title: Clinical predictors of antipsychotic use in children and adolescents with autism spectrum disorders: a historical open cohort study using electronic health records.
abstract: Children with autism spectrum disorders (ASD) are more likely to receive antipsychotics than any other psychopharmacological medication, yet the psychiatric disorders and symptoms associated with treatment are unclear. We aimed to determine the predictors of antipsychotic use in children with ASD receiving psychiatric care. The sample consisted of 3482 children aged 3-17 with an ICD-10 diagnosis of ASD referred to mental health services between 2008 and 2013. Antipsychotic use outcome, comorbid diagnoses, and other clinical covariates, including challenging behaviours were extracted from anonymised patient records. Of the 3482 children (79 % male) with ASD, 348 (10 %) received antipsychotic medication. The fully adjusted model indicated that comorbid diagnoses including hyperkinetic (OR 1.44, 95 %CI 1.01-2.06), psychotic (5.71, 3.3-10.6), depressive (2.36, 1.37-4.09), obsessive-compulsive (2.31, 1.16-4.61) and tic disorders (2.76, 1.09-6.95) were associated with antipsychotic use. In addition, clinician-rated levels of aggression, self-injurious behaviours, reduced adaptive function, and overall parental concern for their child's presenting symptoms were significant risk factors for later antipsychotic use. In ASD, a number of comorbid psychiatric disorders are independent predictors for antipsychotic treatment, even after adjustment for familial, socio-demographic and individual factors. As current trial evidence excludes children with comorbidity, more pragmatic randomised controlled trials with long-term drug monitoring are needed.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box 63, SE5 8AF, London, UK. johnny.downs@kcl.ac.uk.
authors.forename: Johnny
authors.initials: J
authors.lastname: Downs
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box 63, SE5 8AF, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box 63, SE5 8AF, London, UK.|University of Exeter Medical School, Exeter, UK.
authors.forename: Tamsin
authors.initials: T
authors.lastname: Ford
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box 63, SE5 8AF, London, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Simonoff
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box 63, SE5 8AF, London, UK.|South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Jackson
authors.affiliation: South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Hitesh
authors.initials: H
authors.lastname: Shetty
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box 63, SE5 8AF, London, UK.|South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Box 63, SE5 8AF, London, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000067877:Autism Spectrum Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D057286:Electronic Health Records / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D013981:Tic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic medications; Autism spectrum disorders; Challenging behaviours; Child and adolescence; Psychiatric comorbidity