INCREASE IN PSYCHOACTIVE DRUG PRESCRIPTIONS IN THE YEARS FOLLOWING AUTISM SPECTRUM DIAGNOSIS: A POPULATION-BASED COHORT STUDY
Main Article Content
Keywords
autism spectrum disorder, psychoactive drugs, medication use, polypharmacy
Abstract
Background
Psychoactive medications are commonly prescribed to autistic individuals, but little is known about how their use changes after diagnosis.
Objectives
This study describes the use of psychoactive drugs in children and young adults newly diagnosed with autism spectrum, between the year before and up to 5 years after diagnosis.
Methods
Multivariable logistic regression was used to examine the relationship between the use of psychoactive drugs before the first diagnosis of autism spectrum condition (from 1998 to 2010), and the clinical and demographic characteristics, identified from public health care databases in Quebec. The types of drugs prescribed and psychoactive polypharmacy were evaluated over 5 years of follow-up. Generalized estimating equations (GEE) were used to examine the association of age and time with the use of psychoactive drugs.
Results
In our cohort of 2,989 individuals, diagnosis of another psychiatric disorder before autism spectrum strongly predicted psychoactive drug use. We observed that the proportion of users of psychoactive drugs increased from 35.6% the year before, to 53.2% 5 years after the autism spectrum diagnosis. Psychoactive polypharmacy (?2 psychoactive drug classes) also increased from 9% to 22% in that time. Age and time since diagnosis strongly associated with the types and combinations of psychoactive drugs prescribed.
Conclusion
Psychoactive drug use and polypharmacy increases substantially over time after autism spectrum disorder diagnosis in children.
Psychoactive medications are commonly prescribed to autistic individuals, but little is known about how their use changes after diagnosis.
Objectives
This study describes the use of psychoactive drugs in children and young adults newly diagnosed with autism spectrum, between the year before and up to 5 years after diagnosis.
Methods
Multivariable logistic regression was used to examine the relationship between the use of psychoactive drugs before the first diagnosis of autism spectrum condition (from 1998 to 2010), and the clinical and demographic characteristics, identified from public health care databases in Quebec. The types of drugs prescribed and psychoactive polypharmacy were evaluated over 5 years of follow-up. Generalized estimating equations (GEE) were used to examine the association of age and time with the use of psychoactive drugs.
Results
In our cohort of 2,989 individuals, diagnosis of another psychiatric disorder before autism spectrum strongly predicted psychoactive drug use. We observed that the proportion of users of psychoactive drugs increased from 35.6% the year before, to 53.2% 5 years after the autism spectrum diagnosis. Psychoactive polypharmacy (?2 psychoactive drug classes) also increased from 9% to 22% in that time. Age and time since diagnosis strongly associated with the types and combinations of psychoactive drugs prescribed.
Conclusion
Psychoactive drug use and polypharmacy increases substantially over time after autism spectrum disorder diagnosis in children.
References
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3. Ouellette-Kuntz H, Coo H, Lam M et al. The changing prevalence of autism in 3 regions of Canada. J Autism Dev Disord 2014;44(1):120–36.
4. Taylor B, Jick H, MacLaughlin D. Prevalence and incidence rates of autism in the UK: time trend from 2004-2010 in children aged 8 years. BMJ Open 2013;3(10): e003219.
5. National Institute for Health and Care Excellence. Autism: the management and support of children and young people on the autism spectrum. (Clinical guideline 170) 2013.
6. Kendall T, Megnin-Viggars O, Gould N, et al. Management of autism in children and young people: summary of NICE and SCIE guidance. BMJ 2013;347:f4865.
7. Quality AfHRa. Therapies for children with autism spectrum disorders. Comparative Effectiveness Review: Houston, TX: John M. Eisenberg Center for Clinical Decisions and Communications Science; 2014.
8. Siegel M, Beaulieu A. Psychotropic medications in children and adolescents with autism spectrum disorders: a systematic review and synthesis for evidence-based practice. J Autism Dev Disord 2012;42:1592–605.
9. Volkmar F, Siegel M, Woodbury-Smith M et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatr 2014;53(2):237–57.
10. Moyal WN, Lord C, Walkup JT. Quality of life in children and adolescents with autism spectrum disorders: what is known about the effects of pharmacotherapy? Pediatr Drugs 2014;16:1230–38.
