Original Investigation

Psychopharmacology

, Volume 231, Issue 6, pp 1011-1021

Open Access This content is freely available online to anyone, anywhere at any time.

Pharmacological treatments prescribed to people with autism spectrum disorder (ASD) in primary health care

  • Macey L. MurrayAffiliated withCentre for Paediatric Pharmacy Research, Department of Practice and Policy, UCL School of Pharmacy, University College London Email author 
  • , Yingfen HsiaAffiliated withCentre for Paediatric Pharmacy Research, Department of Practice and Policy, UCL School of Pharmacy, University College LondonCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong
  • , Karen GlaserAffiliated withDepartment of Social Science, Health & Medicine, King’s College London
  • , Emily SimonoffAffiliated withDepartment of Child and Adolescent Psychiatry, Institute of Psychiatry and Biomedical Research Centre for Mental Health, King’s College London
  • , Declan G. M. MurphyAffiliated withDepartment of Forensic and Developmental Sciences, Institute of Psychiatry, King’s College London
  • , Philip J. AshersonAffiliated withMRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London
  • , Hanna EklundAffiliated withDepartment of Social Science, Health & Medicine, King’s College LondonDepartment of Forensic and Developmental Sciences, Institute of Psychiatry, King’s College London
  • , Ian C. K. WongAffiliated withCentre for Paediatric Pharmacy Research, Department of Practice and Policy, UCL School of Pharmacy, University College LondonCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong

Abstract

Rationale

Autism spectrum disorders (ASDs) affect 1 % of children, having significant impact on health and social outcomes. Psychotropic medication use by individuals with ASD in the USA increased over time, and polypharmacy occurred in >50 % of those prescribed. In the UK, no psychotropic drugs are approved in ASDs, and little is known about patterns of pharmacological treatment in the ASD population and associated co-morbidities.

Methods

We used The Health Improvement Network, a nationally representative primary care database, to assess the prevalence of ASD diagnoses, psychotropic drug prescribing and neuropsychiatric co-morbidities of 0–24 year olds between 1992 and 2008.

Results

ASD prevalence increased 65-fold from 0.01 % (1992) to 0.50 % (2008). Psychotropic drugs were prescribed to 29 % (1,619/5,651) of the ASD cohort; the most prescribed drugs were sleep medication (9.7 % of prescribed patients), psychostimulants (7.9 %) and antipsychotics (7.3 %). More patients were given psychostimulants and sleep medications over time from 1.5–6.3 % and 2.2–5.9 % respectively. Thirty-seven per cent of the cohort had ≥1 record of a neuropsychiatric co-morbidity, the most common being developmental difficulties and learning disabilities (12.6 %), behavioural, conduct and personality disorders (11.1 %) and attention deficit hyperactivity disorder (7.5 %).

Conclusions

British physicians are more conservative in prescribing practice than American colleagues. However, use of psychostimulants and antipsychotics is much higher in those with ASD than in the general population. Polypharmacy was seen in 34 % of prescribed patients in 2008. Additional studies examining use, efficacy, and long-term safety of antipsychotics and psychostimulants in autistic individuals are warranted.

Keywords

Autistic spectrum disorder Prevalence Psychotropic drugs Primary care Co-morbidity Children Adolescents Young adults