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Profile of psychotropic agents used in autism spectrum disorder according to comorbidities in Turkey: A 4-year evaluation. Int Clin Psychopharmacol 2023:00004850-990000000-00048. [PMID: 36752705 DOI: 10.1097/yic.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
It is known that the use of psychotropic pharmaceuticals is common in comorbidities seen in autism spectrum disorder (ASD). We have very limited knowledge about which psychotropic drugs are prescribed when comorbidities are diagnosed in patients with ASD. It is aimed to determine the profile of psychotropic agents in patients diagnosed with ASD associated with comorbidities between the ages of 0-24 in Turkey over 4 years. Data belonging to ASD in Prescription Information System (PIS) was obtained from the 'Turkish Medicines and Medical Devices Agency'. A total of 34 066 prescriptions including 45 624 psychotropic drugs were analyzed. A total of psychotropic drugs prescribed for patients with ASD was 75.4%. The following psychotropic drugs were prescribed for the patients with ASD and its comorbidities; risperidone (28.6%), aripiprazole (13.7%), and valproic acid (11.3%) are the most preferred psychotropics. The percentage of pharmaceuticals containing psychotropic active substances in prescriptions with ASD and its comorbidities is 7.5%. This study is the first research in which psychotropics used in ASD were evaluated over a wide period and nationwide. Antipsychotics were most commonly prescribed with the diagnosis of ASD. In the presence of ASD and its comorbidities, risperidone was most frequently prescribed.
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Feroe AG, Uppal N, Gutiérrez-Sacristán A, Mousavi S, Greenspun P, Surati R, Kohane IS, Avillach P. Medication Use in the Management of Comorbidities Among Individuals With Autism Spectrum Disorder From a Large Nationwide Insurance Database. JAMA Pediatr 2021; 175:957-965. [PMID: 34097007 PMCID: PMC8185632 DOI: 10.1001/jamapediatrics.2021.1329] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Although there is no pharmacological treatment for autism spectrum disorder (ASD) itself, behavioral and pharmacological therapies have been used to address its symptoms and common comorbidities. A better understanding of the medications used to manage comorbid conditions in this growing population is critical; however, most previous efforts have been limited in size, duration, and lack of broad representation. OBJECTIVE To use a nationally representative database to uncover trends in the prevalence of co-occurring conditions and medication use in the management of symptoms and comorbidities over time among US individuals with ASD. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cohort study mined a nationwide, managed health plan claims database containing more than 86 million unique members. Data from January 1, 2014, to December 31, 2019, were used to analyze prescription frequency and diagnoses of comorbidities. A total of 26 722 individuals with ASD who had been prescribed at least 1 of 24 medications most commonly prescribed to treat ASD symptoms or comorbidities during the 6-year study period were included in the analysis. EXPOSURES Diagnosis codes for ASD based on International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. MAIN OUTCOMES AND MEASURES Quantitative estimates of prescription frequency for the 24 most commonly prescribed medications among the study cohort and the most common comorbidities associated with each medication in this population. RESULTS Among the 26 722 individuals with ASD included in the analysis (77.7% male; mean [SD] age, 14.45 [9.40] years), polypharmacy was common, ranging from 28.6% to 31.5%. Individuals' prescription regimens changed frequently within medication classes, rather than between classes. The prescription frequency of a specific medication varied considerably, depending on the coexisting diagnosis of a given comorbidity. Of the 24 medications assessed, 15 were associated with at least a 15% prevalence of a mood disorder, and 11 were associated with at least a 15% prevalence of attention-deficit/hyperactivity disorder. For patients taking antipsychotics, the 2 most common comorbidities were combined type attention-deficit/hyperactivity disorder (11.6%-17.8%) and anxiety disorder (13.1%-30.1%). CONCLUSIONS AND RELEVANCE This study demonstrated considerable variability and transiency in the use of prescription medications by US clinicians to manage symptoms and comorbidities associated with ASD. These findings support the importance of early and ongoing surveillance of patients with ASD and co-occurring conditions and offer clinicians insight on the targeted therapies most commonly used to manage co-occurring conditions. Future research and policy efforts are critical to assess the extent to which pharmacological management of comorbidities affects quality of life and functioning in patients with ASD while continuing to optimize clinical guidelines, to ensure effective care for this growing population.