11. American Academy of Child and Adolescent Psychiatry. Policy Statement on Comorbidity Treatment in Autism Spectrum Disorders and Intellectual Disabilities. Available at: http://www.aacap.org/aacap/Policy_Statements/2013/Comorbidity_Treatment_in_Autism_Spectrum_Dis-orders_and_Intellectual_Disabilities.aspx. Accessed 16 Apr 2016.
12. Huff man LC, Sutcliff e TL, Tanner ISD, Feldman HM. Management of symptoms in children with autism spectrum disorders: a comprehensive review of pharmacologic and complementary-alternative medicine treatments. J Dev Behav Pediatr 2011;32:56–68.
13. Jureidini J, Tonkin A, Jureidini E. Combination pharmacotherapy for psychiatric disorders in children and adolescents: prevalence, efficacy, risks and research needs. Pediatr Drugs 2013;15:377–91.
14. Mandell DS, Morales KH, Marcus SC, et al. Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics 2008;121(3):e441–8.
15. Logan SL, Nicholas JS, Carpenter LA, et al. High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network. Ann Epidemiol 2012;22(1):1–8.
16. Cidav Z, Lawer L, Marcus SC, Mandell DS. Age-related variation in health service use and associated expenditures among children with autism. J Autism Dev Disord 2013;43:924–31.
17. Schubart JR, Camacho F, Leslie D. Psychotropic medication trends among children and adolescents with autism spectrum disorder in the Medicaid program. Autism 2013;18(6):631–37.
18. Spencer D, Marshall J, Post B, et al. Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics 2013;132(5):833–40.
19. Coury DL, Anagnostou E, Manning-Courtney P, et al. Use of psychotropic medication in children and adolescents with autism spectrum disorder. Pediatrics 2012;130(2): S69–76.
20. Rosenberg RE, Mandell DS, Farmer JE, et al. Psychotropic medication use among children with autism spectrum disorders enrolled in a National Registry, 2007-2008. J Autism Dev Disord 2010;40:324–51.
21. Esbensen AJ, Greenberg JA, Seltzer MM, Aman MG. A Longitudinal investigation of psychotropic and non-psychotropic medication use among adolescents and adults with autism spectrum disorders. J Autism Dev Disord 2009;39:1339–49.
22. Murray ML, Hsia Y, Glaser K et al. Pharmacological treatments prescribed to people with autism spectrum disorder (ASD) in primary health care. Psychopharmacology 2014;231:1011–21.
23. Bachmann CJ, Manthey T, Kamp-Becker, Glaeske G, Hoff mann F. Psychopharmacological treatment in children and adolescents with autism spectrum disorders in Germany. Res Dev Disabil 2013;34:2551–63.
24. Turgeon M, Tremblay E, Déry N, Guay H. L’usage des médicaments chez les enfants et adolescents ayant reçu un diagnostic de trouble du spectre de l’autisme couverts par le régime public d’assurance médicaments du Québec. Neuropsychiatr Enfance Adolesc 2014;62(2):119–26.
25. World Health Organization International Classification of Diseases. Manual of the international statistical classification of diseases, injuries, and cause of death. 9th revision. Geneva, Switzerland: World Health Organization, 1977. PHS 80-1260.
26. Régie de l’Assurance Maladie du Québec. Rapport annuel de gestion 2005-2006. Governement of Quebec, 2006.
27. Wilchesky M, Tamblyn RM, Huang A. Validation of diagnostic codes within medical services claims. J Clin Epidemiol 2004;57(2):131–41.
28. Burke JP, Jain A, Yang W et al. Does a claim diagnosis of autism mean a true case? Autism 2014;18(3):321–30.
29. American Society of Health Systems Pharmacist. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2013.
30. Chen H, Patel A, Sherer J, Aparasu R. The definition and prevalence of pediatric psychotropic polypharmacy. Psychiatr Serv 2011;62(12): 1450–55.
31. Downs J, Hotopf M, Ford T, et al. Clinical predictors of antipsychotic use in children and adolescents with autism spectrum disorders: a historical open cohort study using electronic health records. Eur Child Adolesc Psychiatr 2016;25(6):649–58.
