Journal of Autism and Developmental Disorders

, Volume 47, Issue 1, pp 144–154 | Cite as

Psychotropic Medication Use among Insured Children with Autism Spectrum Disorder

  • Jeanne M. Madden
  • Matthew D. Lakoma
  • Frances L. Lynch
  • Donna Rusinak
  • Ashli A. Owen-Smith
  • Karen J. Coleman
  • Virginia P. Quinn
  • Vincent M. Yau
  • Yinge X. Qian
  • Lisa A. Croen
Original Paper


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.


Autism spectrum disorder Medications Antipsychotics Comorbidities Epidemiological studies 



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.


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

Compliance with Ethical Standards

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.

Supplementary material

10803_2016_2946_MOESM1_ESM.docx (57 kb)
Supplementary material 1 (DOCX 57 KB)


  1. Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., et al. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine: Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 29(6), 870–877. doi: 10.1007/s11606-014-2767-3.CrossRefGoogle Scholar
  2. Aman, M. G., Lam, K. S., & Collier-Crespin, A. (2003). Prevalence and patterns of use of psychoactive medicines among individuals with autism in the Autism Society of Ohio. Journal of Autism and Developmental Disorders, 33(5), 527–534.CrossRefPubMedGoogle Scholar
  3. American Academy of Child and Adolescent Psychiatry. (2011). Practice parameter for the use of atypical antipsychotic medications in children and adolescents. Retrieved from 3615 Wisconsin Ave., NW, Washington, D.C. 20016:
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (DSM-5®): American Psychiatric Association.Google Scholar
  5. American Psychiatric Association, & American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  6. Biederman, J., Mick, E., Faraone, S. V., Braaten, E., Doyle, A., Spencer, T., et al. (2002). Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. The American Journal of Psychiatry, 159(1), 36–42. doi: 10.1176/appi.ajp.159.1.36.CrossRefPubMedGoogle Scholar
  7. Bishop, T. F., Press, M. J., Keyhani, S., & Pincus, H. A. (2014). Acceptance of insurance by psychiatrists and the implications for access to mental health care. JAMA Psychiatry, 71(2), 176–181. doi: 10.1001/jamapsychiatry.2013.2862.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Burke, J. P., Jain, A., Yang, W., Kelly, J. P., Kaiser, M., Becker, L., et al. (2014). Does a claims diagnosis of autism mean a true case? Autism: The International Journal of Research and Practice, 18(3), 321–330. doi: 10.1177/1362361312467709.CrossRefGoogle Scholar
  9. Canitano, R. (2007). Epilepsy in autism spectrum disorders. European Child and Adolescent Psychiatry, 16(1), 61–66. doi: 10.1007/s00787-006-0563-2.CrossRefPubMedGoogle Scholar
  10. Canitano, R. (2015). Mood stabilizers in children and adolescents with autism spectrum Disorders. Clinical Neuropharmacology, 38(5), 177–182. doi: 10.1097/WNF.0000000000000096.CrossRefPubMedGoogle Scholar
  11. Cohen, P., Cohen, J., Kasen, S., Velez, C. N., Hartmark, C., Johnson, J., et al. (1993). An epidemiological study of disorders in late childhood and adolescence–I. Age- and gender-specific prevalence. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 34(6), 851–867.CrossRefPubMedGoogle Scholar
  12. Coleman, K. J., Lutsky, M. A., Yau, V., Qian, Y., Pomichowski, M. E., Crawford, P. M., et al. (2015). Validation of autism spectrum disorder diagnoses in large healthcare systems with electronic medical records. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-015-2358-0.PubMedPubMedCentralGoogle Scholar
  13. Costello, E. J., Egger, H., & Angold, A. (2005). 10-year research update review: The epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child and Adolescent Psychiatry, 44(10), 972–986. doi: 10.1097/01.chi.0000172552.41596.6f.CrossRefPubMedGoogle Scholar
  14. Croen, L. A., Najjar, D. V., Ray, G. T., Lotspeich, L., & Bernal, P. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118(4), e1203–e1211. doi: 10.1542/peds.2006-0127.CrossRefPubMedGoogle Scholar
