Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders.
OBJECTIVE
The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use.


METHODS
This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60,641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use.


RESULTS
Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed > or = 3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications.


CONCLUSIONS
Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. Given the limited evidence base, there is an urgent need to assess the risks, benefits, and costs of medication use and understand the local and national policies that affect medication use.
Mandell
David S
DS
University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA 19104, USA. mandelld@mail.med.upenn.edu
Morales
Knashawn H
KH
Marcus
Steven C
SC
Stahmer
Aubyn C
AC
Doshi
Jalpa
J
Polsky
Daniel E
DE
D000293:Adolescent; D000367:Age Factors; D020817:Asperger Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001291:Attitude of Health Personnel; D001321:Autistic Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D004608:Eligibility Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008484:Medicaid; D001523:Mental Disorders; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D011336:Probability; D011619:Psychotropic Drugs / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome
D011619:Psychotropic Drugs