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Affiliation(s)
| | | | | | - Sajad Mousavi
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Philip Greenspun
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Rajeev Surati
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Isaac S. Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts,Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts,Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
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Quebles I, Solomon O, Smith KA, Rao SR, Lu F, Azen C, Anaya G, Yin L. Racial and Ethnic Differences in Behavioral Problems and Medication Use Among Children With Autism Spectrum Disorders. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 125:369-388. [PMID: 32936891 PMCID: PMC8423191 DOI: 10.1352/1944-7558-125.5.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/14/2020] [Indexed: 06/03/2023]
Abstract
We examined racial and ethnic differences in the prevalence of behavioral problems measured by the Child Behavioral Checklist (CBCL), sleep disturbances measured by the Child Sleep Habits Questionnaire (CSHQ), and medication use among children with Autism Spectrum Disorders (ASD). We analyzed data from the Autism Treatment Network (ATN) dataset for 2,576 children ages 6 to 18 years of age diagnosed with ASD. Multivariable logistic regression accounting for age, gender, Diagnostic and Statistical Manual of Mental Disorders (4th Edition - Text Revision), diagnosis (Autistic Disorder, PDD-NOS, Asperger's Disorder), and parents' education did not show any racial or ethnic differences in behavioral challenges, conduct problems, or sleep disturbances for any of the groups, but Black children had lower odds of Total Problem Behaviors and Asian children had lower odds of Hyperactivity compared to White children. As a group, children from racial and ethnic minorities had lower odds of Total Problem Behaviors and Conduct Problems compared to White children. Hispanic children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct Problems. Asian children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, and Hyperactivity; and had close to lower odds in medication use for Conduct Problems. Black children had lower odds for medication use for Total Problem Behaviors only. As a group, children from racial and ethnic minorities had lower odds for medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct problems, but not for Sleep Disturbances. While these results are consistent with previous studies showing that White children are significantly more likely to receive psychotropic medication compared to children from racial and ethnic minority groups, we found no such differences for sleep challenges, suggesting that they are more consistently identified and equitably treated than other behavioral problems associated with ASD. We draw upon Andersen's (1995) Behavioral Model of Healthcare Use to suggest predisposing, enabling, and needs factors that may contribute to this pattern of racial and ethnic differences in the use of medications among children ASD.
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Affiliation(s)
- Irina Quebles
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Olga Solomon
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Kathryn A Smith
- Irina Quebles, Olga Solomon, and Kathryn A. Smith, Children's Hospital Los Angeles, University of Southern California
| | - Sowmya R Rao
- Sowmya R. Rao and Frances Lu, Massachusetts General Hospital, Boston
| | - Frances Lu
- Sowmya R. Rao and Frances Lu, Massachusetts General Hospital, Boston
| | - Colleen Azen
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
| | - Grace Anaya
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
| | - Larry Yin
- Colleen Azen, Grace Anaya, and Larry Yin, Children's Hospital Los Angeles, University of Southern California
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Criado KK, Sharp WG, McCracken CE, De Vinck-Baroody O, Dong L, Aman MG, McDougle CJ, McCracken JT, Arnold LE, Weitzman C, Leventhal JM, Vitiello B, Scahill L. Overweight and obese status in children with autism spectrum disorder and disruptive behavior. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:450-459. [PMID: 28325061 PMCID: PMC5581311 DOI: 10.1177/1362361316683888] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Overweight and obesity are common in pediatric populations. Children with autism spectrum disorder and disruptive behavior may be at higher risk. This study examined whether children with autism spectrum disorder and disruptive behavior are more likely to be overweight or obese than matched controls. Baseline data from medication-free children with autism spectrum disorder who participated in trials conducted by the Research Units on Pediatric Psychopharmacology Autism Network (N = 276) were compared to 544 control children from the National Health and Nutrition Examination Survey database matched on age, sex, race, parent education, and era of data collection. The mean age of the children with autism spectrum disorder was 7.9 ± 2.6 years; 84.4% were males. In the autism spectrum disorder group, the prevalence was 42.4% for overweight and 21.4% for obesity compared to 26.1% for overweight and 12.0% for obesity among controls (p < 0.001 for each contrast). Within the autism spectrum disorder sample, obesity was associated with minority status and lower daily living skills. These findings suggest that children with autism spectrum disorder and disruptive behavior are at increased risk for obesity and underscore the need for weight management interventions in this population.