  15. Cummings, J. R., Lynch, F. L., Rust, K. C., Coleman, K. J., Madden, J. M., Owen-Smith, A. A., et al. (2016). Health services utilization among children with and without autism spectrum disorders. Journal of Autism and Developmental Disorders, 46(3), 910–920. doi: 10.1007/s10803-015-2634-z.CrossRefPubMedGoogle Scholar
  16. Dawson, G. (2013). Dramatic increase in autism prevalence parallels explosion of research into its biology and causes. JAMA Psychiatry, 70(1), 9–10. doi: 10.1001/jamapsychiatry.2013.488.CrossRefPubMedGoogle Scholar
  17. Developmental, D. M. N. S. Y., & 2010 Principal Investigators. (2014). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveillance Summary, 63(2), 1–21.Google Scholar
  18. Dove, D., Warren, Z., McPheeters, M. L., Taylor, J. L., Sathe, N. A., & Veenstra-VanderWeele, J. (2012). Medications for adolescents and young adults with autism spectrum disorders: A systematic review. Pediatrics, 130(4), 717–726. doi: 10.1542/peds.2012-0683.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Esbensen, A. J., Greenberg, J. S., Seltzer, M. M., & Aman, M. G. (2009). A longitudinal investigation of psychotropic and non-psychotropic medication use among adolescents and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(9), 1339–1349. doi: 10.1007/s10803-009-0750-3.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Glasser, M. (2010). The history of managed care and the role of the child and adolescent psychiatrist. Child Adolescent Psychiatric Clinics of North America, 19(1), 63–74. doi: 10.1016/j.chc.2009.08.009.CrossRefPubMedGoogle Scholar
  21. Harstad, E., Levy, S., & Committee on Substance, A. (2014). Attention-deficit/hyperactivity disorder and substance abuse. Pediatrics, 134(1), e293–301. doi: 10.1542/peds.2014-0992.CrossRefPubMedGoogle Scholar
  22. Hartley, S. L., & Sikora, D. M. (2009). Sex differences in autism spectrum disorder: An examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. Journal of Autism and Developmental Disorders, 39(12), 1715–1722. doi: 10.1007/s10803-009-0810-8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Johnson, C. P., & Myers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215. doi: 10.1542/peds.2007-2361.CrossRefPubMedGoogle Scholar
  24. Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders: A review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 15(3), 247–277. doi: 10.1007/s10567-012-0119-6.CrossRefPubMedGoogle Scholar
  25. Kessler, R. C., Avenevoli, S., & Ries Merikangas, K. (2001). Mood disorders in children and adolescents: An epidemiologic perspective. Biological Psychiatry, 49(12), 1002–1014.CrossRefPubMedGoogle Scholar
  26. Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., & McLennan, J. (1989). Autism diagnostic interview: a standardized investigator-based instrument. Journal of Autism and Developmental Disorders, 19(3), 363–387.CrossRefPubMedGoogle Scholar
  27. Logan, S. L., Nicholas, J. S., Carpenter, L. A., King, L. B., Garrett-Mayer, E., & Charles, J. M. (2012). High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network. Annals of Epidemiology, 22(1), 1–8. doi: 10.1016/j.annepidem.2011.10.007.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Lord, C., Petkova, E., Hus, V., Gan, W., Lu, F., Martin, D. M., et al. (2012). A multisite study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry, 69(3), 306–313. doi: 10.1001/archgenpsychiatry.2011.148.CrossRefPubMedGoogle Scholar
  29. Lord, C., Risi, S., Lambrecht, L., Cook, E. H. Jr., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.CrossRefPubMedGoogle Scholar
  30. Lu, C. Y., Zhang, F., Lakoma, M. D., Madden, J. M., Rusinak, D., Penfold, R. B., … Soumerai, S. B. (2014). Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: Quasi-experimental study. BMJ, 348, g3596.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Mandell, D. S., Morales, K. H., Marcus, S. C., Stahmer, A. C., Doshi, J., & Polsky, D. E. (2008). Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics, 121(3), e441–e448. doi: 10.1542/peds.2007-0984.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Matson, J. L., & Kozlowski, A. M. (2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders, 5.1, 418–425.CrossRefGoogle Scholar
