Psychotropic Medication Use in Youth with Autism and Attention-Deficit/Hyperactivity Disorder

Jessica E. Rast, MPH; Anne M. Roux, MPH; Kristy A. Anderson, MSW; Paul T. Shattuck, Ph.D.

Background and objectives Sample description Medication use may vary by age, but more so by diagnosis Associations with medication use

Multivariable logistic regression models of medication use

Background: Youth with autism spectrum disorder (ASD) may benefit from medication Most children and youth with ASD-only were male (84%), white (65%), and in a two-
to treat symptoms of ASD and co-occurring conditions such as attention- parent household (78%) where English was the primary language (83%). Children and Medication for autism Medication for emotional,
youth with ASD-only were very similar in demographic and household characteristics to Medication for autism symptoms
deficit/hyperactivity disorder (ADHD) or anxiety. There are only two medications symptoms behavioral, or concentration needs
approved by the FDA for use in ASD - risperidone and aripiprazole prescribed for children and youth with ASD+ADHD, but were more often male, of other or multiple ASD + ASD +
ASD-only ASD-only ADHD-only
irritability; there are no medications approved for the core symptoms of ASD (e.g. social races, of Hispanic ethnicity, and in a household where a language other than English 100% ADHD ADHD

Percentage of youth taking medication

communication and interaction deficits). Because prescribing guidelines based on was primarily spoken than children and youth with ADHD-only. Some disability Predisposing factors OR (95% CI)

characteristics can be seen in the table below.

80% Gender, female 0.36 (0.17, 0.75) 0.34 (0.17, 0.70)
impairment profile are lacking, clinical practice often takes a trial-and-error approach to
ASD + ADHD Race
prescription use. Research providing national estimates of medication use in youth on 60%
Hispanic Ethnicity
the autism spectrum is scant. Disability characteristics of children and youth with ASD-only, ASD & ADHD, and ADHD-only
Family Structure
ASD-only ASD + ADHD ADHD-only 40%
Age 1.14 (1.03, 1.26)
Objectives: We aim to report nationally representative findings of the prevalence and (n=755) (n=738) (n=5163) ASD-only Household as a percentage of
correlates of ASD-specific medication use and behavioral medication use by age and by % [95% CI] % [95% CI] % [95% CI] 20%
the federal poverty level
disability group. Diagnosis with a mental, 100-199% FPL 2.05 (0.80, 5.26)
behavioral, or 0%
82.7 [72.7,89.6] 95.8*** [92.4,97.7] 71.2* [68.4,73.8] 6 7 8 9 10 11 12 13 14 15 16 17 200-399% FPL 2.58 (1.01, 6.58)
developmental disorder
Hypotheses: We hypothesize that children with ASD and ADHD (ASD+ADHD) will have a other than ASD or ADHD† Age >400% FPL 1.00 (0.38, 2.62)

higher prevalence of medication use than children with ASD and no ADHD (ASD-only) How well can you and this Enabling factors
and children with ADHD and no ASD (ADHD-only). Furthermore, we expect that child share ideas or talk Type of health insurance
indicators of disability severity will be associated with medication use, as will older age. about things that really Public Only
Medication for emotional, behavioral, or concentration needs Private or private & public
matter? 0.38 (0.13, 1.10)

Very well 24.1 [17.4,32.4] 21.5 [15.9,28.4] 53.9*** [50.9,56.8] Not insured 0.08 (0.01, 0.67)
Andersen model of healthcare utilization Somewhat well 39.4 [28.2,51.8] 46.9 [37.6,56.5] 36.6 [33.8,39.4]
100%
Highest level of parent