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Affiliation(s)
- Kristen K Criado
- Department of Pediatrics, Emory University School of Medicine, USA
- Marcus Autism Center, USA
| | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, USA
- Marcus Autism Center, USA
| | | | | | - Liansai Dong
- Rollins School of Public Health, Emory University, USA
| | | | - Christopher J McDougle
- Lurie Center for Autism, Massachusetts General Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - James T McCracken
- Division of Child Psychiatry, University of California at Los Angeles, USA
| | | | | | | | | | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, USA
- Marcus Autism Center, USA
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Meiri G, Azoulay H, Menashe I. Characteristics Associated with Drug Prescription and Compliance Among Young Children with Autism Spectrum Disorder. J Child Adolesc Psychopharmacol 2018; 28:232-237. [PMID: 29266976 DOI: 10.1089/cap.2017.0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Psychotropic drugs are prescribed to people with autism spectrum disorder (ASD) usually as a means to alleviate comorbidities associated with the disorder. However, despite the uncertainty regarding the efficacy of these treatments for ASD, their prevalence is continuously increasing. The goal of this study was to understand the characteristics associated with drug prescription and compliance among young children with ASD. MATERIALS AND METHODS We studied patterns of drug utilization in a population-based sample of 211 young children with ASD in Southern Israel. Data regarding drug prescription and compliance (percentage of purchased drugs out of total prescriptions) were acquired from the electronic records of these patients. Compliance rates (CRs) were calculated as percentage of purchased drugs of the total number of prescriptions. RESULTS A total of 122 prescriptions were made for 75 children in our sample. Drug prescription was significantly associated with the severity of ASD and the types of comorbidity (p < 0.05). Atypical antipsychotic drugs were the most prevalent drugs (49 children; 23.2%), followed by stimulants (28 children; 13.2%) and first-generation antipsychotic drugs (16 children; 7.6%). The average CR in our sample was 75% ± 3% with about half of the children demonstrating full compliance, and less than fifth of them not complying at all with their drug prescription. CR had a positively linear association with ASD severity at a marginal statistical significance of p = 0.06. No other variables were statistically associated with drug compliance in our study. CONCLUSIONS Our results highlight the significant effect of ASD severity on both the prescription and CRs of drugs among young children with ASD. Further examination of drug utilization for longer periods and larger samples will help confirming our findings and test the effects of other variables on these pharmaceutical parameters.
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Affiliation(s)
- Gal Meiri
- 1 Pre-School Psychiatry Unit, Soroka University Medical Center , Beer Sheva, Israel
| | - Hen Azoulay
- 2 Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheva, Israel
| | - Idan Menashe
- 2 Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer Sheva, Israel .,3 Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev , Beer Sheva, Israel
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Kamimura-Nishimura K, Froehlich T, Chirdkiatgumchai V, Adams R, Fredstrom B, Manning P. Autism spectrum disorders and their treatment with psychotropic medications in a nationally representative outpatient sample: 1994-2009. Ann Epidemiol 2017; 27:448-453.e1. [PMID: 28789776 DOI: 10.1016/j.annepidem.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 04/12/2017] [Accepted: 06/20/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE No prior studies have assessed change in health care provider-coded rates of Autism spectrum disorder (ASD) diagnoses over time, and few have investigated sociodemographic factors associated with having an ASD diagnosis, having behavioral conditions comorbid with ASD, or using psychotropic medications for this group. METHODS We used data from the 1994-2009 National (Hospital) Ambulatory Medical Care Surveys for children aged 2-18 years (n = 158,488). RESULTS Rates of visits with coded-ASD per 100 outpatient medical visits increased from 0.04% to 0.82% from 1994 to 2009. Factors associated with an ASD diagnosis included male gender, lack of private insurance, white race, and later study period. The most frequent comorbid behavioral diagnoses were ADHD, anxiety, disruptive behavior, and mood disorders. Older age was linked to an increased likelihood of having a comorbid behavioral diagnosis and using psychotropic medications. Geographic region was also associated with having a comorbid behavioral diagnosis, and psychotropic use was linked to have a behavioral comorbidity. Comorbidities with the highest rates of psychotropic use were ADHD, mood, and anxiety disorders. CONCLUSIONS Pediatric outpatient visits with an ASD diagnosis have increased dramatically from 1994 to 2009. Further study is needed to determine the reasons for the observed sociodemographic disparities in ASD diagnosis.
