title: Psychotropic medication use and polypharmacy in children with autism spectrum disorders.
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.
authors.affiliation: The Lewin Group, 3130 Fairview Park Dr, Suite 600, Falls Church, VA 22042. anjali.jain@lewin.com.
authors.forename: Donna
authors.initials: D
authors.lastname: Spencer
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Marshall
authors.forename: Brady
authors.initials: B
authors.lastname: Post
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kulakodlu
authors.forename: Craig
authors.initials: C
authors.lastname: Newschaffer
authors.forename: Taylor
authors.initials: T
authors.lastname: Dennen
authors.forename: Francisca
authors.initials: F
authors.lastname: Azocar
authors.forename: Anjali
authors.initials: A
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019338:Polypharmacy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: administrative claims; autism spectrum disorder; commercially insured; psychotropic polypharmacy