from the Rutgers Center for Education and Research on Therapeutics, funded by the Agency for Healthcare Research and Quality.
Results of the analyses, published in the June 2009 issue of the Journal of Clinical Psychopharmacology, indicate that between 2001-2005, psychotropic medications were prescribed during almost 80% of outpatient ASD visits by children aged 1-19 years-of-age (79% [95% CI, 66%-91%]). This represents a 40% increase from an earlier study period of 1996-2000 (39% [95% CI, 13%-65%]). Stimulants, antidepressants, and antipsychotics were the most commonly prescribed classes of medications.
Additionally, the number of pediatric ASD outpatient visits increased nearly three-fold over the course of the study period (number of ASD visits per 100,000 population: 1996-2000, 168 [95% CI, 76-259]; 2001-2005, 543 [95% CI, 268-819]).
The authors attributed these findings to increased public awareness of autism and availability of new medications. They also pointed out that there is a limited evidence base supporting pharmacologic interventions for autistic children, calling for "well-controlled clinical trials that test the safety and efficacy of psychotropic medications in this patient population."
Study data were obtained for a 10-year period (1996-2000 and 2001-2005) from nationally representative surveys conducted by the National Center for Health Statistics, specifically, the National Ambulatory Medical Survey (NAMCS) and the outpatient portion of the National Hospital Ambulatory Medical Care Survey (NHAMCS). Study limitations include small sample size, independent judgment of physicians in making diagnoses, sampling based on visits rather than patients, and presence of comorbid mental disorders.
Other findings for the 2001-2005 period include:
- Visits were made by patients who were overwhelmingly male (79%, 95%CI, 72-86), white (82%, 95%CI, 75-90), and non-Hispanic (90%, 95%CI, 82-98), with a mean age of 10.6 years (95% CI, 9.7-11.6).
- Most visits occurred in physician offices with nearly 75% provided by office-based psychiatrists or neurologists (73%, 95%CI, 53-93; limited to the NAMCS sample).
- Private insurance was the most common source of payment (46%, 95%CI, 22-69).
- Mean number of psychotropic medication classes prescribed per visit was 2.4 (95% CI, 1.6-3.1).
- Nearly one half of visits reported a comorbid mental disorder (46%, 95% CI, 23-70).
- Psychotherapy or mental health management was provided during 65% of visits (95% CI, 46-85).
- Gerhard T, Chavez B, Olfson M, and Crystal S. National Patterns in the Outpatient Pharmacological Management of Children and Adolescents With Autism Spectrum Disorder. Journal of Clinical Psychopharmacology.2009;29(3):307-310.
Posted May 29, 2009