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Affiliation(s)
- Kelly Kamimura-Nishimura
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Tanya Froehlich
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Ryan Adams
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bridget Fredstrom
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Patty Manning
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Lamberti M, Siracusano R, Italiano D, Alosi N, Cucinotta F, Di Rosa G, Germanò E, Spina E, Gagliano A. Head-to-Head Comparison of Aripiprazole and Risperidone in the Treatment of ADHD Symptoms in Children with Autistic Spectrum Disorder and ADHD: A Pilot, Open-Label, Randomized Controlled Study. Paediatr Drugs 2016; 18:319-29. [PMID: 27278054 DOI: 10.1007/s40272-016-0183-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are frequently overlapping neurodevelopmental disorders. Individuals in whom the disorders are comorbid show more severe impairment because of deficits in the processing of social situations, adaptive functioning, and executive control than individuals with either disorder alone. OBJECTIVE This open-label pilot study aimed to evaluate and compare the efficacy and tolerability of risperidone and aripiprazole for treating ADHD symptoms in patients with both ASD and ADHD over the course of 24 weeks of treatment. METHODS Patients (n = 44) were randomly assigned to start treatment with risperidone (22 patients) or aripiprazole (22 patients). Children were evaluated before starting treatment (T0), and after 12 weeks (T1) and 24 weeks (T2) of treatment. At each visit, specific psychiatric clinical scales were administered to assess the efficacy of the two drugs. RESULTS The mean age was 8.4 ± 2.9 years in the aripiprazole group and 7.8 ± 2.3 years in the risperidone group. A total of 37 children (29 boys and 8 girls) completed the study (18 in the aripiprazole group and 19 in the risperidone group). Aripiprazole and risperidone appeared to have similar benefits in terms of efficacy and tolerability, although there were slight differences between the two drugs. Both groups showed a significant improvement in ADHD symptoms after 24 weeks of treatment (ADHD Rating Scale, Conners Parent Rating Scale-Hyperactivity, and Clinical Global Improvement-Severity Scale). No significant difference between the two drugs on any parameters at 24 weeks were found. Prolactin levels were decreased in the aripiprazole group. Both drugs were well tolerated, with no serious adverse events detected. CONCLUSIONS Our study confirms the efficacy of both aripiprazole and risperidone in ameliorating ADHD symptoms of children also presenting with ASD.
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Affiliation(s)
- Marco Lamberti
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, 98125, Messina, Italy.
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | | | - Domenico Italiano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Norma Alosi
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Francesca Cucinotta
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Gabriella Di Rosa
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Eva Germanò
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonella Gagliano
- Division of Child Neurology and Psychiatry, Department of Pediatrics, University of Messina, Policlinico Universitario G. Martino, Via Consolare Valeria 1, 98125, Messina, Italy
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Gotham K, Bishop SL, Brunwasser S, Lord C. Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent-adult ASD sample. Autism Res 2014; 7:381-91. [PMID: 24802136 DOI: 10.1002/aur.1377] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/19/2014] [Indexed: 11/06/2022]
Abstract
The aim of this study was to examine the association between depressive symptoms and several psychosocial constructs (insight into autism symptoms, rumination, desire for social interaction, and satisfaction with social support) that may play a role in the development or maintenance of depression in verbally fluent adolescents and adults with ASD. Participants included 50 individuals with ASD and verbal IQ ≥ 70, aged 16-35 (sample size varied by measure). Elevated depressive symptoms on the Beck Depression Inventory, 2nd edition (BDI-II), were associated with greater self-perceived, autism-related impairments (n = 48), greater rumination (n = 21), and lower perceived social support (n = 37). Rumination tended to moderate the association between self-perceived autism symptoms and BDI-II scores (n = 21), and was significantly associated with ASD-related insistence on sameness behaviors (n = 18). An unexpected relationship between depressive features and social participation and motivation will need to be clarified by longitudinal research. These and similar findings contribute to our understanding of the phenomenology of depression in ASD, which is critical to the development of practical prevention and treatment.