32. King M, Bearman P. Diagnostic change and the increased prevalence of autism. Int J Epidemiol 2009;38(5):1224–34.
33. Aman MG, Lam KSL, Van Bourgondien ME. Medication patterns in patients with autism: temporal, regional, and demographic influences. J Child Adolesc Psychopharmacol 2005;15(1):116–26.
34. Fecteau S, Mottron L, Berthiaume C, Burack JA. Developmental changes of autistic symptoms. Autism 2003;7(3):255–68.
35. Shattuck PT, Seltzer MM, Greenberg JS et al. Change in autism symptoms and maladaptive behaviours in adolescents and adults with an autism spectrum disorder. J Autism Dev Disord 2007;37(9):1735–47.
36. Howlin P, Moss P. Adults with autism spectrum disorders. Can J Psychiatry 2012;57(5):275–83.
37. Mahajan R, Pilar Berna M, Panzer R, et al. Clinical practice pathways for evaluation and medication choice for attention-deficit/hyperactivity disorder symptoms in autism spectrum disorders. Pediatrics 2012;130(suppl 2): S125–38.
38. Ameis SH, Corbett-Dick P, Cole L, Correll CU. Decision making and antipsychotic medication treatment for youth with autism spectrum disorders: applying guidelines in the real world. J Clin Psychiatr 2013;74(10):1022–24.
39. McGuire K, Fung LK, Hagopian L, et al. Irritability and problem behavior in autism spectrum disorder: A Practice pathway for pediatric primary care. Pediatrics 2016;137(S2):e20152851L.
40. Baribeau DA, Anagnostou E. An update on medication management of behavioral disorders in autism. Curr Psychiatr Rep 2014;16(3):437.
41. Hsia Y, Wong AYS, Murphy DGM, Simonoff E, Buitelaar JK, Wong ICK. Psychopharmacological prescriptions for people with autism spectrum disorder (ASD): a multinational study. Psychopharmacology 2014;231(6): 999–1009.
42. Zito JM, Safer DJ, de Jong-van den Berg LTW et al. A three-country comparison of psychotropic medication prevalence in youth. Child Adolesc Psychiatr Ment Health 2008;2(1):26.
43. Caccia S. Safety and pharmacokinetics of atypical antipsychotics in children and adolescents. Pediatr Drugs 2013;15:217–33.
44. Williams KB, Brignell A, Randall M, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD) (Review). Cochrane Database of Systematic Reviews 2013; Issue 8. Art. No. CD004677.
45. Hirota T, Veenstra-Vanderweele J, Hollander E, Kishi T. Antiepileptic medications in autism spectrum disorder: a systematic review and meta-analysis. J Autism Dev Disord 2014;44:948–57.
46. Institut national d’excellence en santé et en services sociaux. Portrait de l’usage des médicaments chez les enfants et les adolescents ayant reçu un diagnostic de trouble du spectre de l’autisme couverts par le régime public d’assurance médicaments. Portrait d’usage rédigé par Mélanie Turgeon, Éric Tremblay, Nicole Déry et Hélène Guay. Québec, Qc : INESSS; 2013.
47. Mandell DS, Morales KH, Xie M, Lawer LJ, Stahmer AC, Marcus SC. Age of diagnosis among Medicaid-enrolled children with autism, 2001-2004. Psychiatr Serv 2010;61(8):822–29.
2. Autism and Developmental Disabilities Monitoring Network. Surveillance Year 2010. Prevalence of autism spectrum disorders among children aged 8 years - Autism and Developmental Disabilities Monitoring Network 11 Sites, United States, 2010. Morb Mortal Wkly Rept Surveillance summaries/CDC 2014;63(SS02):1–21.
3. Ouellette-Kuntz H, Coo H, Lam M et al. The changing prevalence of autism in 3 regions of Canada. J Autism Dev Disord 2014;44(1):120–36.
4. Taylor B, Jick H, MacLaughlin D. Prevalence and incidence rates of autism in the UK: time trend from 2004-2010 in children aged 8 years. BMJ Open 2013;3(10): e003219.
5. National Institute for Health and Care Excellence. Autism: the management and support of children and young people on the autism spectrum. (Clinical guideline 170) 2013.
