OBJECTIVE: The objectives of this study were to examine rates and predictors of psychotropic use and multiclass polypharmacy among commercially insured children with autism spectrum disorders (ASD). METHODS: This retrospective observational study used administrative medical and pharmacy claims data linked with health plan enrollment and sociodemographic information from 2001 to 2009. Children with ASD were identified by using a validated ASD case algorithm. Psychotropic polypharmacy was defined as concurrent medication fills across ≥ 2 classes for at least 30 days. Multinomial logistic regression was used to model 5 categories of psychotropic use and multiclass polypharmacy. RESULTS: Among 33,565 children with ASD, 64% had a filled prescription for at least 1 psychotropic medication, 35% had evidence of psychotropic polypharmacy (≥ 2 classes), and 15% used medications from ≥ 3 classes concurrently. Among children with polypharmacy, the median length of polypharmacy was 346 days. Older children, those who had a psychiatrist visit, and those with evidence of co-occurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy. CONCLUSIONS: Despite minimal evidence of the effectiveness or appropriateness of multidrug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its co-occurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD.
OBJECTIVE: The objectives of this study were to examine rates and predictors of psychotropic use and multiclass polypharmacy among commercially insured children with autism spectrum disorders (ASD). METHODS: This retrospective observational study used administrative medical and pharmacy claims data linked with health plan enrollment and sociodemographic information from 2001 to 2009. Children with ASD were identified by using a validated ASD case algorithm. Psychotropic polypharmacy was defined as concurrent medication fills across ≥ 2 classes for at least 30 days. Multinomial logistic regression was used to model 5 categories of psychotropic use and multiclass polypharmacy. RESULTS: Among 33,565 children with ASD, 64% had a filled prescription for at least 1 psychotropic medication, 35% had evidence of psychotropic polypharmacy (≥ 2 classes), and 15% used medications from ≥ 3 classes concurrently. Among children with polypharmacy, the median length of polypharmacy was 346 days. Older children, those who had a psychiatrist visit, and those with evidence of co-occurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy. CONCLUSIONS: Despite minimal evidence of the effectiveness or appropriateness of multidrug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its co-occurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD.
Authors: Thomas W Frazier; Paul T Shattuck; Sarah Carter Narendorf; Benjamin P Cooper; Mary Wagner; Edward L Spitznagel Journal: J Child Adolesc Psychopharmacol Date: 2011-12-13 Impact factor: 2.576
Authors: Rahul Ganguly; Jeffrey A Kotzan; L Stephen Miller; Klugh Kennedy; Bradley C Martin Journal: J Clin Psychiatry Date: 2004-10 Impact factor: 4.384
Authors: Julie M Zito; Albert T Derivan; Christopher J Kratochvil; Daniel J Safer; Joerg M Fegert; Laurence L Greenhill Journal: Child Adolesc Psychiatry Ment Health Date: 2008-09-15 Impact factor: 3.033
Authors: Benjamin Zablotsky; Beverly A Pringle; Lisa J Colpe; Michael D Kogan; Catherine Rice; Stephen J Blumberg Journal: J Dev Behav Pediatr Date: 2015 Feb-Mar Impact factor: 2.225
Authors: Johanna K Lake; Danica Denton; Yona Lunsky; Amy M Shui; Jeremy Veenstra-VanderWeele; Evdokia Anagnostou Journal: J Autism Dev Disord Date: 2017-05
Authors: Logan K Wink; Ernest V Pedapati; Ryan Adams; Craig A Erickson; Kahsi A Pedersen; Eric M Morrow; Desmond Kaplan; Matthew Siegel Journal: J Autism Dev Disord Date: 2018-11
Authors: Sarah L Logan; Laura Carpenter; R Scott Leslie; Elizabeth Garrett-Mayer; Kelly J Hunt; Jane Charles; Joyce S Nicholas Journal: J Child Adolesc Psychopharmacol Date: 2015-04-28 Impact factor: 2.576