Percentage of youth taking medication

ASD + ADHD
We organized our conceptualization of correlates using Andersen’s model of Health Not very well 19.5 [13.6,27.3] 21.5 [16.0,28.3] 8.6*** [7.3,10.1] education more than high school
80%
Care Utilization. The Andersen model focuses on contextual and individual determinants Not at all 16.9 [8.0,32.2] 10.0 [4.4,21.4] 1.0*** [0.6,1.6] Need factors
of health to improve access to care (Andersen, 1995). This model clustered predictors of Serious difficulty Diagnosis with a mental,
60%
concentrating, behavioral, or developmental
health care use into three main groups: ADHD-only 5.67(1.32, 24.41) 4.46(1.28, 15.49) 1.36 (1.01, 1.82)
remembering, or making disorder other than ASD/ADHD†
• predisposing factors (factors or conditions that influence an individual’s propensity 62.9 [52.0,72.6] 80.3** [73.7,85.6] 50.3* [47.3,53.2] 40%
decisions because of a How well the child share ideas
to use services), physical, mental, or ASD-only
or talk about things that matter
• enabling factors (conditions that help or hinder service use), and emotional condition 20%
Somewhat well 1.47 (0.72, 3.01) 1.16 (0.49, 2.77) 1.09 (0.53, 2.25)
• need factors (aspects of health impairment that require medical services). Not very well or at all 3.24 (1.42, 7.36) 2.77 (1.14, 6.75) 3.53 (1.32, 9.41)
0%
†Other Mental, Behavioral, or developmental disorders (MBDDs) include "depression," "anxiety problems," 6 7 8 9 10 11 12 13 14 15 16 17 Serious difficulty concentrating,
"behavioral or conduct problems," "Tourette syndrome," "learning disability," "intellectual disability,” Age remembering, or making
2.43 (1.11, 5.33) 2.84 (1.38, 5.85) 2.93 (2.22, 3.87)
"developmental delay," and "speech or other language disorder".
decisions because of a physical,
mental, or emotional condition
Statistical comparisons made to the ASD-only group *p<0.05; **p<0.01; ***p<0.001

Methods Unadjusted comparisons of medication use Adjusted comparisons of medication use Conclusions

Data: We used data from the National Survey of Children’s Health (NSCH), combining
data from study years 2016-2017 (CAHMI, 2019). The NSCH is a cross-sectional,
nationally representative survey designed to provide national estimates on the health
and well-being of children from parent or caregiver report.
Analysis: First, we used proportions to describe the survey sample and unadjusted
percentages of children and youth taking medication. We further explored medication
Age specific prevalence of medication use in children with Children and youth with ASD+ADHD had 6 times the odds of medication use for ASD Three quarters of youth with ASD+ADHD used medication for behavioral needs, more
ASD-only, ASD + ADHD, and ADHD-only. symptoms as children and youth with ASD-only when controlling for all covariates. than youth with ADHD-only and ASD-only. About half of youth with ASD&ADHD used
Children and youth with ASD+ADHD had 19 times the odds of medication use for medication to treat autism symptoms. This study adds to the literature on medication
emotions, concentration, or behavior of children and youth with ASD-only. Similarly, use in children and youth with ASD, presenting recent, nationally representative
100%
children and youth with ADHD-only had 14 times the odds of medication use for estimates of prevalence of psychotropic drug use. The high use of medication in youth
74%*** emotions, concentration, or behavior of children and youth with ASD-only. All with ASD+ADHD is noteworthy, particularly for medication used to treat ASD symptoms
*** 67%***
66% 63%
***
¥ predisposing, enabling, and need factors were included as covariates. as no medications are approved by the FDA for the core symptoms of ASD.
ASD-only

use by year of age and by age group (ages 6-11 and 12-17). We then used multivariate 50%*** The current study does not include specific medication types taken to address these
47%*** Covariate-adjusted comparison of medication use across comparison groups
ASD + ADHD

logistic regression to assess the odds of medication use for children and youth with symptoms; the specific medication, number of medications, and frequency and amount
ADHD-only
ASD+ADHD or ADHD-only compared to ASD-only, controlling for all independent are not known.
variables. This adjusted model showed the odds of medication use in the ASD+ADHD or 20% Medication for emotional,
14% Medication for autism symptoms
ADHD-only group compared to the ASD-only. Finally, we used multivariable logistic 10% 10% behavioral, or concentration needs
References
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Medication for emotion,
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Medication for Medication for emotion, Medication for
ASD symptoms behavior, concentration ASD symptoms behavior, concentration ASD-only 1 1 health and social behavior. 1995:1-10.

NSCH survey questions on medication use: ASD + ADHD 6.84*** [3.92, 11.91] 18.78*** [11.52, 30.61] Child and Adolescent Health Measurement Initiative (CAHMI) (2019). 2016-2017 National Survey of
Age 6-11 Age 12-17 Children's Health 2 Years Combined Stata Indicator Data Set. Data Resource Center for Child and
• Child currently taking medication for autism, ASD, Asperger’s disorder, or PDD. ADHD-only -- 13.78*** [9.42, 20.07] Adolescent Health supported by Cooperative Agreement from the U.S. Department of Health and
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emotions, concentration, or behavior. Statistical comparisons made to the ASD-only group ***p<0.001 and the ASD + ADHD group ¥p<0.05 . Statistical comparisons made to the ASD-only group *p<0.05; **p<0.01; ***p<0.001 Bureau (MCHB). Retrieved [03/01/2019] from childhealthdata.org

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under UJ2MC31073: Autism Transitions Research Project. This
information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.