  33. Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52(7), 679–688. doi: 10.1016/j.jaac.2013.05.006.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Mazzone, L., Ruta, L., & Reale, L. (2012). Psychiatric comorbidities in asperger syndrome and high functioning autism: Diagnostic challenges. Annals of General Psychiatry, 11(1), 16. doi: 10.1186/1744-859x-11-16.CrossRefPubMedPubMedCentralGoogle Scholar
  35. McPheeters, M. L., Warren, Z., Sathe, N., Bruzek, J. L., Krishnaswami, S., Jerome, R. N., & Veenstra-Vanderweele, J. (2011). A systematic review of medical treatments for children with autism spectrum disorders. Pediatrics, 127(5), e1312–e1321. doi: 10.1542/peds.2011-0427.CrossRefPubMedGoogle Scholar
  36. MHRN. Mental Health Research Network (website). Retrieved from
  37. Oswald, D. P., & Sonenklar, N. A. (2007). Medication use among children with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 17(3), 348–355. doi: 10.1089/cap.2006.17303.CrossRefPubMedGoogle Scholar
  38. Penfold, R. B., Stewart, C., Hunkeler, E. M., Madden, J. M., Cummings, J. R., Owen-Smith, A. A., et al. (2013). Use of antipsychotic medications in pediatric populations: What do the data say? Current Psychiatry Reports, 15(12), 426. doi: 10.1007/s11920-013-0426-8.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Peters-Scheffer, N., Didden, R., Korzilius, H., & Sturmey, P. (2011). A meta-analytic study on the effectiveness of comprehensive ABA-based early intervention programs for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5.1, 60–69.CrossRefGoogle Scholar
  40. Pletcher, B. A., Rimsza, M. E., Cull, W. L., Shipman, S. A., Shugerman, R. P., & O’Connor, K. G. (2010). Primary care pediatricians’ satisfaction with subspecialty care, perceived supply, and barriers to care. Journal of Pediatrics, 156(6), 1011–1015, 1015.e1. doi: 10.1016/j.jpeds.2009.12.032.CrossRefPubMedGoogle Scholar
  41. Rosenberg, R. E., Mandell, D. S., Farmer, J. E., Law, J. K., Marvin, A. R., & Law, P. A. (2010). Psychotropic medication use among children with autism spectrum disorders enrolled in a national registry, 2007–2008. Journal of Autism and Developmental Disorders, 40(3), 342–351. doi: 10.1007/s10803-009-0878-1.CrossRefPubMedGoogle Scholar
  42. Siegel, M., & Beaulieu, A. A. (2012). Psychotropic medications in children with autism spectrum disorders: A systematic review and synthesis for evidence-based practice. Journal of Autism and Developmental Disorders, 42(8), 1592–1605. doi: 10.1007/s10803-011-1399-2.CrossRefPubMedGoogle Scholar
  43. Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. doi: 10.1097/CHI.0b013e318179964f.CrossRefPubMedGoogle Scholar
  44. Solomon, M., Miller, M., Taylor, S. L., Hinshaw, S. P., & Carter, C. S. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(1), 48–59. doi: 10.1007/s10803-011-1215-z.CrossRefPubMedGoogle Scholar
  45. Thomas, C. R., & Holzer, C. E. (2006). The continuing shortage of child and adolescent psychiatrists. Journal of American Academy Child Adolescent Psychiatry, 45(9), 1023–1031. doi: 10.1097/01.chi.0000225353.16831.5d.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jeanne M. Madden
    • 1
    • 2
  • Matthew D. Lakoma
    • 2
  • Frances L. Lynch
    • 3
  • Donna Rusinak
    • 2
    • 8
  • Ashli A. Owen-Smith
    • 4
    • 5
  • Karen J. Coleman
    • 6
  • Virginia P. Quinn
    • 6
  • Vincent M. Yau
    • 7
    • 9
  • Yinge X. Qian
    • 7
  • Lisa A. Croen
    • 7
  1. 1.Department of Pharmacy and Health Systems SciencesSchool of Pharmacy, Bouvé College of Health Sciences, Northeastern UniversityBostonUSA
  2. 2.Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonUSA
  3. 3.The Center for Health Research, Kaiser Permanente NorthwestPortlandUSA
  4. 4.School of Public HealthGeorgia State UniversityAtlantaUSA
  5. 5.Kaiser Permanente Georgia, Center for Clinical and Outcomes ResearchAtlantaUSA
  6. 6.Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  7. 7.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  8. 8.Massachusetts General HospitalBostonUSA
  9. 9.McKesson CorporationSan FranciscoUSA

Personalised recommendations