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Affiliation(s)
- Katherine Gotham
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee
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Spencer D, Marshall J, Post B, Kulakodlu M, Newschaffer C, Dennen T, Azocar F, Jain A. Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics 2013; 132:833-40. [PMID: 24144704 PMCID: PMC3813388 DOI: 10.1542/peds.2012-3774] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Donna Spencer
- The Lewin Group, 3130 Fairview Park Dr, Suite 600, Falls Church, VA 22042.
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Schubart JR, Camacho F, Leslie D. Psychotropic medication trends among children and adolescents with autism spectrum disorder in the Medicaid program. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 18:631-7. [PMID: 24165274 DOI: 10.1177/1362361313497537] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study characterized psychotropic medication use among Medicaid-enrolled children and adolescents with autism spectrum disorders by examining trends over time, including length of treatment and polypharmacy using 4 years of administrative claims data from 41 state Medicaid programs (2000-2003). The data set included nearly 3 million children and adolescents who were 17 years or younger. Approximately, 65% of children with autism spectrum disorder received a psychotropic medication. The results indicate an increasing overall trend in the use of psychotropic drugs among children and adolescents with autism spectrum disorders. Among the different classes of psychotropic drugs, antipsychotics were the most common. Increasing trends in polypharmacy were observed both within and between medication classes.
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Jureidini J, Tonkin A, Jureidini E. Combination pharmacotherapy for psychiatric disorders in children and adolescents: prevalence, efficacy, risks and research needs. Paediatr Drugs 2013; 15:377-91. [PMID: 23757196 DOI: 10.1007/s40272-013-0032-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Polypharmacy, defined as the concomitant use of two or more psychotropic drugs, has become increasingly common in the paediatric and adolescent population over the past two decades. Combining psychotropic drugs leads to possible increases in benefits, but also in risks, particularly given the potential for psychotropic drug interactions. Despite the increasing use of concomitant therapy in children and adolescents, there is very little evidence from controlled clinical trials to provide guidance for prescribers. Even while acknowledging the small evidence base, clinical practice guidelines from eminent medical organizations are either relatively silent on or tend to support the use of concomitant treatments more enthusiastically than the evidence would warrant, so that practice and guidance are running ahead of the science. Our narrative review shows that the published evidence for efficacy and safety of concomitant psychotropic drugs in children and adolescents is scanty. A comprehensive search located 37 studies published over the last decade, of which 18 were randomized controlled trials (RCTs). These focused mainly on stimulants, central sympatholytics (such as clonidine), antipsychotics and 'mood stabilizers'. While several small, often methodologically weak, RCTs demonstrated statistically significant advantages for dual pharmacotherapy over monotherapy, only adding central sympatholytics to stimulants for treating attention-deficit hyperactivity disorder (ADHD) symptoms was supported by substantial studies with an effect size large enough to suggest clinical importance. Non-randomized studies tended to have results that supported concomitant treatment, but all have design-related problems that decrease the reliability of the results. Two studies that specifically examined tolerability of combination pharmacotherapy compared with monotherapy showed significant increases in adverse effects, both subjective and objective, and other studies confirmed a statistically significant increase in adverse effects, including sedation and self-harm. Given the extent of combination therapy occurring, particularly in conditions such as ADHD, and the ambiguous evidence for benefit with clear evidence of harm, we propose that further research should be carried out as a matter of urgency. Until such a time, the attitude to combination pharmacotherapy should be conservative, and combining psychotropic medications should be considered as an 'n of 1' trial to be closely monitored.