6. Kendall T, Megnin-Viggars O, Gould N, et al. Management of autism in children and young people: summary of NICE and SCIE guidance. BMJ 2013;347:f4865.
7. Quality AfHRa. Therapies for children with autism spectrum disorders. Comparative Effectiveness Review: Houston, TX: John M. Eisenberg Center for Clinical Decisions and Communications Science; 2014.
8. Siegel M, Beaulieu A. Psychotropic medications in children and adolescents with autism spectrum disorders: a systematic review and synthesis for evidence-based practice. J Autism Dev Disord 2012;42:1592–605.
9. Volkmar F, Siegel M, Woodbury-Smith M et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatr 2014;53(2):237–57.
10. Moyal WN, Lord C, Walkup JT. Quality of life in children and adolescents with autism spectrum disorders: what is known about the effects of pharmacotherapy? Pediatr Drugs 2014;16:1230–38.
11. American Academy of Child and Adolescent Psychiatry. Policy Statement on Comorbidity Treatment in Autism Spectrum Disorders and Intellectual Disabilities. Available at: http://www.aacap.org/aacap/Policy_Statements/2013/Comorbidity_Treatment_in_Autism_Spectrum_Dis-orders_and_Intellectual_Disabilities.aspx. Accessed 16 Apr 2016.
12. Huff man LC, Sutcliff e TL, Tanner ISD, Feldman HM. Management of symptoms in children with autism spectrum disorders: a comprehensive review of pharmacologic and complementary-alternative medicine treatments. J Dev Behav Pediatr 2011;32:56–68.
13. Jureidini J, Tonkin A, Jureidini E. Combination pharmacotherapy for psychiatric disorders in children and adolescents: prevalence, efficacy, risks and research needs. Pediatr Drugs 2013;15:377–91.
14. Mandell DS, Morales KH, Marcus SC, et al. Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders. Pediatrics 2008;121(3):e441–8.
15. Logan SL, Nicholas JS, Carpenter LA, et al. High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network. Ann Epidemiol 2012;22(1):1–8.
16. Cidav Z, Lawer L, Marcus SC, Mandell DS. Age-related variation in health service use and associated expenditures among children with autism. J Autism Dev Disord 2013;43:924–31.
17. Schubart JR, Camacho F, Leslie D. Psychotropic medication trends among children and adolescents with autism spectrum disorder in the Medicaid program. Autism 2013;18(6):631–37.
18. Spencer D, Marshall J, Post B, et al. Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics 2013;132(5):833–40.
19. Coury DL, Anagnostou E, Manning-Courtney P, et al. Use of psychotropic medication in children and adolescents with autism spectrum disorder. Pediatrics 2012;130(2): S69–76.
20. Rosenberg RE, Mandell DS, Farmer JE, et al. Psychotropic medication use among children with autism spectrum disorders enrolled in a National Registry, 2007-2008. J Autism Dev Disord 2010;40:324–51.
21. Esbensen AJ, Greenberg JA, Seltzer MM, Aman MG. A Longitudinal investigation of psychotropic and non-psychotropic medication use among adolescents and adults with autism spectrum disorders. J Autism Dev Disord 2009;39:1339–49.
22. Murray ML, Hsia Y, Glaser K et al. Pharmacological treatments prescribed to people with autism spectrum disorder (ASD) in primary health care. Psychopharmacology 2014;231:1011–21.
23. Bachmann CJ, Manthey T, Kamp-Becker, Glaeske G, Hoff mann F. Psychopharmacological treatment in children and adolescents with autism spectrum disorders in Germany. Res Dev Disabil 2013;34:2551–63.
24. Turgeon M, Tremblay E, Déry N, Guay H. L’usage des médicaments chez les enfants et adolescents ayant reçu un diagnostic de trouble du spectre de l’autisme couverts par le régime public d’assurance médicaments du Québec. Neuropsychiatr Enfance Adolesc 2014;62(2):119–26.
25. World Health Organization International Classification of Diseases. Manual of the international statistical classification of diseases, injuries, and cause of death. 9th revision. Geneva, Switzerland: World Health Organization, 1977. PHS 80-1260.
