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Psychotropic Medication Use among Insured Children with Autism Spectrum Disorder

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Abstract

This study examined psychotropic medication use among 7901 children aged 1–17 with autism spectrum disorder (ASD) in five health systems, comparing to matched cohorts with no ASD. Nearly half (48.5 %) of children with ASD received psychotropics in the year observed; the most common classes were stimulants, alpha-agonists, or atomoxetine (30.2 %), antipsychotics (20.5 %), and antidepressants (17.8 %). Psychotropic treatment was far more prevalent among children with ASD, as compared to children with no ASD (7.7 % overall), even within strata defined by the presence or absence of other psychiatric diagnoses. The widespread use of psychotropics we observed, particularly given weak evidence supporting the effectiveness of these medications for most children with ASD, highlights challenges in ASD treatment and the need for greater investment in its evaluation.

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Acknowledgments

All phases of this study were supported by a grant from NIH, U19MH092201 (PI: Simon). The authors are grateful to Fang Zhang, PhD (Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston) for statistical advice and Gregory E. Simon, MD, MPH (Group Health Research Institute, Seattle), Stephen B. Soumerai, ScD (HMS/HPHCI), and Elizabeth B. Caronna, MD (Harvard Vanguard Medical Associates, Developmental and Behavioral Pediatrics, Boston) for critical reading and content advice.

Author Contributions

JM designed the study, led data acquisition from HPHC site, led all study analyses, and drafted and revised the manuscript; ML was primary analyst and carried out all statistical analyses; FL led data acquisition from KPNW site and contributed to interpretation of analyses; DR was project manager for the study; AOS led data acquisition from KPGA site and contributed to interpretation of analyses; KC led data acquisition from KPSC site and contributed to interpretation of analyses; VQ contributed to interpretation of analyses; VY contributed toward initial study design and interpretation of analyses; YQ prepared the unified 5-site dataset; LC was Principal Investigator, established the concept for the study, led data acquisition from KPNC site, and contributed to interpretation of analyses; all authors were involved in critical revisions of the manuscript and approved the final version as submitted.

Funding

This study was funded by the National Institutes of Health (Grant U19MH092201).

Author information

Author notes

  1. Donna Rusinak

    Present address: Massachusetts General Hospital, Boston, MA, USA

  2. Vincent M. Yau

    Present address: McKesson Corporation, San Francisco, CA, USA

Authors and Affiliations

  1. Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue R218X TF, Boston, MA, 02115, USA

    Jeanne M. Madden

  2. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Jeanne M. Madden, Matthew D. Lakoma & Donna Rusinak

  3. The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA

    Frances L. Lynch

  4. School of Public Health, Georgia State University, Atlanta, GA, USA

    Ashli A. Owen-Smith

  5. Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta, GA, USA

    Ashli A. Owen-Smith

  6. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Karen J. Coleman & Virginia P. Quinn

  7. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Vincent M. Yau, Yinge X. Qian & Lisa A. Croen

Authors
  1. Jeanne M. Madden
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  2. Matthew D. Lakoma
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  10. Lisa A. Croen
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Corresponding author

Correspondence to Jeanne M. Madden.

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Conflict of Interest

All authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of the Harvard Pilgrim Health Care Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Human Subjects Committee of Harvard Pilgrim Health Care determined that our study met the regulatory requirements necessary in order to waive informed consent. This article does not contain any studies with animals performed by any of the authors.

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Madden, J.M., Lakoma, M.D., Lynch, F.L. et al. Psychotropic Medication Use among Insured Children with Autism Spectrum Disorder. J Autism Dev Disord 47, 144–154 (2017). https://doi.org/10.1007/s10803-016-2946-7

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