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Affiliation(s)
- Jon Jureidini
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia,
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Mire SS, Nowell KP, Kubiszyn T, Goin-Kochel RP. Psychotropic medication use among children with autism spectrum disorders within the Simons Simplex Collection: are core features of autism spectrum disorder related? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 18:933-42. [PMID: 24031086 DOI: 10.1177/1362361313498518] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychotropic medication use and its relationship to autism spectrum core features were examined in a well-characterized but nonstratified North American sample (N = 1605) of children/adolescents diagnosed with autism spectrum disorders utilizing the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, from the multisite Simons Simplex Collection. Analyses included (a) prevalence of psychotropic use (overall, and by classes), (b) correlations between prevalence of use and autism spectrum core features, age, and cognitive functioning, and (c) logistic regression to identify whether these factors were predictive of psychotropic use. Results indicated 41.7% ever used one or more classes of psychotropic medications, with attention deficit hyperactivity disorder medications used most. Small but significant correlations between psychotropic medication use and (a) social impairment (p < .001) and (b) repetitive behaviors (p < .001) were found. Overall, however, autism spectrum disorder core features are weakly related to medication use. Older children used more psychotropics (p < .001), and higher cognitive functioning was associated with less overall psychotropic use (p < .001). Logistic regression indicated that use of psychotropics was predicted by repetitive behaviors (both clinician-observed and parent-reported), age, and cognitive ability level. Limitations inherent to the Simons Simplex Collection sample, methodology, and the correlational analyses are discussed. Directions for future research include investigation of factors more influential than core symptoms on psychotropic treatment (e.g. parent perceptions, comorbid symptoms).
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Bachmann CJ, Manthey T, Kamp-Becker I, Glaeske G, Hoffmann F. Psychopharmacological treatment in children and adolescents with autism spectrum disorders in Germany. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:2551-2563. [PMID: 23747941 DOI: 10.1016/j.ridd.2013.05.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 06/02/2023]
Abstract
Data on psychopharmacological treatment of individuals with autism spectrum disorder (ASD) are scarce, especially for European countries. This study evaluated psychopharmacotherapy utilisation in children and adolescents with a diagnosis of ASD in Germany. Data of a large statutory health insurance company were analysed and outpatients aged 0-24 years with a diagnosis of ASD during a 1-year-period (2009) were identified. For this cohort, the prescription of psychopharmacotherapy was evaluated. Aditionally, we analysed time trends in prescriptions from 2004 to 2009. One thousand one hundred twenty-four patients (75.4% male; mean age: 11.1 years) matched the inclusion criteria. The prevalence of ASD was 0.37% in males and 0.12% in females, respectively. Of all ASD patients, 33.0% were prescribed psychotropic drugs in 2009. 12.5% of ASD patients were treated with stimulants or atomoxetine, 11.7% with antipsychotics, 9.1% with antiepileptics, 6.8% with benzodiazepines, and 3.8% with antidepressants/SSRI. Regarding substances, methylphenidate (24.4% of all psychotropic prescriptions), risperidone (13.3%) and valproate (9.1%) were most frequently prescribed. Psychopharmacologic treatment prevalence was age-related and increased from 16.3% in individuals aged 0-4 years to 55.1% in 20-24 year olds. From 2004 to 2009, the proportion of ASD patients treated with psychotropic drugs rose from 25.9% to 33.0%. This naturalistic study furnishes evidence that the proportion of ASD patients treated with psychotropic drugs has grown considerably in Germany over the least years, with methylphenidate and risperidone being the most frequently prescribed substances. Compared with data from the USA, the proportion of ASD patients with psychopharmacological treatment is noticeably lower in Germany.
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Affiliation(s)
- Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Philipps-University Marburg, Schützenstr. 49, D-35039 Marburg, Germany.
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Rudy BM, Lewin AB, Storch EA. Managing anxiety comorbidity in youth with autism spectrum disorders. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.53] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Theoharides TC, Asadi S, Patel AB. Focal brain inflammation and autism. J Neuroinflammation 2013; 10:46. [PMID: 23570274 PMCID: PMC3626551 DOI: 10.1186/1742-2094-10-46] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/15/2013] [Indexed: 12/28/2022] Open
Abstract
Increasing evidence indicates that brain inflammation is involved in the pathogenesis of neuropsychiatric diseases. Autism spectrum disorders (ASD) are characterized by social and learning disabilities that affect as many as 1/80 children in the USA. There is still no definitive pathogenesis or reliable biomarkers for ASD, thus significantly curtailing the development of effective therapies. Many children with ASD regress at about age 3 years, often after a specific event such as reaction to vaccination, infection, stress or trauma implying some epigenetic triggers, and may constitute a distinct phenotype. ASD children respond disproportionally to stress and are also affected by food and skin allergies. Corticotropin-releasing hormone (CRH) is secreted under stress and together with neurotensin (NT) stimulates mast cells and microglia resulting in focal brain inflammation and neurotoxicity. NT is significantly increased in serum of ASD children along with mitochondrial DNA (mtDNA). NT stimulates mast cell secretion of mtDNA that is misconstrued as an innate pathogen triggering an auto-inflammatory response. The phosphatase and tensin homolog (PTEN) gene mutation, associated with the higher risk of ASD, which leads to hyper-active mammalian target of rapamycin (mTOR) signalling that is crucial for cellular homeostasis. CRH, NT and environmental triggers could hyperstimulate the already activated mTOR, as well as stimulate mast cell and microglia activation and proliferation. The natural flavonoid luteolin inhibits mTOR, mast cells and microglia and could have a significant benefit in ASD.