26. Régie de l’Assurance Maladie du Québec. Rapport annuel de gestion 2005-2006. Governement of Quebec, 2006.
27. Wilchesky M, Tamblyn RM, Huang A. Validation of diagnostic codes within medical services claims. J Clin Epidemiol 2004;57(2):131–41.
28. Burke JP, Jain A, Yang W et al. Does a claim diagnosis of autism mean a true case? Autism 2014;18(3):321–30.
29. American Society of Health Systems Pharmacist. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2013.
30. Chen H, Patel A, Sherer J, Aparasu R. The definition and prevalence of pediatric psychotropic polypharmacy. Psychiatr Serv 2011;62(12): 1450–55.
31. Downs J, Hotopf M, Ford T, et al. Clinical predictors of antipsychotic use in children and adolescents with autism spectrum disorders: a historical open cohort study using electronic health records. Eur Child Adolesc Psychiatr 2016;25(6):649–58.
32. King M, Bearman P. Diagnostic change and the increased prevalence of autism. Int J Epidemiol 2009;38(5):1224–34.
33. Aman MG, Lam KSL, Van Bourgondien ME. Medication patterns in patients with autism: temporal, regional, and demographic influences. J Child Adolesc Psychopharmacol 2005;15(1):116–26.
34. Fecteau S, Mottron L, Berthiaume C, Burack JA. Developmental changes of autistic symptoms. Autism 2003;7(3):255–68.
35. Shattuck PT, Seltzer MM, Greenberg JS et al. Change in autism symptoms and maladaptive behaviours in adolescents and adults with an autism spectrum disorder. J Autism Dev Disord 2007;37(9):1735–47.
36. Howlin P, Moss P. Adults with autism spectrum disorders. Can J Psychiatry 2012;57(5):275–83.
37. Mahajan R, Pilar Berna M, Panzer R, et al. Clinical practice pathways for evaluation and medication choice for attention-deficit/hyperactivity disorder symptoms in autism spectrum disorders. Pediatrics 2012;130(suppl 2): S125–38.
38. Ameis SH, Corbett-Dick P, Cole L, Correll CU. Decision making and antipsychotic medication treatment for youth with autism spectrum disorders: applying guidelines in the real world. J Clin Psychiatr 2013;74(10):1022–24.
39. McGuire K, Fung LK, Hagopian L, et al. Irritability and problem behavior in autism spectrum disorder: A Practice pathway for pediatric primary care. Pediatrics 2016;137(S2):e20152851L.
40. Baribeau DA, Anagnostou E. An update on medication management of behavioral disorders in autism. Curr Psychiatr Rep 2014;16(3):437.
41. Hsia Y, Wong AYS, Murphy DGM, Simonoff E, Buitelaar JK, Wong ICK. Psychopharmacological prescriptions for people with autism spectrum disorder (ASD): a multinational study. Psychopharmacology 2014;231(6): 999–1009.
42. Zito JM, Safer DJ, de Jong-van den Berg LTW et al. A three-country comparison of psychotropic medication prevalence in youth. Child Adolesc Psychiatr Ment Health 2008;2(1):26.
43. Caccia S. Safety and pharmacokinetics of atypical antipsychotics in children and adolescents. Pediatr Drugs 2013;15:217–33.
44. Williams KB, Brignell A, Randall M, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD) (Review). Cochrane Database of Systematic Reviews 2013; Issue 8. Art. No. CD004677.
45. Hirota T, Veenstra-Vanderweele J, Hollander E, Kishi T. Antiepileptic medications in autism spectrum disorder: a systematic review and meta-analysis. J Autism Dev Disord 2014;44:948–57.
46. Institut national d’excellence en santé et en services sociaux. Portrait de l’usage des médicaments chez les enfants et les adolescents ayant reçu un diagnostic de trouble du spectre de l’autisme couverts par le régime public d’assurance médicaments. Portrait d’usage rédigé par Mélanie Turgeon, Éric Tremblay, Nicole Déry et Hélène Guay. Québec, Qc : INESSS; 2013.
47. Mandell DS, Morales KH, Xie M, Lawer LJ, Stahmer AC, Marcus SC. Age of diagnosis among Medicaid-enrolled children with autism, 2001-2004. Psychiatr Serv 2010;61(8):822–29.