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Affiliation(s)
- Theoharis C Theoharides
- Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Molecular Physiology and Pharmacology, Tufts University School of Medicine, Suite J304, 136 Harrison Avenue, Boston, MA 02111, USA.
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Is Medication Information for Children with Autism Spectrum Disorder Monitored and Coordinated Across Professionals? Findings from a Teacher Survey. SCHOOL MENTAL HEALTH 2013; 5:48-57. [PMID: 23526921 DOI: 10.1007/s12310-012-9098-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Prescription medications are commonly used for children with autism spectrum disorder (ASD), however, there is little research regarding how the effect of medication is monitored across settings once prescribed. The present study addressed this issue for children with ASD in school by administering a questionnaire to teachers of students with ASD who were and were not being given medication. Specifically, the questionnaire assessed the teachers' knowledge about whether the child was being given medication, and whether behavior changes or side effects were being communicated in any way to the child's family and prescribing physician. The results showed that for children who were being given medication, fewer than half of the teachers reported knowing the child was being given medication. For those children who were not being given medication, only 53% of the teachers reported correct information for their students. Of the teachers who knew their students were being given medication, all reported that they were not conferring with the child's prescribing physician regarding behavioral observations or side effects. Whether teachers are blind to the medication types and dosage the students are being given or not, some type of communication to physicians about the children's behavior at school is important. Given the importance of monitoring medication for children with ASD, implications for system change, for professionals and for funding agencies are discussed.
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Coury DL, Anagnostou E, Manning-Courtney P, Reynolds A, Cole L, McCoy R, Whitaker A, Perrin JM. Use of psychotropic medication in children and adolescents with autism spectrum disorders. Pediatrics 2012; 130 Suppl 2:S69-76. [PMID: 23118256 DOI: 10.1542/peds.2012-0900d] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goal of this study was to examine rates of psychotropic medication use and identify associated child and family characteristics among children and adolescents with autism spectrum disorder (ASD) enrolled in an autism registry maintained by the Autism Treatment Network (ATN). METHODS The sample, derived from the ATN registry, consists of 2853 children aged 2 to 17 years with diagnoses of ASD supported by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the Autism Diagnostic Observation Schedule with available data on medication use. As part of initial enrollment in the registry, parents completed questionnaires on current psychotropic medication use, psychiatric and medical conditions, and demographics. RESULTS Of the 2853 children, 763 (27%) were taking ≥ 1 psychotropic medication; 15% were prescribed 1 medication, 7.4% received 2 medications, and 4.5% received ≥ 3. Among children aged 3 to 5 years, 11% were taking ≥ 1 psychotropic medication; among 6- to 11-year-old children, 46%; and 66% of adolescents aged 12 to 17 years were taking at ≥ 1 psychotropic medication. A parent report of comorbid diagnosis of attention-deficit/hyperactivity disorder, bipolar disorder, obsessive-compulsive disorder, depression, or anxiety was associated with a high rate of use, with 80% receiving ≥ 1 psychotropic medication. Only 15% of children with no comorbid psychiatric disorder were taking psychotropic medication. Psychotropic medication use was also related to sleep and gastrointestinal problems. CONCLUSIONS The prescription of psychotropic medications in this registry sample is highly related to comorbid psychiatric disorder. Other factors associated with use include medical comorbidities, race, ethnicity, and older age.
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Affiliation(s)
- Daniel L Coury
- Department of Pediatrics, Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Dr, Timken G-350, Columbus, Ohio 43205-2696, USA.
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Unwanted interactions among psychotropic drugs and other treatments for autism spectrum disorders. J Clin Psychopharmacol 2012; 32:437-40. [PMID: 22722515 DOI: 10.1097/jcp.0b013e31825e00e4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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